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Part I SPECIAL EDUCATION IN THE PHILIPPINES

Yolanda S. Quijano

To the Course Professors and Students:

Welcome to the world of special education! The Department of Education has taken great strides in
the development and sustenance of its Special Education program for nearly a century now. The last
fifty years were marked by bold developments in legislation, teacher training, organization of special
education classes and support services in all the regions of the country. The Bureau of Elementary
Education manages the programs through the Special Education Division.
A number of children with special needs are mainstreamed in regular classes. A special education
teacher assists the regular teacher in planning class activities that would enable both regular and
special children to learn together in the regular school. Similarly, there are children who are enrolled
in special schools, residential schools and special classes in the community. Special education extends
as well to hospital and homebound instruction.
As future teachers, you will find children with special needs in regular schools. That is why, you should
know what special education is all about, its rich history starting in 1907, the laws that have been
legislated to give special education its legal bases, and the current programs and services in both
public and private schools and communities.
Part I starts with inspiring stories about children and youth who have disabilities, but who are able to
overcome their difficulties in school through special education. Vignettes about children, young and
elderly persons who have risen above their disabilities, testimonies of parents and families who stand
by them, government, and nongovernment organizations, civic and social organizations that extend
assistance to them are often featured in magazines and newspapers. Despite their disabilities, these
people lead productive lives and continue to inspire others like them and normal persons as well.
The salient features of special education in the Philippines together with the milestones in its history
in the last one hundred years and the laws that provide the legal bases for special education in the
country are discussed in Chapter 1.
Chapter 2 covers the prevalence of children with special needs and the different programs and
services that are administered by the Special Education Division of the Bureau of Elementary
Education.
Each chapter ends with a brief formative evaluation of content knowledge learned and a check on the
student's ability to reflect, analyze and apply the
competencies thus gained.
At the end of the chapter, the students should be able to:
1. explain how the government promotes the education of children with special needs;
2. explain the vision of government for children with special needs;
3. cite the policy of special education, its goal and objectives;

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4. enumerate the milestones in the history and development of special education from 1907 to the
present time;
5. cite the legislations that give legal bases to special education; and
6. appreciate and gain inspiration from the lives of successful persons with disabilities.
Vignettes About Successful Young Persons with Disabilities
Roselle Ambubuyog triumphs over her disability
She is determined to excel because she is a role model for others. By Mandy Navarro Philippine Daily
Inquirer, 2001
Does the name sound familiar? Maybe the memory needs a little jogging. A few years back, she made
the cover story of a popular broadsheet - a little girl confidently making it to the top of her class
despite her being blind.
Loving parents
She was not always that way, according to her loving parents. Roselle had asthma, and in one of her
attacks, she was prescribed a combination of four over-the-counter medicines. Something freaky
happened, an unexplained acute allergic reaction, and at six, she was blind.
"I stopped school for two years," Roselle adds, "then I went back to school at the Batino Elementary
School in Quezon City, and afterwards, at the Ramon Magsaysay High School. I graduated
Valedictorian of Batch '97. I was 17 then."
Failure
How did the family deal with Roselle's unfortunate experience? "Matapang siya" her mother Deanna
smiles in recollection. "After her first operation's failure, Roselle did not show anguish or
discouragement. Kami pa nga siguro ang nalulungkot nang husto para sa kanya."
What the family did is a shining example of familial love, bonding and unity. "We made sure Roselle
did not miss out on anything. We read to her. Her father handled sciences, one brother took care of
mathematics, the other one Filipino," Deanna relates. Roselle shares, "I majored in BS Mathematics in
Ateneo University, where I graduated Valedictorian and Summa Cum Laude." And today? "I am at UP,
taking up my Masters in Applied Mathematics, majoring in Actuarial Science."
Why Actuarial Science? "I was attracted to it because no insurance policies are issued to disabled
Filipinos. My dream is to be able to help formulate policies to meet their insurance needs."

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"Sadly, the Magna Carta for Disabled Persons is not really enforced. Like there are no facilities for
blind students in most schools. The only schools that allow entry of blind students are UP, PNU,
Ateneo, PWU, UST, PCU and Trinity College," Roselle informs. What else keeps her busy? She has a
Nokia 8250. It's useless to ask about Roselle and texting, the country's favorite pastime. "Oh, but I do
text a lot!" she exclaims. "But someone has to be nearby to read messages to me."
"I am using a Touch Mobile system by Globe now. It's cheaper than the other systems. I can also
receive voice messages. Hopefully, telephone manufacturers like Nokia can design phones for the
blind. That would be really something!"
Rebuilding strength and confidence after a devastating loss
Overcoming the silence
By Anne A. Jambora
Philippine Daily Inquirer, November 22, 2004
There is solace in silence. But when life unexpectedly snatches away those dear to your heart, comfort
is not found in stillness - especially when you're deaf, haltingly reaching out for someone to "talk" to.
Genalin "Gen" D. Marco, a deaf accounting scholar at the Miriam College, was 18 when she lost her
mother to cancer. Two years later, in an alleged dispute with some associates, her father was shot
dead. Marco quietly grieved.
Many believe the worse disability is blindness, for how can one seek simple pleasures when sight is
compromised? But while blindness separates the blind from objects, deafness separates one from
people. It is the inability to communicate that has prompted many deaf people to recoil in their tiny
comfort zones, anxious and oftentimes fearful of being misunderstood, of not being accepted. But not
Marco.
The third of four children, Marco says she and her siblings were forced to look after themselves. Her
parents were not insured, and they had to make do with the little savings they left behind. Although
there were relatives who offered to help and visited occasionally, the siblings decided to take care of
each other on their own.
"We did fine on our own and we chose to live that way," says Marco in a text message.
Indispensable teammate
Marco is the only deaf member of the family. She completely lost her hearing before reaching the age
of six when German measles affected her inner ear. Save for Marco and her younger brother who are
still finishing their studies, her two older sisters were already working when both parents died. Still,
that wasn't enough to get Marco through college.

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Her interpreter alone, an indispensable teammate who goes to class with her every single day, could
easily cost more than the tuition and other fees. Insisting on staying at the dormitory was out of the
question. Marco had to learn how to commute on her own from faraway Bulacan to Quezon City
every day to get to class.
Then Link Center for the Deaf came to the rescue. Marical C. Ui, its finance director, had met Marco
during the summer prior to her first year college enrollment in Miriam College. It was Ui who had
taught the young Marco sign language, a college requirement for deaf students.
Link Center is a service-oriented organization dedicated to the holistic development of deaf people by
providing them support programs (interpreting, tutorials, therapy and counseling) and scholarships. It
works for the empowerment and integration of the deaf into Philippine society. It is the first
accredited training arm of the Philippine Registry of Interpreters for the Deaf.
Ui, who interpreted this interview for the INQUIRER, says Link Center took in Marco as a scholar by
providing interpreting services for free. Since Marco smoothly passed the entrance exam, she holds
the distinction as the first deaf scholar at Miriam College who went straight to enrolling in a degree
course. Marco never bothered to learn sign language before college. She grew up in a family of
hearing people, and before she knew it she had mastered the art of lip-reading. Nobody in the family
studied the hand language either. Besides, she grew up in a small town where practically everyone
knew of and adjusted to her disability. People were used to her as she was with them, and so her
mere shadow in a crowd automatically demanded, unconsciously, for everyone to adjust. Her
teachers have the lectures facing the class in order for her to lip-read and comprehend the lessons,
and like most high school classes, often wrote notes on the blackboard.
Another story
Stepping outside her cloistered world, however, was another story. True, Marco was apprehensive
about college life away from home. But her real monster, her source of shame and denial, was her
inability to accept her condition. She couldn't even bring herself to learn sign language at first because
it only made her condition real.
Marco actually speaks articulate Tagalog and English. And because she could lip-read and speak, she
managed to convince herself at one point that she could hear. She wasn't entirely to blame. Up until
college, Marco had never met another deaf person.
"Meeting deaf people was hard because I was seeing myself for the first time. With the help of
friends, I realized there was nothing to be ashamed of, that there are other things I should be thankful
for instead. "So ngayon tanggap ko na. Bingi nga talaga ako" she says, letting out a hearty laugh.
Sharp, witty and intelligent, Marco is now a senior, the first and only deaf accounting student at
Miriam. She says it is the analytical aspect of accounting
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that appealed to her the most. "Your mind is always at work. Hindi ka aantukin kasi lagi kang nag-
iisip," she says.
There are no special treatments, Marco says. In fact, she works doubly hard than her peers, reading
up her lessons the night before so she could focus only on her interpreter during class. Taking notes
during class is impossible as she dares not glance away from her interpreter for fear she might miss
something. Instead, she takes mental notes before jotting down everything in her notebook. Her
interpreter helps her out with the note taking as well.
"I'm doing things by myself, and I can do things on my own. Life will be hard if I allow it to be hard for
myself. I can always adjust and adapt to a new environment like everybody else," she says.
Her quest for independence was fostered early on by her parents. Though more attention was given
to Marco because she has many needs, she said her parents treated their children equally. And
because her friends at the Link Center believed in her, Marco learned to rebuild her strength and
confidence after the devastating loss.
As early as today, Marco is already anticipating the problems she might encounter in the "real" world,
working with hearing people who don't know sign language and without an interpreter to rely on. But
thoughts such as those only fuel her to hold on to her dreams.
"Maybe it won't be easy for me, but that won't stop me from pursuing what I want," says Marco in
slow but confident English.
"This is what my parents want me to become. I owe it to them to reach my goals, and to the people
who believe in me, who have been helping me all the way. I cannot let them down."
Change the world
Having Down Syndrome does not mean you 're doomed for life.
By Cheryl Tiu
Philippine Daily Inquirer, 2004
The common misconception is that a person with Down Syndrome is born mentally retarded. People
often think the condition is communicable, uncontrollable and irreversible.
All these are false. In fact, Down Syndrome and normal children have the same brain cells. The only
difference is a Down Syndrome child has an extra chromosome - 47 instead of 46. The extra
chromosome produces ammonia that destroys brain cells and retards physical, intellectual and
language development.
Genevieve Yang Chung, 17, an incoming senior at the Hong Kong International School, encountered
children with Down Syndrome when she did volunteer work in Hong Kong this summer. Deciding she
wanted to help, she held an exhibit of her Chinese watercolor paintings on August 2 at Discovery
Suites, to promote Down Syndrome awareness in the Philippines.

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'My aunt told me that the Down Syndrome Association in the Philippines doesn't even have an office.
She also said Filipinos were not even aware of the term. So I decided to hold an exhibit and invite
people not only to see my paintings but also to be aware of the Down Syndrome situation," she said.
At the exhibit, almost 200 guests pledged their support to the association and interacted with three
Down Syndrome children who shared their experiences.
Through her paintings, Chung tried to let people know that having Down Syndrome "doesn't mean
children can't lead a normal life. They can still enjoy art and appreciate other cultures."
Acceptance
Wisdom and Betty Sy, parents of Kayla, a two-year-old girl with Down Syndrome, have learned to
understand and accept her situation.
Adorable and energetic, Kayla doesn't have the classical signs of the syndrome. "When we first found
out we grieved," Wisdom admitted. "We felt as though all our dreams were shattered, like our
daughter had just died."
The couple turned to God, and through and with the help of physical and occupational therapists,
they realized that Down Syndrome did not bring death but rather represented hope, strength,
comfort and many possibilities.
"When parents see their child with Down Syndrome, but still consider him/her their child, it makes a
big difference," Betty said. "Most parents give up on their child or give him/her away. But when I
started praying, I realized it was really He who gave Kayla the blessing to do the things she does. And I
see that God has a purpose that He has a mission and that's why He gave her to us."
"It's a lot of hard work," she added, "but she teaches me some of the most important things in life -
patience, perseverance, unconditional love and compassion."
Although a person with Down Syndrome generally has straight, thin hair, small nose and broad face,
the only real difference between him/her and other children is that the latter would grow at a normal
pace. A Down Syndrome child, on the other hand, would develop a lot slower.
But both children can reach their full potential with the right nurturing, love, and support. Chung said,
through her art, "I want people to be more compassionate toward those with Down Syndrome. And I
want them to understand that it doesn't mean you are doomed for life."
At 19, Fil-Am youngest Harvard law graduate, a magna cum laude
By Cristina DC Pastor
Philippine Daily Inquirer, August 4, 2004
NEW YORK - He was reading serious grownup books at 3, carrying on a conversation about Warren
Buffet's stock picks at 6, and had written on alternative treatments for rheumatoid arthritis by the
time he was 11.

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He finished an undergraduate course in computer science and mathematics at 16. Last June, at age
19, he earned his doctorate in law, magna cum laude, making him possibly the youngest graduate in
Harvard Law School history.
Philippine born Kiwi Alejandro Danao Camara, who turned 20 on June 16, has a life running on fast-
forward and he is enjoying the ride immensely.
"But I don't feel I'm different," Kiwi told the Inquirer in a phone interview. "I'm just a regular guy"
While awaiting results of the bar exams he took, Kiwi is winding down his research for the Harvard
units of the John M. Olin Fellowship in Law and Economics and Berkman Center for Internet and
Society. In September, the clerk for Court of Appeals Judge Harris Hartz of the 10th Circuit, eased his
transition from the academe to professional practice. The position is one of prestige: Recent law
graduates turn down six-figure annual salaries in private firms to work for government at $48,000.00.
'Reason moved by passion'
He speaks with as much humor and easy confidence as maturity, depth and authority. He exudes the
seriousness of purpose of a Jack McCoy but does not mind quoting the movie character Elle Woods in
"Legally Blonde" to define law as "reason moved by passion."
Kiwi himself does not try to explain his "gift." He believes his family to be just like any other. As a kid,
although he had a computer, he mostly played with children his age. In time, though, Jorge did notice
that the boy was associating more with adults than with his peers. On the other hand, Kiwi is an avid
reader of academic-type, legal and scientific literature, and is a member of Mensa, the international
society of certified geniuses. A year after Kiwi was born, the family moved to Cleveland. The boy
attended Rartner Academy, a Jewish school, where his ability to use complex words and his reading
discipline - he finished all book assignments before school closed each summer - set him apart from
the other children. When the couple decided to transfer their practice to Honolulu and moved there
in 1991, Kiwi went to Punahou School to finish the remainder of his elementary years.
Record-shattering scores
In his new environment - the weather was better, he said - Kiwi excelled once more as a student,
registering a record-shattering score in his scholastic aptitude test. He was given the option to skip
high school and take early college courses at the Hawaii Pacific University (HPU). Thus, he took the
leap from eighth grade to college.
His parents were not so sure if it was a good idea. One of their concerns was that Kiwi would be
missing the social interaction in high school, which they believed was an important phase.

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"To me as a parent, it was a difficult decision because academics aren't the only things you learn in
high school. There's overall character development, social and emotional development," said Enrico.
Why Harvard
But as usual, they let Kiwi decide. By 16, Kiwi has an undergraduate degree in computer science from
the HPU. Moving on to law school, he chose Harvard over Yale and the University of Pennsylvania. "He
was the youngest on record to graduate," Harvard spokesperson Michael Rodman said.
Bar exams
Asked about the bar exams, Kiwi sounded like any other new young and hopeful graduate: "I hope to
pass," he simply said, quite obviously not realizing the irony of such statement.
Roselle, Marco, Kayla and Kiwi have one thing in common. They are exceptional children. They
possess additional characteristics or attributes in terms of their physical traits and learning abilities.
Actually, all persons differ from one another in inherited physical characteristics as bone structure.
Some have large, others have smaller skeletal systems that explain differences in height - some are
short, others are taller. Physical differences show in facial features - large or chinky eyes, high-bridged
or flat nose, thick or thin lips, big or small face. Likewise, all persons exhibit differences in learning
abilities. Some children learn fast, others, learn slowly, while there are those who learn just at the
right pace for their chronological ages. Children and youth may be average, below average or above
average in mental characteristics.
In addition to their physical characteristics and learning abilities, Roselle, Genalin and Kiwi have
acquired additional physical characteristics. Roselle has blindness. Genalin has deafness. On the other
hand, Kiwi has giftedness and talent. Kayla has mental retardation. But Roselle's, Genalin's, and
Kayla's disabilities have not stopped them from going to school to get an education. Kiwi, as a highly
gifted and talented person, is able to accelerate his studies and finish college education much earlier
than other students of his age.
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Figure 1. Successful Young Filipinos with Disabilities

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Chapter 1 VISION, POLICY, GOAL, AND OBJECTIVES OF SPECIAL EDUCATION

To the Course Professors and Students:

This chapter starts with the vision for children with special needs followed by the policy, goal and
objectives of special education set by the Department of Education. An account of the historical
events in the implementation of special education in the Philippines as well as its legal bases are
discussed in detail.
Course professors are encouraged to use visual aids in presenting the different topics in this chapter.
At the end of the chapter, the students should be able to:
1. identify the different categories of children and youth with special needs;
2. explain the vision for children with special needs;
3. discuss the policy of Inclusive Education for All;
4. enumerate the goal and objectives of special education;
5. cite important events relevant to the implementation of special education in the Philippines; and
6. discuss the legal bases of special education in the country.
Children and youth with special needs have always been recognized as legitimate beneficiaries of the
Philippine government's reforms in basic education. For almost a century now, the Department of
Education through its Special Education Division has been providing the broad framework and
standards in establishing and maintaining special education programs in both public and private
schools all over the country. The past decades witnessed the continuous development of programs for
a wide range of exceptional children and youth together. Likewise, the professionalization of special
education continues to be pursued through teacher and administrator training programs. Bold moves
are undertaken to: (1) promote access, equity and participation of children with special needs
education in the mainstream of basic education; (2) improve the quality, relevance and efficiency of
special education in schools and communities and; (3) sustain special education programs and
services in the country.

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Vision for Children with Special Needs

The Department of Education clearly states its vision for children with special needs in consonance
with the philosophy of inclusive education, thus:
"The State, community and family hold a common vision for the Filipino child with special needs. By
the 21st century, it is envisioned that he/she could be adequately provided with basic education. This
education should fully realize his/her own potentials for development and productivity as well as
being capable of self-expression of his/her rights in society. More importantly, he/she is God-loving
and proud of being a Filipino.
It is also envisioned that the child with special needs will get full parental and community support for
his/her education without discrimination of any kind. This special child should also be provided with a
healthy environment along with leisure and recreation and social security measures" (Department of
Education Handbook on Inclusive Education, 2000).

Policy, Goal and Objectives of Special Education

The policy on Inclusive Education for All is adopted in the Philippines to accelerate access to education
among children and youth with special needs. Inclusive education forms an integral component of the
overall educational system that is committed to an appropriate education for all children and youth
with special needs.
The goal of the special education programs of the Department of Education all over the country is to
provide children with special needs appropriate educational services within the mainstream of basic
education. The two-pronged goal includes the development of key strategies on legislation, human
resource development, family involvement and active participation of government and non-
government organizations. Likewise, there are major issues to address on attitudi-nal barriers of the
general public and effort towards the institutionalization and sustainability of special education
programs and services.
Special education aims to:
1. provide a flexible and individualized support system for children and youth with special needs in a
regular class environment in schools nearest the students' home,
2. provide support services, vocational programs and work training, employment opportunities for
efficient community participation and independent living,
3. implement a life-long curriculum to include early intervention and parent education, basic
education and transition programs on vocational training or preparation for college, and

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4. make available an array of educational programs and services: the Special Education Center built on
"a school within a school concept" as the resource center for children and youth with special needs;
inclusive education in regular schools, special and residential schools, homebound instruction,
hospital instruction and community-based programs; alternative modes of service delivery to reach
the disadvantaged children in far-flung towns, depressed areas and underserved barangays.
The past decades saw the continuous development of special education programs for a wide range of
exceptional children and youth: those with mental retardation, giftedness and talent, blindness,
deafness, language and speech disorders, crippling conditions, behavior problems, severe disabilities
and physical impairments. The then Philippine Normal College and the University of the

Figure 2. The SPED Science High School in the Division of Capiz for Students Who Are Gifted and
Talented

The SPED Center in Dapa Central Elementary School, Division of Siargao,

Surigao del Norte
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Philippines, both state tertiary institutions, continue to work hand in hand with the Department of
Education to enhance the professionalization of special education through their teacher training
programs.

Historical Perspectives
Historically, the interest to educate Filipino children with disabilities was expressed more than a
century ago in 1902 during the American regime. The General Superintendent of Education, Mr. Fred
Atkinson, reported to the Secretary of Public Instruction that deaf and blind children were found in a
census of school-aged children in Manila and nearby provinces. He proposed that these children be
enrolled in school like the other children. However, it was not until 1907 when the special education
program formally started in the country. The Director of Public Education, Mr. David Barrows, worked
for the establishment of the Insular School for the Deaf and the Blind in Manila. Miss Delight Rice, an
American educator, was me first administrator and teacher of the special school. At present the
School for the Deaf is located on Harrison Street, Pasay City while the Philippine National School for
the Blind is adjacent to it on Polo Road.
1926 to 1949
The Philippine Association for the Deaf (PAD) composed mostly of hearing impaired members and
special education specialists was founded in 1926. The following year in 1927, the government
established the Welfareville Children's Village in Mandaluyong, Rizal. In 1936, Mrs. Maria Villa
Francisco was appointed as the first Filipino principal of the School for the Deaf and the Blind (SDB). In
1945, the National Orthopedic Hospital opened its School for Crippled Children (NOHSCC) for young
patients who had to be hospitalized for long periods of time. In 1949, the Quezon City Science High
School for gifted students was inaugurated. In the same year, the Philippine Foundation for the
Rehabilitation of the Disabled (PFRD) was organized.
1950 to 1975
In 1950, PAD opened a school for children with hearing impairment. The Elsie Gaches Village (EGV)
was established in 1953 in Alabang, Muntinlupa, Rizal to take care of abandoned and orphaned
children and youth with physical and mental handicaps. The following year in 1954, the first week of
August was declared as Sight Saving Week.
The private sector supported the government's program for disabled Filipinos. In 1955, members of
Lodge No. 761 of me Benevolent and Protective Order of Elks organized the Elks Cerebral Palsy Project
Incorporated. In the same year the First Parent Teacher Work Conference in Special Education was
held at the SDB.

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In 1956, the First Summer Institute on Teaching the Deaf was held at the School for the Deaf and the
Blind in Pasay City. The following school year marked the beginning of the integration of deaf pupils in
regular classes.
In 1957, the Bureau of Public Schools (BPS) of the Department of Education and Culture (DEC) created
the Special Education Section of the Special Subjects and Services Division. The inclusion of special
education in the structure of DEC provided the impetus for the development of special education in
all regions of the country. The components of the special education program included legislation,
teacher training, census of exceptional children and youth in schools and the community, the
integration of children with disabilities in regular classes, rehabilitation of residential and special
schools and materials production. Baguio Vacation Normal School ran courses on teaching children
with handicaps. The Baguio City Special Education Center was organized in the same year.
In 1958, the American Foundation for Overseas Blind (AFOB) opened its regional office in Manila. For
many years AFOB assisted the special education program of the DEC by providing consultancy services
in the teacher training program that focused on the integration of blind children in regular classes and
materials production at the Philippine Printing House for the Blind.
In 1960, some private colleges and universities started to offer special education courses in their
graduate school curriculum. In 1962, the Manila Youth and Rehabilitation Center (MYRC) was opened.
The center extended services to children and youth who were emotionally disturbed and socially
maladjusted. In the same year, DEC issued Circular No. 11 s. 1962 that specified the "Qualifications of
Special Education Teachers." Also in 1962, PFRD sponsored the Second Pan Pacific Rehabilitation
Conference in Manila that convened international experts in the rehabilitation of handicapped
persons. Another milestone in 1962 was the experimental integration of blind children at the Jose
Rizal Elementary School in Pasay City. The First National Seminar in Special Education was held at SDB
in Pasay City in 1962. It was also in 1962 when the St. Joseph of Cupertino School for the Mentally
Retarded, a private day school, was founded.
The training of DEC teacher scholars at the University of the Philippines commenced in 1962 in the
areas of hearing impairment, mental retardation and mental giftedness under R.A. 5250. In the same
year, the Philippine General Hospital opened classes for its school-age chronically ill patients.
With the approval of R.A. No. 3562 in 1963, the training of DEC teacher scholars for blind children
started at the Philippine Normal College. The Philippine Printing House for the Blind was established
at the DEC compound with the assistance of the American Foundation for Overseas Blind, UNICEF and
CARE Philippines. In the same year, the Manila Science High School for gifted students was
established. In 1964, the Quezon City Schools Division followed suit with the establishment of the
Quezon City Science High School for gifted students.
The year 1965 marked the start of the training program for school administrators on the organization,
administration and supervision of special education

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classes. The First Institute on the Education and Training of the Mentally Retarded was sponsored by
the Special Child Study Center, the Bureau of Public Schools and the Philippine Mental Health
Association at the Ateneo de Manila University. In 1967, BPS organized the National Committee on
Special Education. General Letter No. 213 regulating the size of special classes for maximum
effectiveness was issued in the same year.
With the approval of R.A. No. 5250 in 1968 the teacher training program for teachers of exceptional
children was held at the Philippine Normal College for the next ten years. In the same year, the First
Asian Conference on Work for the Blind was held in Manila.
In 1969, classes for socially maladjusted children were organized at the Manila Youth Reception
Center. The Jose Fabella Memorial School was divided into five units and assigned to different parts of
Metro Manila: the Philippine Training School for Boys in Tanay, Rizal; the Philippine Training School for
Girls in Marillac Hills, Alabang, Muntinlupa; Reception and Child Study Center in Manila; Elsie Gaches
Village in Alabang and Nayon ng Kabataan in Pasay City.
The training of teachers for children with behavior problems started at the University of the
Philippines in 1970. In the same year, the School for the Deaf and the Blind established in 1907 was
reorganized into two separate residential schools: the School for the Deaf (PSD) stayed in the original
building and the Philippine National School for the Blind (PNSB) was built next to PSD. Also in the
same year, a special school was established in San Pablo City, the Paaralan ng Pag-ibig at Pag-asa.
DEC issued a memorandum on Duties of the Special Education Teacher for the Blind in 1971. In 1973,
the Juvenile and Domestic Relations Court of Manila established the Tahanan Special School for
socially maladjusted children and youth. Meanwhile, in the same year, the First Asian Conference on
Mental Retardation was held in Manila under the auspices of the UNESCO National Commission of the
Philippines and the Philippine Association for the Retarded (PAR). Caritas Manila's Special School for
the Retarded was organized by Rev. Fr. Arthur Malin, SVD.
In 1974, the First National Conference on the Rehabilitation of the Disabled was held at the Social
Security Building in Quezon City. The Southeast Asian Institute for Deaf (SAID), a private day school,
was established in the same year. The following year, the Division of Manila City Schools implemented
the Silahis Concept of Special Education in public elementary schools. Six schools were chosen to
organize special education programs for the different types of exceptional children. Until today, the
Silahis Centers continue to lead in the inclusion of exceptional children in regular classes.
When the DEC was reorganized into the Ministry of Education Culture (MEC) in 1975, the Special
Subjects and Services Division was abolished. The personnel of the Special Education Section were
divided into two. Half of them composed the Special Education Unit of the MEC while the other half
was

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assigned to the Special Education Unit of the MEC National Capital Region in Quezon City.
1976 to 2000
In 1976, Proclamation 1605 declared 1977 to 1987 as the Decade of the Filipino Child. The National
Action Plan for Education was promulgated which included provisions for in-and-out-of-school
exceptional children. In the same year, the First Camp Pag-ibig, a day camp for handicapped children
was held on Valentine's Day in Balara, Quezon City. Meanwhile, the Juvenile and Domestic Relations
Court in Quezon City organized the Molave Youth Hall for Children with Behavior Problems.
In 1977, MEC issued Department Order No. 10 that designated regional and division supervisors of
special education programs. The West Visayas State College of Iloilo City started its teacher training
program and offered scholarships to qualified teachers. The Bacarra Special Education Center, Division
of Ilocos Sur and the Bacolod Special Education Center, Division of Bacolod City opened in the same
year.
The year 1978 marked the creation of the National Commission Concerning Disabled Persons
(NCCDP), later renamed National Council for the Welfare of Disabled Persons or NCWDP through
Presidential Decree 1509. MEC Memorandum No. 285 directed school divisions to organize special
classes with a set of guidelines on the designation of teachers who have no formal training in special
education. In the same year, the University of the Philippines opened its special education teacher
training program for undergraduate students. Meanwhile, the Philippine Association for the Deaf
started its mainstreaming program in the Division of Manila City Schools. The Davao Special School
was established in the Division of Davao City while the Philippine High School for the Arts was
organized in Mt. Makiling, Laguna. The Second International Conference on Legislation Concerning
Disabled was held in Manila under the leadership of the PFRD.
In 1979, the Bureau of Elementary Education Special Education Unit conducted a two-year nationwide
survey of unidentified exceptional children who were in school. The Caritas Medico-Pedagogical
Institution for the Mentally Retarded was organized. The Jagna Special Education Center in the
Division of Bohol was organized.
The School for Crippled Children at the Southern Island Hospital in Cebu City was organized in 1980. In
1981, the United Nations Assembly proclaimed the observance of the International Year of Disabled
Persons. Three special education programs were inaugurated: the Exceptional Child Learning Center
at the West City Central School Division of Dumaguete City, the Zapatera Special Education Center at
the Division of Cebu, and the Deaf Evangelistic Alliance Foundation (DEAF) in Cavinti, Laguna.

18
In 1982, three special schools were opened: the Cebu State College Special High School for the Deaf,
the Siaton Special Education Center in the Division of Negros Oriental and the St. John Maria de
Vianney Special Education Learning Center in Quezon City. In 1983, Batas Pambansa Bilang 344
enacted the Accessibility Law, "An Act to Enhance the Mobility of Disabled Persons by Requiring Cars,
Buildings, Institutions, Establishments and Public Utilities to Install Facilities and Other Devices." In the
same year, the Batac Special Education Center in the Division of Ilocos Norte was organized. In 1984,
two special education programs were inaugurated: the Labangon Special Education Center Division of
Cebu City and the Northern Luzon Association's Heinz Wolke School for the Blind at the Marcos
Highway in Baguio City. More SPED Centers opened the next three years: the Pedro Acharon Special
Education Center in the Division of General Santos City, the Legaspi City Special Education Center in
Pag-asa Legaspi City, and the Dau Special Education Center in the Division of Pampanga.
In 1990, the Philippine Institute for the Deaf (PID) an oral school for children with hearing impairment
was established. The following year, the First National Congress on Street Children was held at La Salle
Greenhills in San Juan Metro Manila. In 1992, the Summer Training for Teachers of the Visually
Impaired started at the Philippine Normal University. The program was sponsored by the Department
of Education Culture and Sports (DECS), the Resources for the Blind Incorporated (RBI) and the
Christoffel Blindenmission (CBM).
In 1993, DECS issued Order No. 14 that directed regional offices to organize the Regional Special
Education Council (RSEC). The years 1993 to 2002 were declared as the Asian and the Pacific Decade
of the Disabled Persons. Three conventions were held in 1995: the First National Congress on Mental
Retardation at the University of the Philippines in Diliman, Quezon City; the First National Convention
on Deaf Education in Cebu City which was subsequently held every two years; and the First National
Sports Summit for the Disabled and the Elderly. The National Registration Day for Persons with
Disabilities was held this year too. The Summer Training of Teachers for Children with Hearing
Impairment started at the Philippine Normal University with funding from the Christoffel
Blindenmission (CBM).
In 1996, the third week of January was declared as Autism Consciousness Week. Likewise, the First
National Congress on Visual Impairment was held in Quezon City and subsequently held every two
years. The First Seminar Workshop on Information Technology for the Visually Impaired was held in
Manila sponsored by the RBI. The First Congress on Special Needs Education was held in Baguio City.
A number of events took place in 1997. DECS Order No. 1 was issued which directed the organization
of a Regional Special Education Unit and the Designation of a Regional Supervisor for Special
Education. Similarly, DECS Order No. 26 on the Institutionalization of Special Education Programs in All
Schools was promulgated. The First Philippine Wheelathon-a-race for Wheelchair Users was the main
event of the 19th National Disability Prevention and Rehabilitation

19
Week. The SPED Mobile Training on Inclusive Education at the Regional Level was held with funding
from CBM. The Urdaneta II Special Education Center was opened in the Division of Urdaneta City and
the Bayawan West Special Education Center in the Division of Negros Oriental. The First Teacher
Training Program for the Integration of Autistic Children was held in Marikina City.
In 1998, DECS Order No. 5 "Reclassification of Regular Teacher and Principal Items to Special
Education Teacher and Special Schools Principal Item" was issued. Palarong Pinoy May K was held at
Philsports Complex in Pasig City. The La Union Special Education Center was opened in the Division of
La Union.
The following events took place in 1999: the Philspada National Sports Competition for the Disabled
in Cebu City; the Second National Congress on Special Needs Education in Baguio City; issuance of the
following DECS Orders -No. 104 "Exemption of the Physically Handicapped from Taking the National
Elementary Achievement Test (NEAT) and the National Secondary Aptitude Test (NSAT)"; No. 108
"Strengthening of Special Education Programs for the Gifted in the Public School System"; No. 448
"Search for the 1999 Most Outstanding Special Education Teacher for the Gifted"; and Memorandum
No. 457 "National Photo Contest on Disability."
The following DECS Orders were issued: No. 11 "Recognized Special Education Centers in the
Philippines"; No. 33 "Implementation of Administrative Order No. 101 directing the Department of
Public Works and Highways, the DECS and the Commission on Higher Education to provide
architectural facilities or structural features for disabled persons in all state colleges, universities and
other public buildings"; Memorandum No. 24 "Fourth International Noise Awareness Day"; and No.
477 "National Week for the Gifted and the Talented."

Figure 3. The Special Education Learning Center of San Francisco Pilot Elementary School Division,
Agusan del Sur

20

The Legal Bases of Special Education

Special education in the Philippines is anchored on fundamental legal documents that present a
chronology of events on the growth and development of the program. The first legal basis of the care
and protection of children with disabilities was enacted in 1935. Articles 356 and 259 of
Commonwealth Act No. 3203 asserted "the right of every child to live in an atmosphere conducive to
his physical, moral and intellectual development" and the concomitant duty of the government "to
promote the full growth of the faculties of every child."
Republic Act No. 3562, "An Act To Promote the Education of the Blind in the Philippines" on June 21,
1963 provided for the formal training of special education teachers of blind children at the Philippine
Normal College, the rehabilitation of the Philippine National School for the Blind (PNSB) and the
establishment of the Philippine Printing House for the Blind.
Republic Act No. 5250, "An Act Establishing a Ten-Year Teacher Training Program for Teachers of
Special and Exceptional Children" was signed into law in 1968. The law provided for the formal
training of teachers for deaf, hard-of-hearing, speech handicapped, socially and emotionally
disturbed, mentally retarded and mentally gifted children and youth at the Philippine Normal College
and the University of the Philippines.
The 1973 Constitution of the Philippines, the fundamental law of the land, explicitly stated in Section
8, Article XV the provision of "a complete, adequate and integrated system of education relevant to
the goals of national development." The constitutional provision for the universality of educational
opportunities and the education of every citizen as a primary concern of the government clearly
implies the inclusion of exceptional children and youth.
In 1975, Presidential Decree No. 603, otherwise known as the Child and Youth Welfare Code was
enacted. Article 3 on the Rights of the Child provides among others that "the emotionally disturbed or
socially maladjusted child shall be treated with sympathy and understanding and shall be given the
education and care required by his particular condition." Equally important is Article 74 which
provides for the creation of special classes. Thus, "where needs warrant, there shall be at least special
classes in every province, and if possible, special schools for the physically handicapped, the mentally
retarded, the emotionally disturbed and the mentally gifted. The private sector shall be given all the
necessary inducement and encouragement."
In 1978, Presidential Decree No. 1509 created the National Commission Concerning Disabled Persons
(NCCDP). It was renamed as National Council for the Welfare of Disabled Persons (NCWDP).
The Education Act of 1982 or Batas Pambansa Bilang 232 states that "the state shall promote the right
of every individual to relevant quality education regardless of sex, age, breed, socioeconomic status,
physical and mental condition, social and ethnic origin, political and other affiliations. The State shall
there-

21
fore promote and maintain equality of access to education as well as enjoyment of the benefits of
education by all its citizens."
Section 24 "Special Education Service" of the same law affirms that "the State further recognizes its
responsibility to provide, within the context of the formal education system services to meet special
needs of certain clientele. These specific types shall be guided by the basic policies of state embodied
on General Provisions of this Act which include: (2) "special education, the education of persons who
are physically, mentally, emotionally, socially, culturally different from the so-called 'normal'
individuals that they require modification of school practices/services to develop to their maximum
capacity."
In 1983, Batas Pambansa Bilang 344 was enacted. The Accessibility Law, "An Act to Enhance the
Mobility of Disabled Persons" requires cars, buildings, institutions, establishments and public utilities
to install facilities and other devices for persons with disabilities.
The 1987 Constitution of the Philippines cites the rights of exceptional children to education in Article
XIV. Section 1 declares that the State shall protect and promote the right of all citizens to quality
education at all levels and shall take appropriate steps to make such education accessible to all.
Section 2 emphasizes that "the State shall provide adult citizens, the disabled and out-of-school youth
with training in civics, vocational efficiency and other skills."
In 1989, R.A. No. 6759 was enacted. The law declared August 1 of each year as "White Cane Safety
Day in the Philippines." Blind persons use the cane in traveling.
In 1992, R.A. No. 7610 was enacted. The law is "An Act Providing for Strong Deterrence and Special
Protection Against Child Abuse, Exploitation and Discrimination, Providing Penalties for Its Violation
and Other Purposes."
In the year 2000, Presidential Proclamation No. 361 set new dates for the National Disability
Prevention and Rehabilitation Week Celebration on the third week of July every year which shall
culminate on the birth date of the Sublime Paralytic Apolinario Mabini.
The year 2004 ushered in a landmark legislation spearheaded by the Department of Health. Republic
Act No. 9288 otherwise known as "The Newborn Screening Act of 2004" is based on the premise that
a retarded child could have been normal. A drop of blood can save the baby from mental retardation
and death. Newborn screening is a very simple test that should be given to the baby twenty-four
hours after birth. If the test is given too late, the baby can either die or eventually be severely
retarded. Newborn screening is a blood test wherein a blood sample will be taken from the heel of
the child. The sample, which is dropped in a special paper, is then sent by the hospital to a centralized
testing center which is run by the National Institute of Health at its head office at the University of the
Philippines in Manila. The test primarily checks for five metabolic disorders that could affect the
health of the child within the first few weeks of life. These are congenital hypothyroidism, congenital
adrenal hyperplasia, galactosemia, phenylke-
22
tonuna and G6PD deficiency. If gone undetected, these disorders may cause severe mental
retardation, cataracts, severe anemia or even death for the child. However, if these disorders are
diagnosed early enough, the child can grow up as a normal, healthy human being. The test and the
24-hour window can literally be the difference between life and death. If a baby is shown to be
positive for any of the disorders, the parents will be immediately informed and more tests will be
done to the child to confirm the test. Once properly diagnosed, proper treatment and care can be
given to the baby to correct the disorder. The baby can then go on to live a happy and normal life.
ANNOUNCEMENT TO ALL HOSPITALS AND BIRTHING FACILITIES
Compliance with Republic Act No. 9288 (Newborn Screening Act of 2004) Pursuant to Rules and
Regulations Implementing RA 9288
Sec. 2...The National Comprehensive Newborn Screening System shall ensure that every baby barn in
the Philippines is offered the opportunity to undergo newborn screening and thus be spared from
heritable conditions that can lead to mental retardation and death if undetected and untreated.
Sec. 21-a ALL HOSPITALS, BIRTHING FACILITIES, RURAL HEALTH UNITS. HEALTH CENTERS AND OTHER
COLLECTING UNITS throughout the country shall have NBS Specimen Collection kits at all times.
Sec. 24 The DOH through the Bureau of Health Facilities and Sen tees (BHFS) shall include, among
others, the provision of NBS services in the licensing requirements for hospitals and birthing facilities.
The Newborn Screening Reference Center (NSRC) will send the final list of facilities offering Newborn
Screening to the Bureau of Health Facilities and Services -Department of Health on January 31, 2006.
For facilities that are not yet offering newborn screening services, please contact your respective DOH
Newborn Screening regional coordinators or NSRC for assistance or you may call tel. nos. (02) 711-
6982 / 711-9572 (DOH), (02) 522-4396 (NSRC) or visit www.nsrc-nih.org.ph for further details.
A message from the Department of Health and the National Institutes of Health-UP Manila

Figure 4. Newborn Screening

23
Read and Respond
Test on Content Knowledge
Test how much you have learned from this chapter by answering the following questions.
1. What is the status of special education programs in the Philippines? How does the Department of
Education sustain its special education programs in the country?
2. List the significant events that have shaped the history of special education in the last century:
a. in the early 1900s until 1949
b. the third quarter of the century
c. the last thirty years
3. What is the importance of legislation in the development and sustenance of special education
programs?
4. Enumerate the laws that pertain to:
a. the inclusion of children with special needs in all programs and concerns of the government.
b. the education of children with special needs
c. the participation of the home, parents and the community in special education activities
d. commemoration of significant events
Reflection and Application of Learning
1. Discuss the vignettes about successful exceptional youth with your classmates. What
characteristics of these children and youth impress you most? Why?
2. Gain firsthand experience about special education programs in the Philippines by doing the
following activities:
Touch base with children with special needs by visiting a special school or a special education class in
your community.
• Ask the special education teacher about the types of exceptionality or disabilities of his/her
students, their characteristics and how well they are doing in school.
• Talk to the pupils. Introduce yourself, then ask them about their school activities.
• Write a brief narrative report on your visit. Include the information that you got as well as your
personal feelings about the activity.
• Invite your classmates to form learning circles. Share the report with each other.
3. Start clipping stories and articles from newspapers and magazines about
people with disabilities who became successful by going to school. Share the vignettes with your
classmates.

24

Chapt er 2 SPECIAL EDUCATION PROGRAMS AND SERVICES

Many of the things we need can wait

The child cannot.
Right now is the time.
His bones are being formed
His blood is being made
And his senses are being developed.
To him, we cannot answer
'Tomorrow.'
His name is 'Today.'
Gabriela Mistral Nobel Prize Laureate, Chile
-To the Course Professors and Students:
This chapter is introduced through a quotation that implies the urgency of providing education to all
Filipino children. For children and youth with special needs, the urgency is shown through the
discussions on the prevalence of this group. This is followed by the descriptions of the different
special education programs and services with emphasis on inclusive education, its definition, salient
features and support services.
Course professors are encouraged to use visual aids in presenting the different topics in this chapter.
At the end of the chapter, the students should be able to:
1. define the following terms: prevalence, identifiable prevalence, true prevalence, incidence;
2. compare the prevalence estimate of children with special needs done by the UNICEF and the
World Health Organization;
3. explain the figure on the true prevalence of Filipino children and youth with special needs;
4. describe the different special education programs and services offered by the Philippine public
and private schools or institutions and cite examples for each;
5. discuss the definition of inclusive education and its salient features; and
6. enumerate the support services extended to children with special needs.

25
The quotation cited impresses the urgency of EDUCATION FOR ALL children and youth irrespective of
race, religious affiliations, socio and economic status and gender. As learned in the previous chapter,
the Philippine Constitution and other laws of the land guarantee education for all Filipino children and
youth. Those who have exceptional gift and talent, those with intellectual and physical disabilities,
those with emotional and behavior disorders, like their peers in regular schools, benefit from special
education programs and services.
The Special Education Division of the Bureau of Elementary Education is in-charge of all the programs
and services in the country. It has the following functions: (1) formulate policies, plans and programs;
(2) develop standards of programs and services; (3) monitor and evaluate the efficiency of programs
and services; (4) conduct in-service training programs to upgrade the competencies of special
education administrators, teachers and ancillary personnel; and (5) establish and strengthen linkages
and networks. This chapter presents the array of special education programs and services that are
implemented in the different regions of the country.

Prevalence of Children and Youth with Special Needs

Prevalence refers to the total number of cases of a particular condition, in this chapter, those with
exceptionality (giftedness and talent) and developmental disabilities and impairments. Prevalence is
viewed in two ways (Grossman, 1983 cited in Beirne-Smith, 2002). Identifiable prevalence refers to
the cases that have come in contact with some systems. The number of children and youth with
special needs is derived from census data. On the other hand, true prevalence assumes that there are
a larger number of children and youth with special needs who are in school or in the community who
have not been identified as such and are not in the special education programs of the Department of
Education. Meanwhile, the word incidence which is considerably synonymous in some contexts with
the term prevalence, refers to the number of new cases identified within a population over a specific
period of time.
The 1997 UNICEF report on the Situation Analysis of Children and Women in the Philippines indicates
that the mean percentage of persons with some types of disabilities is 13.4 per one thousand
population. This means that 134 out of 1,000 persons have certain disabilities. For every million of the
population, 10,720 have certain disabilities. In the projected population of eighty (80) million, more
than eight and a half million have disabilities. The distribution of the different categories of
exceptionalities and disabilities among children is as follows:
1. 43.3% have speech defects
2. 40.0% are mute
3. 33.3% have mental retardation
4. 25.9% are those without one or both arms or hands

26
5. 16.4% are those without one or both legs or feet
6. 16.3% have mental illnesses
7. 11.5% are totally deaf
8. 11.4% are totally blind
Philippine Population 80M

Figure 5. True Prevalence of Filipino Children and Youth with Special Needs

The universal estimate of the prevalence of children with special needs stands at 10% with disabilities
(World Health Organization) and 2% with gifted-ness and talent.
Figure 5 shows that approximately half of the total population of 80 million belongs to the category of
children and youth whose chronological ages range from zero to twenty-four. Based on these statistics
and using the universal estimate of 12%, it may be assumed that at least 4.8 million Filipino children
and youth need special education services. The true prevalence of those with disabilities is estimated
to be four (4) million. Those who are gifted and talented are estimated to number 800,000.
Of the estimated number of exceptional children and youth how many are enrolled in special
education classes? At present, only a small number of these children are in special education classes.
Many of them remain unidentified in regular classes and in the communities. Current figures show
that there are seven hundred ninety-four (794) special education programs in all the regions, six hun-
dred sixteen (616) of which are in public schools. One hundred forty-four (144) programs utilize the
Special Education Center delivery mode for the full or partial mainstreaming of children with special
needs in regular classes. Likewise, there are thirty-four (34) state and private special and residential
schools.
The Special Education Division report on statistics for the school year 2004 - 2005 gives the following
data.

27
Table 1. Special Education Enrolment Data in Public and Private Schools School Year 2004-2005: N =
156,270
Categories No. of Children
1. gifted and fast learners 77,152
2. with learning disabilities 40,260
3. with mental retardation 12,456
4. with hearing impairment 11,597
5. with autism 5,172
6. with behavior problems 5,112
7. with visual impairments 2,670
8. with speech defects 917
9. with orthopedic 760
impairments
10. with special health 142
problems
11. with cerebral palsy 32
with disabilities = 79,118 grand
total =156,270

Tabulated enrolment data in public and private schools show that only 3% of the estimated 4,800,000
children and youth with special needs are receiving special education services. The majority of these
exceptional children are unidentified either in the schools or in their homes and communities. A small
number may be in community-based programs provided by nongovernment entities, church groups,
and civic organizations.

Range of Special Education Programs and Services

An array of special education programs and services are available in the country. These are offered by
public schools and private institutions.
1. The Special Education Center is a service delivery system which operates on the "school within a
school" concept. The SPED Center functions as the base for the special education programs in a
school. A SPED principal administers the Center following the rules and regulations for a regular
school. The special education teachers manage special or self-contained classes, mainstreaming,
tutorial and mentoring resource room services, assessment, parent education, guidance and
counseling and advocacy programs to promote the education of children with special needs in regular
schools. The SPED teacher functions both as a teacher and tutor as well as a consulting teacher to the
regular school in planning and implementing appropriate strategies for the maximum participation of
the special children in the regular class.

28
2. The special class or self-contained class is the most popular type among the special education
programs. A special class is composed of pupils with the same exceptionality or disability. The special
education teacher handles the special class in the Special Education Center or resource room. Thus, in
public and private regular schools, there are special classes for children with mental retardation,
giftedness and talent, hearing impairment, visual impairment, learning disabilities, or behavior
problems.
3. Integration and main streaming programs have allowed children and youth with disabilities to
study in regular classes and learn side by side with their peers for the last forty years. Integration was
the term used earlier. At present, when it is no longer unusual to find blind, deaf and even mentally
retarded students participating in regular class activities at certain periods of the school day, the
preferred term is mainstreaming. There are two types of mainstreaming. In partial mainstreaming,
children who have moderate or severe forms of disabilities are mainstreamed in regular classes in
subjects like Physical Education, Home Technology, and Music and Arts. In full mainstreaming,
children with disabilities are enrolled in regular classes and recite in all the subjects. A special educa-
tion teacher assists the regular teacher in teaching the children with special needs. Likewise, the SPED
teacher gives tutorial lessons at the SPED Center or resource room. The best model of mainstream
special education programs is exemplified at the Division of Manila City Schools. Built around the
Silahis Concept of Special Education or "rays of the sun," fifteen (15) elementary schools have
developed mainstream programs that are supplemented with resource room activities as shown in
Table 2.
In school divisions where one special education teacher serves two or more programs in separate
schools, the itinerant plan is used. The SPED teacher travels (thus the word "itinerant") to the schools
to assist the regular teachers where the children are mainstreamed and to attend to the other needs
of the program.
4. The special day school serves one or more types of disabilities. The special education classes are
taught by trained teachers. Aside from special education, a comprehensive array of service is available
or arranged, such as medical, psychological and social services. Examples of special day schools are
the Southeast Asian Institute for the Deaf (SAID) and the St. John Maria Vianney Special School for the
Mentally Retarded in Quezon City.
5. The residential school provides both special education and dormitory services for its students.
Complementing the curricular programs are houseparent services, diagnostic services, guidance and
counseling, recreation and social activities. The School for the Deaf and the Philippine National School
for the Blind in Pasay City and the Elsie Gaches Village School for Children with Mental Retardation in
Alabang are examples of residential schools.

29
Table 2. "Silahis" Special Education Centers - Manila City Schools Division
SPED Center School Address
1. Kagitingan SPED Rizal Elementary School Tayuman, Sta.
Center Cruz
2. Diwa SPED Center Hizon Elementary School Abad Santos
3. Pag-asa SPED Center Obrero Elementary Obrero, Tondo
School
4. Kaunlaran SPED P. Gomez Elementary P. Guevarra
Center School
5. Kagandahan SPED Albert Elementary School Dapitan
Center
6. Kapayapaan SPED Legarda Elementary Lealtad
Center School
7. Pag-ibig SPED Burgos Elementary Altura, Sta.
Center School Mesa
8. Kabutihan SPED A. Quezon Elementary San Andres
Center School
9. Ligaya SPED Center Lucban Elementary Paco
School
10. Kalinisan SPED R. Palma Elementary Vito Cruz
Center School
11. Tagumpay SPED Sta. Ana Elementary M. Roxas, Sta.
Center School Ana
12. Liwanag SPED Magsaysay High School España
Center
13. Pagkakaisa SPED Manila High School Intramuros
Center
14. Kalusugan SPED PGH Pediatric Unit PGH, Taft Ave.
Center • chronically ill and
abused PGH
Rehabilitation Medicine
Unit
• developmental
disabilities
15. Sikat/Gabay SPED Manila Youth & Paco
Center Reception Center

Inclusive Education for Children with Special Needs

The Department of Education strongly advocates inclusive education as a basic service for all types of
exceptional children. In the 1994 Conference on Special Needs Education held in Salamanca Spain, the
participants reaffirmed the right to education of every individual to education as enshrined in the
1984 Universal Declaration of Human Rights. The reaffirmation served as a renewal of the pledge
made by the world community at the 1990 World Conference on Education for All. With these
declarations and the urgency of the need for early intervention, the Department of Education
adopted the policy of inclusive education in 1997. A Handbook on Inclusive Education was issued as
the main reference and guide to the practice of inclusive education. National, regional and division-
wide training on inclusive education were conducted to promote the concept of inclusive education.

30

Figure 6. A Graphic Illustration of Inclusive Education

31
• What is inclusive education?
Inclusion describes the process by which a school accepts children with special needs for enrolment in
regular classes where they can learn side by side with their peers. The school organizes its special
education program and includes a special education teacher in its faculty. The school provides the
mainstream where regular teachers and special education teachers organize and implement
appropriate programs for both special and regular students.
-
• What are the salient features of inclusive education?
Inclusion means implementing and maintaining warm and accepting classroom communities that
embrace and respect diversity or differences. Teachers and students take active steps to understand
individual differences and create an atmosphere of respect.
Inclusion implements a multilevel, multimodality curriculum. This means that special needs students
follow an adapted curriculum and use special devices and materials to learn at a suitable pace.
Inclusion prepares regular teachers and special education teachers to teach interactively. The
classroom model where one teacher teaches an entire group of children single-handedly is being
replaced by structures where students work together, teach one another and participate actively in
class activities. Students tend to learn with and from each other rather than compete with each other.
Inclusion provides continuous support for teachers to break down barriers of professional isolation.
The hallmarks of inclusive education are co-teaching, team teaching, collaboration and consultation
and other ways of assessing skills and knowledge learned by all the students.
Here are some collaborative activities that take place in the regular classroom.
• If the class is discussing activities on saving the environment, the deaf student can work on
collage of pictures on the topic.
• Prompts or cues are added to learning tasks to assist children with mental retardation in task
performance. Prompts can be verbal, visual or physical. If a student confuses addition and subtraction
symbols, the teacher might encircle the symbols, make them large and write them in red (visual); or
remind students to "check each other's work to see whether it's addition or subtraction problems"
(verbal); or draw a V or x on the arm of the student to signal whether his/her response is correct or
wrong (physical). Inclusion involves parents, families and significant others in planning meaningful
ways for students with special needs to learn in the regular class with their normal peers.

32

Support Services for Children with Special Needs

At least two types of support services are extended to children with special needs:
1. While the SPED program can implement only the screening and informal assessment so that the
child can be enrolled in the program as early as possible, referral services are solicited from medical
and clinical specialists as soon as possible. Some of the specialists are:
• Clinical Psychologist, School Psychologist, Psychometrician for psychological testing
• Medical Doctor and Dentist for a general check-up of all children
• • Ophthalmologist for all children especially those with blindness and low vision
• Otologist or Otolaryngologist for all children especially those with hearing loss, deafness,
language and speech disorders
• Neurologist and Child Psychiatrist for children with mental retardation, learning disabilities and
emotional-behavioral disorders
Speech Therapist for all children with language and speech problem
• Physical and Occupational Therapist for all children especially those with physical disabilities
• Interpreter for the deaf who communicates verbal activities to deaf children through speech
reading, sign language and gestures
• Orientation and Mobility Instructor who teaches independent travel techniques to blind children
2. Assistive devices are specialized instructional and learning materials and equipment that enable
children with special needs to function efficiently. Some of the assistive devices are:
• For blind students: braille writer, braille slate and stylus, braille books, braille watch, braille ruler
and tape measure, braille calculator, arithmetic slate, computer with voice synthesizer, embossed
materials, manipulative materials, talking books, tape recorder, braille paper;
• For low vision students: large print books, large print typewriter, magnifying lenses, Grade I lined
pad paper;
• For deaf students: individual hearing aid, sign language book, speech kit, wall mirror, speech
trainer, group hearing aid;
• For children with mental retardation: teacher-made materials specific to the Individual Education
Plan (IEP) on the functional curriculum and adaptive behavior skills; and
For children with physical disabilities: mobility devices such as wheelchair, braces and splints;
adjustable desk, table and chair; communication aids for clear speech, adapted computer system.

33

Figure 7. Deaf Students and Children with Mental Retardation

34
Read and Respond
Test on Content Knowledge
Test how much you have learned from this chapter by answering the following questions:
1. What is the meaning of prevalence? What is the prevalence of children with special needs based
on:
a. the World Health Organization's estimate?
b. the UNICEF's estimate?
How do the two prevalence estimates compare?
2. Based on the number of Filipino children with special needs who are in special education
programs, how many are out-of-school? What do the numbers mean to you?
3. Fill in the matrix below to illustrate the salient features, similarities and differences among the types of special
education services.
Types of SPED Services Salient features, similarities and
differences
1.

2.

3.

4.

5.

Reflection and Application of Learning

1. What can persons with disabilities do despite their handicaps?
2. Recall and write short vignettes about persons with disabilities you know, have met or heard
about. How did they overcome their disabilities? Share your articles with each other.
3. Revisit the special class you went to earlier. Find out from the teacher how inclusive education is
implemented. Write your impressions about this type of special education service delivery mode.
35

Part II THE ESSENTIAL CONCEPTS OF SPECIAL EDUCATION

Julieta A. Gregorio

Chapter 3 MEANING OF SPECIAL EDUCATION AND CATEGORIES OF CHILDREN WITH

SPECIAL NEEDS
To the Course Professors and Students:
Exceptional children and youth like all other pupils in regular classes are individuals with their unique
traits and characteristics. Some of them learn slower than the average pupils, like those with mental
retardation. Meanwhile, those who are gifted and talented learn very fast and show creativity in their
work. There are exceptional children who have learning disabilities, so that, although their mental
ability is average or even above average, they do not learn as much as they can. Still others have
sensory disabilities like blindness or low vision and deafness; communication disorders, physical
disabilities, like cerebral palsy, spina bifida, spinal cord injuries and limb deficiency; chronic health
impairments like epilepsy, juvenile diabetes mellitus, asthma, cystic fibrosis and hemophilia, among
others.
However, in spite of their disabilities, exceptional children and youth like all other children have the
same psychological needs: they want to belong,.to be accepted, to be appreciated and to be loved. In
return, they are capable of showing appreciation, gratitude, love and friendship.
The Department of Education Special Education Division of the Bureau of Elementary Education
manages and supervises the special education programs all over the country. Special education
enables exceptional children to study in regular schools or in special schools. The special education
teacher helps them participate in school activities through a modified or functional curriculum.
At the end of the chapter, the students should be able to:
1. define special education and explain the meaning of individually planned, systematically
implemented, and carefully evaluated instruction for children with special needs;
2. explain how special education enables exceptional children to benefit from the basic education
program of the Department of Education;
3. cite the difference between special education as essentially instruction and as purposeful
intervention;
4. define the terms exceptional children and youth and children with special needs (CSN);
5. distinguish the following basic terms in special education from each other: developmental
disability, impairment or disability, handicap and at risk;
6. define, compare, and contrast the nine categories of CSN from each other; and
7. develop positive attitudes towards exceptional children and youth.

38

What Is Special Education?

Current literature defines special education as individually planned, systematically implemented, and
carefully evaluated instruction to help exceptional children achieve the greatest possible personal self-
sufficiency and success in present and future environments (Heward, 2003).
Individually planned instruction. In the United States, the law on Individuals with Disabilities
Education Act (IDEA) requires that an individualized education program (IEP) be developed and
implemented for every special education student between the ages of 3 and 21. The basic
requirements of IDEA for all IEPs include statements of: (1) the child's present level of performance,
academic achievement, social adaptation, prevocational and vocational skills, psychomotor skills, and
self-help skills; (2) annual goals describing the educational performance to be achieved by the end of
each school year; (3) short-term instructional objectives presented in measurable, intermediate steps
between the present level of educational performance and the annual goals; (4) specific educational
services; and (5) needed transition services from age 16 or earlier before the student leaves the
school setting.
Systematically implemented and evaluated instruction. Each type of children with special education
needs requires particular educational services, curriculum goals, competencies and skills, educational
approaches, strategies and procedures in the evaluation of learning and skills.
Personal self-sufficiency. An important goal of special education is to help the child become
independent from the assistance of adults in personal maintenance and development, homemaking,
community life, vocational and leisure activities and travel.
The present environment refers to the current conditions in the life of the child with a disability. The
present environment includes the family, the school, the community where he/she lives, the
institutions in society that extend assistance and support to children and youth with special education
needs such as the government, nongovernment organizations, socio-civic organizations and other
groups.
The future environment is a forecast of how the child with a disability can move on to the next level of
education, from elementary to secondary school and on to college or vocational program, and finally,
to the workplace where he/ she can be gainfully employed. Special education helps the child in the
transition from a student to a wage earner so that he or she can lead a normal life even if he or she
has a disability.

39

Figure 8. Boy with Physical Disability

Figure 9. Blind Boy

Figure 10. A Little Boy with Mental Retardation and SPED Teacher

Figure 11. Vocational Rehabilitation

Training for Young Adult with Mental
Retardation
40

Who Are Exceptional Children or Children and Youth with Special Needs?
Children and youth who have one or more of the conditions mentioned in the vignettes in Chapter 1,
among others, are called exceptional children. The term exceptional children and youth covers those
with mental retardation, gift-edness and talent, learning disabilities, emotional and behavioral
disorders, communication disorders, deafness, blindness and low vision, physical disabilities, health
impairments, and severe disabilities. These are children and youth who experience difficulties in
learning the basic education curriculum and need a modified or functional curriculum, as well as
those whose performance is so superior that they need a differentiated special education curriculum
to help them attain their full potential.
Exceptional children are also referred to as children with special needs (CSN). Like the children and
youth in elementary and secondary schools, the mental ability of exceptional children or CSN may be
average, below or above average.
There are four points of view about special education (Heward, 2003).
1. Special education is a legislatively governed enterprise.
This point of view is expressed in the legal bases of special education that are discussed in Chapter 1.
Article IV, Section 1 and Section 5, Article XIII, Section 11 of the 1987 Philippine Constitution
guarantee that the State shall protect and promote the rights of all citizens to quality education at all
levels and shall take appropriate steps to make such education available to all. The State shall provide
adult citizens, the disabled and out-of-school youth with training in civics, vocational efficiency and
other skills. The State shall adopt an integrated and comprehensive approach to health and other
social services available to all people at affordable costs. There shall be priority to the needs of the
underprivileged, the sick, the elderly, the disabled, women and children.
R.A. 7277 - The Magna Carta for Disabled Persons - provides for the rehabilitation, self-development
and self-reliance of disabled persons and their integration into mainstream society.
The Philippine Policies and Guidelines for Special Education provides that every child with special
needs has a right to an educational program that is suitable to his/her needs. Special education shares
with regular education basic responsibilities of the educational system to fulfill the right of the child to
develop his/her potential.
There are many other laws, memoranda and circulars that have been enacted through the years in
support of special education.

41
2. Special education is a part of the country's educational system.
Special education is a part of the Department of Education's basic education program. With its
modest historical beginning in 1907, special education is now a major part of the basic education
program in elementary and secondary schools. The Special Education Division of the Bureau of
Elementary Education formulates policies, plans and programs, develops standards of programs and
services. There are special education programs in public and private schools in all the regions of the
country. The government continues to grant scholarships to deserving school administrators and
teachers to pursue the graduate degrees at the Philippine Normal University and the University of the
Philippines. In-service education programs are conducted to upgrade the competencies of
administrators, teachers and non-teaching personnel. Networks and linkages in the country and
overseas are sustained.
3. Special education is teaching children with special needs in the least restrictive environment.
In the final analysis, teaching is what special education is all about. From this perspective, special
education is defined in terms of the who, what, how and where of its implementation.
WHO: The exceptional children or the children and youth with special education needs are the most
important persons in special education. Then there are the school administrators, the special
education teachers, the regular teachers, the interdisciplinary teams of professionals such as the
guidance counselors, the school psychologists, the speech therapists, physical and occupational
therapists, medical doctors, and specialists who help provide the specific services that exceptional
children need.
WHAT: Every exceptional child needs access to a differentiated and modified curricular program to
enable him/her to learn the skills and competencies in the basic education curriculum. The
individualized education program (IEP) states the annual goals, the quarterly objectives, the strategies
for teaching and evaluation of learning and the services the exceptional child needs.
HOW: Children with mental retardation are taught adaptive skills and basic academic content that are
suitable to their mental ability. Gifted children are provided with enrichment activities and advanced
content knowledge so that they can learn more than what the basic education curriculum offers. Most
of them are in accelerated classes where they finish elementary education in five years instead of six.
Children who are blind learn braille and orientation and mobility or travel techniques. Children who
are deaf learn sign language and speech reading.

42
WHERE: There are several educational placements for these children. The most preferred is inclusive
education where they are mainstreamed in regular classes. Other types of educational placements
are special schools, residential schools, self-contained classes, home-bound and hospital instruction.
4. Special education is purposeful intervention.
Intervention prevents, eliminates and/or overcomes the obstacles that might keep an individual with
disabilities from learning, from full and active participation in school activities, and from engaging in
social and leisure activities.
Preventive intervention is designed to keep potential or minor problems from becoming a disability.
Primary prevention is designed to eliminate or counteract risk factors so that a disability is not
acquired. Secondary intervention is aimed at reducing or eliminating the effects of existing risk
factors. Tertiary prevention is intended to minimize the impact of a specific condition or disability
among those with disabilities. Remedial intervention attempts to eliminate the effects of a disability.

The Basic Terms in Special Education: Developmental Disability, Impairment or Disability, Handicap and At
Risk
Developmental disability refers to a severe, chronic disability of a child five years of age or older that
is:
1. attributable to a mental or physical impairment or a combination of mental and physical
impairments;
2. manifested before the person attains age 22;
3. likely to continue indefinitely;
4. results in substantial functional limitations in three or more of the areas of major life activities
such as self-care, language, learning, mobility, self-direction, capacity for independent living and eco-
nomic self-sufficiency; and
5. reflects the person's need for a combination and sequence of special care, treatment or other
services that are lifelong or of extended duration and are individually planned and coordinated.
(Beirne-Smith, 2002)
Impairment or disability refers to reduced function or loss of a specific part of the body or organ. A
person may have disabilities such as blindness or low vision, deafness or hard of hearing condition,
mental retardation, learning disabilities, communication disorders, emotional and behavioral
disorders, physical and health impairments and severe disabilities. These disabilities or impairments
limit or restrict the normal functions of a particular organ of the body. In the case of the

43
sensory disabilities - blindness and deafness — vision or sight and audition or hearing do not function
normally and restrict the person's seeing and hearing. The speech mechanism is impaired in
communication disorders and causes the person to have voice problems, improper rhythm and timing
in speech and even stuttering. The skeletal and nervous systems are impaired in cases of physical and
health impairments and severe disabilities. The results are crippling conditions, cerebral palsy and
other physical disabilities. Impairment and disability are used interchangeably.
Handicap refers to a problem a person with a disability or impairment encounters when interacting
with people, events and the physical aspects of the environment. For example, a child with low vision
or blindness cannot read the regular print of textbooks. The child either reads books that are
published in large print or transcribed into braille. A child who is hard of hearing or who suffers from
deafness cannot hear regular conversation and uses a hearing aid and reads the lips of the speaker. A
child who has a physical disability such as a crippling condition cannot walk normally and uses a
wheelchair, braces or artificial limbs. However, it must be remembered that a disability may pose a
handicap in one environment but not in another. A wheelchair-bound child with a physical disability
may not be able to compete with his classmates in the Physical Education class, but may excel in
Mathematics, Science and other academic subjects.
At risk refers to children who have greater chances than other children to develop a disability. The
child is in danger of substantial developmental delay because of medical, biological, or environmental
factors if early intervention services are not provided. Down syndrome occurs during the early phase
of pregnancy when one parental chromosome fails to separate at conception resulting in the child's
having forty-seven chromosomes instead of the normal forty-six or twenty-three pairs. At birth, the
infant has abnormal physical characteristics and mental retardation. If a pregnant woman contracts
German measles or rubella during the first three months of pregnancy, the fetus is at risk for
blindness, deafness or mental retardation. The fetus in the womb of a woman who consumes alcohol
heavily and chain-smokes, or takes prohibited drugs is at risk for brain injury that causes disabilities. If
a disability runs in the family, the fetus may inherit it and the infant will be born with a disability.
Children may meet accidents, suffer from certain diseases, malnutrition and other environmental
deprivations that can lead to disabilities.
Categories of Children at Risk
Children with established risk are those with cerebral palsy, Down syndrome, and other conditions
that started during pregnancy. Children with biological risk are those who are born prematurely,
underweight at birth, whose mother contracted diabetes or rubella during the first trimester of
pregnancy, or who had bacterial infections like meningitis and HIV. Environmental risk results from
extreme poverty, child abuse, absence of adequate shelter and medical care, parental substance
abuse, limited opportunities for nurturance and social stimula-

44

Figure 12. A Young Girl with Mental Retardation

Figure 13. Pupils and Teacher of the
Philippine School for the Deaf in
Pasay City

Figure 14. A Girl with Physical Disability

Figure 15. Mary Jane Viñas reads her lessons in Braille.

45
What Are the Categories of Exceptionalities Among Children and Youth with Special Needs?
1. Mental retardation refers to substantial limitations in present functioning. It is characterized by
significantly sub-average intellectual functioning, existing concurrently with related limitations in two
or more of the following applicable adaptive skill areas: communication, self-care, home living, social
skills, community use, self-direction, health and safety, functional academics, leisure and work.
Mental retardation manifests before age 18 (American Association of Mental Retardation, 1992).
2. Giftedness and talent refers to high performance in intellectual, creative or artistic areas,
unusual leadership capacity, and excellence in specific academic field (US Government). Giftedness
refers to the traits of above-average general abilities, high level task commitment, and creativity
(Renzulli, 1978). Giftedness emphasizes talent as the primary defining characteristic (Feldhusen,
1992). Giftedness shows in superior memory, observational powers, curiosity, creativity, and ability to
learn (Piirto, 1994).
3. Specific learning disability means a disorder in one or more of the basic psychological processes
involved in understanding or in using language, spoken or written, which may manifest itself in an
imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations. The term
includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia,
and developmental aphasia. The term does not include children who have learning problems which
are primarily the result of visual, hearing or motor handicaps, of mental retardation or of
environmental, cultural, or economic disadvantages (US Office of Education, 1977).
4. The term emotional and behavioral disorders means a condition exhibiting one or more of the
following characteristics over a long period of time and to a marked degree, which adversely affects
educational performance: (a) an inability to learn which cannot be explained by intellectual, sensory,
and health factors; (b) an inability to build or maintain satisfactory interpersonal relationships with
peers and teachers; (c) inappropriate types of behavior or feelings under normal circumstances; (d) a
general pervasive mood of unhappiness or depression; or (e) a tendency to develop physical
symptoms or fears associated with personal or school problems. The term includes children who are
schizophrenic (or autistic). The term does not include children who are socially maladjusted unless it
is determined that they are seriously emotionally disturbed (US Department of Education).
5. Speech and language disorders or communication disorders exist when the impact that a
communication pattern has on a person's life meets any one of the following criteria: (a) the
transmission and/or

46
perception of messages is faulty; (b) the person is placed at an economic disadvantage; (c) the person
is placed at a learning disadvantage; (c) there is negative impact on the person's emotional growth;
(d) the problem causes physical damage or endangers the health of the person (Emerick and Haynes,
1986).
6. Hearing impairment is a generic term that includes hearing disabilities ranging from mild to
profound, thus encompassing children who are deaf and those who are hard of hearing. A person
who is deaf is not able to use hearing to understand speech, although he or she may perceive some
sounds. Even with a hearing aid, the hearing loss is too great to allow a deaf person to understand
speech through the ears alone. A person who is hard of hearing has a significant hearing loss that
makes some special adaptations necessary (Paul and Quigley, 1990, cited in Heward, 2003).
7. Students with visual impairment display a wide range of visual disabilities - from total blindness
to relatively good residual (remaining) vision. There is a visual restriction of sufficient severity that it
interferes with normal progress in a regular educational program without modifications (Scholl, 1986,
cited in Heward, 2003). A child who is blind is totally without sight or has so little vision that he or she
learns primarily through the other senses, such as touch to read braille. A child with low vision is able
to learn through the visual channel and generally learns to read print.
8. Physical impairments may be orthopedic impairments that involve the skeletal system - the
bones, joints, limbs, and associated muscles. Or, they may be neurological impairments that involve
the nervous system affecting the ability to move, use, feel, or control certain parts of the body. Health
impairments include chronic illnesses, that is, they are present over long periods and tend not to get
better or disappear.
9. The term severe disabilities generally encompass individuals with severe and profound
disabilities in intellectual, physical and social functioning. Because of the intensity of their physical,
mental or emotional problems, or a combination of such problems, they need highly specialized
educational, social, psychological and medical services beyond those which are traditionally offered
by regular and special education programs in order to maximize their potential for useful and
meaningful participation in society and for self-fulfillment. Children and youth with severe disabilities
include those who are seriously emotionally disturbed, schizophrenic, autistic, profoundly and
severely mentally retarded, deaf-blind, mentally retarded-blind and cerebral-palsied-deaf (US
Department of Education).
Labels and names that were derogatory were used in the past to describe people with physical
deformities, mental retardation and behavior problems. These demeaning terms that are not used
anymore are

47
"imbecile, moron, idiot, mentally deficient, dunce and fool." Even the words "mute" and "dumb" are
unacceptable and inappropriate to describe persons who manifest speech and language problems as
a result of deafness.

Is It Correct to Use Disability Category Labels?

There are two points of view regarding the use of labels to describe children and youth with
disabilities. The first point of view frowns on labeling these children as mentally retarded, learning
disabled, emotionally disturbed, socially maladapted, blind, deaf or physically disabled. Use of
disability labels calls attention to the disability itself and overlooks the more important and positive
characteristics of the person. These negative labels cause the "spread phenomenon" to permeate the
mind of the able-bodied persons. The disability becomes the major influence in the development of
preconceived ideas that tend to be negative, such as helplessness, dependence and doom to a life of
hopelessness. The truth is, persons with disabilities are first and foremost human beings who have
the same physical and psychological needs like everybody else. They need to belong, to be loved, to
be useful.
The second and less popular point of view is that it is necessary to use workable disability category
labels in order to describe the exceptional learning needs for a systematic provision of special
education services.
Nevertheless, decades of research and debates on the issue have not arrived at any conclusive
resolution of the labeling problem. A number of pros and cons have been advanced by various
specialists and educators (Heward, 2003).
Pros and Possible Benefits of Labeling
Categories can relate diagnosis to specific types of education and treatment.
Labeling may lead to "protective" response in which children are more accepting of the atypical
behavior by a peer with disabilities than they would be if that same behavior were emitted by a child
without disabilities.
• Labeling helps professionals communicate with one another and classify and assess research
findings.
• Funding of special education programs is often based on specific categories of exceptionality.
Labels enable disability-specific advocacy groups to promote specific programs and to spur legislative
action.
Labeling helps make exceptional children's special needs more visible to the public.

48
Possible Disadvantages of Labeling
• Because labels usually focus on disability, impairment, and performance deficits, some people
may think only in terms of what the individual cannot do instead of what he or she can or might be
able to learn to do.
• • Labels may cause others to hold low expectations for and to differen-
tially treat a child on the basis of the label, which may result to a "self-fulfilling prophecy." For
example, in one study, student teachers gave a child labeled "autistic" more praise and rewards and
less verbal correction for incorrect responses than they gave a child labeled "normal." Such
differential treatment could hamper a child's acquisition of new skills and contribute to the
development and maintenance of a level of performance consistent with the label's prediction.
• Labels that describe a child's performance deficit often mistakenly acquire the role of
explanatory constructs. For example, "Sherry acts that way because she is emotionally disturbed."
Labels suggest that learning problems are primarily the result of something wrong within the child,
thereby reducing the systematic examination of and accountability for instructional variables as the
cause of performance deficits. This is especially damaging outcome when the label provides educators
with a built-in excuse for ineffective instruction. For example, "Jalen hasn't learned to read because
he's____").
• A labeled child may develop poor self-concept.
• Labels may lead peers to reject or ridicule the labeled child.
• Special education labels have a certain permanence; once labeled, it is difficult for a child to
ever again achieve the status of simply being "just another kid."
Labels often provide a basis for keeping children out of the regular classroom.
• A disproportionate number of children from diverse cultural, ethnic and linguistic groups have
been inaccurately labeled as disabled, especially under the category mild mental retardation.
• Classification of exceptional children requires the expenditure of a great amount of money and
professional and student time that could better be spent in planning and delivering instruction.

The Individuals with Disabilities Education Act of America

In the United States, there is a powerful law ("blockbuster legislation") that was enacted in 1975.
Public Law 94-142, the Individuals with Disabilities Education Act (IDEA) has changed the American
system education. It has affected every school in the country and has changed the roles of regular and
special education teachers, school administrators, parents and others in the educational

49
system. The IDEA is a comprehensive legislation regarding the education of children with disabilities.
The law clearly reflects the concern of society for citizens with disabilities to be treated like all other
citizens with the same rights and privileges.
The major provision of IDEA states that all children with disabilities who are between the ages of 3 to
21, regardless of the type or severity of their disabilities shall receive a free, appropriate public
education. All children with disabilities shall be located and identified. Six major principles shall be
followed in organizing and implementing special education programs: (Heward, 2003)
1. Zero reject. Schools must enroll every child, regardless of the nature or severity of his or her
disabilities; no child with disabilities may be excluded from a public education.
2. Nondiscriminatory testing. Schools must use nonbiased, multifactored methods of evaluation
to determine whether a child has a disability and, if so, whether special education is needed. Testing
and evaluation procedures must not discriminate on the basis of race, culture, or native language. All
tests must be administered in the child's native language, and identification and placement decisions
must not be made on the basis of a single test score.

Figure 16. SPED Resource Room

50
3. Appropriate education. Schools must develop and implement an individualized education
program (IEP) for each student with a disability. The IEP must be individually designed to meet the
child's unique needs.
4. Least restrictive environment. Schools must educate students with disabilities, with children
who do not have disabilities to the maximum extent possible.
5. Due process. Schools must provide safeguards to protect the right of children with disabilities
and their parents by ensuring due process, confidentiality of records, and parental involvement in
educational planning and placement decisions.
6. Parent participation. Schools must collaborate with the parents of students with disabilities in
the design and implementation of special education services.
Read and Respond
Test on Content Knowledge
1. Define and explain the following terms: exceptional children, special education, disability or
impairment, handicap, and at risk.
2. In what ways is special education:
• A legislatively governed enterprise?
• A part of basic education?
• The process of teaching children and youth with special education
needs?

• An intervention process?
3. Fill in the following matrix with the definition, learning and behavior characteristics of the categories of CSN.
CATEGORY OF CSN DEFINITION, TYPES, CHARACTERISTICS
1.
2.
3.
4.
5.
6.
7.
8.
9.

51
Reflection and Application of Learning
Touch base with exceptional children in your community. Locate a public or private elementary and
secondary school where CSN are enrolled. Ask your instructor for a letter requesting the school
principal's permission to visit the special education classes.
Ask the SPED teacher for information about the children: the category of their exceptionality, the
causes, personal data like their age, family background, number of years in school and other relevant
information.
Observe how the SPED teacher goes about his or her job. You may ask how he or she feels about
teaching these children. You may also ask him or her about the future of these children when they
leave school.
Write a report on your visit and observation of CSN. Share your findings with your classmates.

52

Chapter 4 THE BIOLOGICAL AND ENVIRONMENTAL CAUSES OF DEVELOPMENTAL

DISABILITIES
To the Course Professors and Students:
This chapter starts with a review of the basic concepts of human reproduction and the stages of
human development in utero. The causes or etiologies of developmental disabilities are traced in
each of the stages of prenatal development or pregnancy, during the neonatal stage or birth process,
and the post natal stage or after birth. Aside from the biological or congenital etiologies, the
environmental factors that cause developmental disabilities are discussed. Some examples of
disabilities are presented.
Course professors are encouraged to use visual aids in presenting the different topics in this chapter.
At the end of the chapter, the students should be able to:
1. define the following terms: heredity, genome, chromosomes, deoxyribonucleic acid, gene,
gametes, meiosis, ovum, spermatozoa, fertilization, embryo, fetus;
2. explain the basic concepts of human reproduction;
3. enumerate and discuss the basic principles of genetic determination;
4. describe the course of prenatal development and the stages of human reproduction;
5. identify the deviations from normal human development that can lead to developmental
disabilities;
6. define the examples of developmental disabilities; and
7. cite the significant outcomes of the Human Genome Project.

53
The Basic Concepts of Human Reproduction
Heredity is the mechanism for the transmission of human characteristics from one generation to the
next. Each person carries a genetic code or genome, a complete set of coded instructions for making
and maintaining an organism. The genome is inherited from both parents. The genome is described as
the blueprint or book of human life. It carries and determines all the characteristics of a person yet to
be born. The genome is located within each of the one hundred trillion cells in the human body.
The nucleus inside the cell contains a complete set of the body's genome that is twisted into forty-six
packets of threadlike microscopic structures called chromosomes. The chromosomes come in twenty-
three pairs. Each pair is composed of one chromosome from the male (Y) and female (X) parents,
respectively. Each set has twenty-two single chromosomes called autosomes that carry the physical,
mental and personality characteristics. Meanwhile, the twenty-third pair, the XY chromosomes,
determines the sex of the organism. A normal female will have a pair of XX chromosomes while a
normal male will have an XY pair of chromosomes.
Inside the chromosome is the long threadlike molecule and genetic substance called the
deoxyribonucleic acid or DNA. The DNA is a complex molecule that contains the genome. The DNA
molecule consists of two strands of twisted ladder-shaped structure called the double helix that wrap
around each other. The double helix was discovered in 1953 by American biochemist James Watson
and British biophysicist Francis Crick. The discovery of the double helix launched an era of molecular
genetics. The genetic code can be read in the rung of the ladder. The code is spelled out by four
chemicals or nucleotide bases, namely, Adenine, Thymine, Guanine and Cystosine. Adenine pairs with
Thymine, while Guanine pairs with Cystosine to form the rungs of the ladder. There are three billion
chemical pairs in the DNA that contain the human genetic code.
Each DNA molecule contains many genes, the basic physical and functional units of hereditary
information. A gene is a specific sequence of the four nucleotide bases whose sequences carry the
information for constructing proteins. Proteins provide the structural components of the cells, tissues
and enzymes for essential biochemical reactions. Genes act as blueprint for cells to reproduce them-
selves and manufacture the proteins that maintain life. Scientists estimate that there are 80,000 to
140,000 or so genes that largely determine every physical characteristic in the human body (Human
Genome Project 2000).
Some Principles of Genetic Determination
Genetic determination is a complex affair. Much is unknown about the way genes work. But a number
of genetic principles have been discovered, among them the principles of dominant-recessive genes,
sex-linked genes, polygenically inherited characteristics, reaction range and canalization.

54
Dominant-recessive genes principle. If one gene of the pair is dominant and one is recessive, the
dominant gene exerts its effect, overriding the potential influence of the recessive gene. For example,
brown eyes, farsightedness and dimples are common dominant genes that rule over blue eyes,
nearsightedness and freckles.
A recessive gene exerts its influence only if the genes of a pair are both recessive. If a recessive gene is
inherited from only one parent, the trait will not show. The person may never know that he or she
carries the recessive gene. Can two brown-eyed parents have a blue-eyed baby? Yes, they can, if each
parent carries a dominant gene for brown eyes and a recessive gene for blue eyes. The parents have
brown eyes because brown eyes are dominant over blue eyes. But both are carriers of blueness and
can pass on their recessive genes for blue eyes. With no dominant genes to override them, the
recessive genes will make the child's eyes blue.
Sex-linked genes principle. As mentioned earlier, females have two X sex chromosomes and males
have an X and a Y sex chromosome in their respective karyotypes. When one X female chromosome
combines with the X male chromosome, the XX chromosome results that make the organism a
female. Meanwhile, when one female X chromosome combines with the Y male chromosome, the XY
chromosome results that make the organism a male.
Polygenic inheritance principle. Genetic transmission is usually more complex than the simple
examples mentioned earlier. Poly (many) genic (genes) inheritance describes the interaction of many
genes to produce a particular characteristic. Considering that there are as many as 140,000 genes, the
huge number of combinations possible is hard to imagine. Traits that are produced by the mixing of
genes are said to be polygenically determined.

Figure 17. The Female Reproductive System

55
Genotype and phenotype genetic heritage. Nobody possesses all the characteristics that the genetic
structure makes possible. Genotype refers to the person's genetic heritage or the actual genetic
material. The genotype is established at conception during the process of fertilization and usually
remains constant and does not change. On rare occasions, the constancy is disturbed when mutation
takes place or errors in cell division alter subsequent cell division. Genotype is not readily available for
actual inspection.
Phenotype refers to the person's observable traits that may be used to draw inferences about the
genotype. The phenotype is the observable result between the genotype and the environment.
The Biological Sources of Developmental Disabilities
Basic terms in human reproduction
Gametes are the human reproduction cells which are created in the reproductive organs. The ovaries
of the female produce the ovum (ova) or egg cells while the testicles or testes of the male produce
the spermatozoa or sperm cells.
Meiosis is the process of cell division in which each pair of chromosomes in the cell separates, with
one member of each pair going into each gamete or daughter cell. Thus, each gamete, the ovum and
the sperm, has twenty-three unpaired chromosomes.
The ovum is only about one-fourth the size of a period, but it is the largest cell in the human body.
When a female is born, she already has about 400,000 immature ova in her two ovaries. Each ovum is
contained in its own small sac or follicle. After a female matures sexually (as early as age nine to as
late as sixteen) and until menopause, ovulation takes place once every twenty-eight days when a
mature follicle in one of her ovaries ruptures and expels its ovum. The ovum is about 90,000 times as
large as the sperm cell. Thousands of sperm cells must combine to break down the ovum's membrane
barrier to allow even a single sperm cell to penetrate it.
In contrast to the ovum, the sperm, which is tadpole like and only one six-hundredth (1/600th) inch
from head to tail is one of the smallest cells in the body. Furthermore, sperms are much more
numerous, several millions, and more active than the ova. A mature male testicle normally produces
several hundred million sperms a day which are ejaculated in the semen at sexual climax. An
estimated twenty million sperms must enter a woman's ovary at one time to make fertilization likely.
The fertilization of a female's ovum by a male's sperm starts the process of human reproduction.

56
Fertilization results in the formation of a single cell called the zygote. In the zygote, two sets of
twenty-three unpaired chromosomes, one set each from the male and the female combine to form
one set of paired chromosomes. In this manner, each parent contributes fifty percent or half of the
zygote's genetic code or genome.
Critical periods and developmental vulnerability during pregnancy
Certain periods of development during pregnancy are critical for both the growth and the organism's
vulnerability to injury and developmental risks. Vulnerability refers to how susceptible the organism is
to being injured or altered by a traumatic incident. A traumatic incident includes such broad
occurrences as teratogens or toxic agents, cell division mutation and other deviations from the usual
sequence of development.
Deviancy from the normal course of prenatal development results to the occurrence of
developmental disabilities. The organism in utero, the zygote, the embryo and the fetus are
vulnerable to injuries and developmental risks.
After birth during postnatal development, the newborn, the infant and the child are all vulnerable and
susceptible to injuries that can persist for the duration of the person's life.
The Course of Prenatal Development
Development in utero covers about thirty-eight (38) weeks or two hundred eighty (280) days or nine
months of gestation or growth in the mother's womb. Prenatal development is divided into three
phases.
The Germinal Phase. The initial stage of prenatal development covers the first two weeks after
fertilization. The three significant developments during this phase are the creation of the zygote,
continuous cell division/cell and tissue differentiation and implantation or attachment of the zygote to
the uterine wall.
• Creation of the zygote. Reproduction begins with the fertilization of a
female's ovum by a male sperm.
Ovulation occurs once every twenty-eight days or so, as an ovum out of hundreds of ova matures and
the single ripe ovum bursts from its follicle. The ovum is drawn into the fallopian tube during the
ninth to the sixteenth day of the menstrual cycle which is the fertile period. Ovulation sends a
chemical signal to unleash a carefully tuned sequence of biochemical substances. One chemical
substance dissolves the jellylike veil surrounding the ovum. Another chemical substance softens the
ovum's tough outer shell. Millions of sperms deposited by the male race to penetrate the ovum's
shell. Only one strong and healthy sperm succeeds. Once it enters the ovum, an electric charge fires
across the membrane and a signal causes the ovum to close, blocking the entry of other sperms.

57
Fertilization takes place with the union of the genetic materials in the ovum and sperm cells. The
process occurs in the upper third of the fallopian tube within eighteen to twenty-four hours after
sexual intercourse. When fertilization does not take place, "the womb weeps" and the menstrual cycle
continues the following month. When an ovum is fertilized, the menstrual cycle ceases. The first sign
of pregnancy is amenorrhea or the cessation of menses. The first menses is called menarche; the final
cessation of menses is called menopause, while excessive sometimes painful menses is called
menorrhagia.
The zygote is a new cell which results from the transmission of the genetic materials twenty-four to
thirty hours after fertilization. The zygote weighs about one twenty-millionth of an ounce. This is one-
sixteenth of a pound (2.2 pounds equals one kilo). The zygote carries the human genetic code or
genome, the instruction that orchestrates one's physical and mental traits and sociobiological
tendencies and the new person's entire lifelong blueprint of characteristics.
• Continuous cell division and cell tissue differentiation. Chemical reactions occur that cause the
zygote to divide repeatedly and generate new cells and tissues of different types.
Cell division occurs very rapidly in the first few days and progresses with considerable speed. The
zygote divides into two cells after thirty-six hours; four cells after forty-eight hours. In three days,
there is a small compact ball of sixteen to thirty-two cells. In four days, a hollow ball has sixty-four to
one hundred twenty-eight cells. By approximately one week, the zygote has divided into about one
hundred fifty cells.
Cell differentiation continues as the inner and outer layers of the organism are formed. The inner
layer of cells which develops into the embryo later on is called blastocyst. The outer layer of cells that
provides nutrition and support for the embryo is called trophoblast.
• Implantation or attachment of the zygote to the uterine wall.
Implantation starts on the sixth to the seventh day when the blastocyst starts to attach itself to the
uterine wall. Two weeks after, from the eleventh to the fifteenth day, the blastocyst invades or fully
attaches itself into the uterine wall and becomes implanted in it.
What can go wrong during the germinal phase?
Abnormalities in the genes and chromosomes can occur. Both the speed of cell division and the
process of cell differentiation expose the zygote to trauma. Genetic disorders can be transmitted, such
as:
1. dominant and recessive diseases like Tay Sachs disease, galactosemia, phenylketonuria (PKU),
genetic mutations;

58
2. sex-linked inheritances such as Lesch Nyhan Syndrome, Fragile X Syndrome;
3. polygenic inheritances;
4. chromosomal deviations, the most common of which is Down Syndrome;
5. other sex chromosomal anomalies like Klinefelter Syndrome, Turner Syndrome; and
6. cranial or skull malformations such as anencephaly or absence of major portions of the brain,
microcephaly and hydrocephaly.
Biological causes of developmental disabilities are traceable to congenital or inherited genetic
materials as well as prenatal factors associated with teratogens or toxic substances, maternal
disorders, substance exposure or too much ingestion of alcohol and drugs and too much smoking. The
genetic disorders are discussed in the chapter on mental retardation.
Figure 18. Significant Developments in the Germinal Period
The Embryonic Phase. The second phase of human development occurs from the end of the germinal
phase to the second month of pregnancy. The mass of cells is now called the embryo. The three main
processes during this phase are intensification of cell differentiation, development of the support
systems for continued cell development and organogenesis or the appearance of the different organs
of the body.
• Intensification of cell differentiation. During implantation, the mass
of cells form three layers from which every part of the human body will develop.

59
1. The ectoderm is the outermost layer of cells that will develop into the surface body parts, such
as the outer skin or the epidermis including the cutaneous glands - the hair, nails and lens of the eye.
2. The mesoderm is the middle layer that will develop into the body parts surrounding the
internal areas, such as the muscles, cartilage, bone, blood, bone ureter, gonads, genital ducts,
suprarenal cortex and the joint cavities.
3. The endoderm is the inner layer of cells that will develop into the epithelium of the pharynx,
tongue, auditory tube, tonsils, thyroid, larynx, trachea, lungs, digestive tube, bladder, vagina and
urethra.
4
• Development of the life support systems. As the embryo's three layers of cells develop, the life
support systems develop from the embryo for the transfer of substances from the mother to the
zygote and vice versa. Very small molecules of oxygen, water, salt, and food from the mother's blood
are transferred to the embryo. Carbon dioxide and digestive waste from the embryo's blood are
transferred to the mother's blood.
1. The placenta is a disk-shaped mass of tissues in which small blood vessels from the mother
intertwine.
2. The umbilical cord contains two arteries and one vein that connects the embryo to the
placenta.
3. The amnion or amniotic fluid is a bag of water that contains clear fluid where the embryo
floats. The amnion provides an environment that is temperature and humidity controlled and shock
proof. The amnion comes from the fetal urine that the kidney of the fetus produces at approximately
the sixteenth week until the ninth month or the end of pregnancy.
• Organogenesis is the process of organ formation and the appearance of body organs during the
first two months.
1. By the third week, the neural tube forms and eventually becomes the spinal cord. At the same
time, the eye buds begin to appear.
2. By the twenty-fourth day, the cells for the heart begin to differentiate.
3. The fourth week is marked by the first appearance of the urogenital systems. The arm and leg
buds appear. The four chambers of the heart take shape and blood vessels surface.
4. On the fifth to the eighth week, the arms and legs differentiate further. The face starts to form
but it is not very recognizable. The intestinal tract develops and the facial structures fuse. The embryo
weighs about one-thirtieth of an ounce.

60

1. Once every 28 days or so, an

egg matures in an ovary, bursts from its follicle and enters the Fallopian tube.

2. Millions of sperm race from the vagina, through the uterus and into the Fallopian tube. A single
sperm fertilizes the egg; the others are locked out.
3. Cell division begins, and the
embryo drifts down the Fallopian tube, reaching the uterus in about a week.

4 ) The embryo anchors itself to the wall of the uterus, where it develops into a fetus.
Figure 19. Human Development "In Utero'

61
What can go wrong during the embryonic phase?
The cells divide very rapidly during organogenesis. The organs and systems that are developing are
especially vulnerable to environmental changes. Induced abortion in case of unwanted pregnancy can
disturb normal processes of organogenesis. Chromosomal abnormalities can cause spontaneous
abortion mostly in the second or third month.
During specific periods, for example, if the central nervous system is the primary system that is
developing, the cells that constitute the central nervous system - the brain and the spinal cord - divide
more rapidly than the other organs. At this time the central nervous system is most vulnerable to
trauma. Ingestion of dermatogens or toxic agents from alcohol, drugs and nicotine, artificial food
additives, stress and accidents can cause trauma and affect the development that is taking place.
Physical abnormalities can result as well. At birth, there are infants born with extra or missing limbs
and fingers, ears and other body parts, a tail-like protrusion, heart or brain, digestive or respiratory
organs outside the body. Facial development and body shapes can be affected by what scientists
describe as "accidents in cell development." Some clusters of cells that are meant to develop into
certain organs and parts of the body fail to follow the precise genetic instructions and appear at birth
as inhuman, with the face for example, resembling that of a frog or other animals, statues, or even
pictures. People tend to attribute such occurrences to maternal impressions. But it is clear that the
scientific explanation goes back to the disturbances in development during pregnancy.
The Fetal Phase. The third phase covers seven months that lasts from the third to the ninth month of
pregnancy on the average. The length and weight of the fetus mentioned below are for average
Caucasian babies. Asians are generally shorter and lighter.
1. At three months, the fetus is about three inches long and weighs about one ounce. It is active,
moves its arms, legs and head, opens and closes its mouth. The face, forehead, eyelids, nose, chin,
upper and lower arms are distinguishable. Genitals can be identified as male or female.
2. At four months, the fetus is five and a half inches long, weighing about four ounces. Growth
spurt occurs in the body's lower parts. Prenatal reflexes are stronger. Arms and leg movements can be
felt by the mother.
3. At five months, the fetus-is ten to twelve inches long and weighs one-half to one pound or
almost half a kilo. Structures of the skin, toenails and fingernails have formed. The fetus is more active
and shows preference for a particular position in the womb.
4. At six months, the fetus is fourteen inches long and has gained one-half to one pound. The eyes
and eyelids are completely formed. A thin layer of hair covers the head. Grasping reflex is present.
Irregular breathing occurs.

62
5. At seven months, the fetus is almost seventeen inches long, has gained one pound and weighs
about three pounds.
6. During the eighth and ninth months, the fetus continues to grow longer to about twenty inches
and gains about four pounds. Fatty tissues develop and the functioning of the organ systems steps up.
The fetus normally weighs six to eight pounds shortly before birth.

Figure 20. Genetic Disorders

What can go wrong during the fetal phase?
The same effects of teratogens can occur and disturb normal development. The fetus continues to be
vulnerable to trauma that can result to the occurrence of disabilities. Deliberate termination of
pregnancy or abortion for whatever reasons - poor health, rape, incest, out-of-wedlock relations, if
unsuccessful can lead to disabilities. Inadequate birth weight due to malnutrition or early birth places
the infant at developmental risks.
Birth of the infant. After full gestation for thirty-eight weeks, the fetus leaves the intrauterine
environment of the mother's womb and begins life in the outside world. There are changes in the
mother's body that start around the fourth month or mid-pregnancy. These changes are necessary so
that the natural birth process can occur normally. Some of the changes are:
1. rearrangement of the muscle structure of the uterus to facilitate fetal expulsion or to permit
the normal passage of the fetus through the birth canal.
2. Shortly before birth and during the onset of labor which lasts for seven to twelve hours on the
average, the upper part of the cervi-

63
cal area undergoes expansion. By the time the fetus is passing through the birth canal, the muscle
structure of the cervix has loosened and expanded. The process is called effacement that enables the
fetus to be expelled.
The normal and desirable position of the fetus when labor begins is with the head toward the cervix.
This position occurs in almost 80% of all childbirth. As the fetus begins to move downward into the
birth canal, the pelvic girdle or the bony hip structure stretches more. The pressure of the pelvic girdle
also molds the head of the fetus. This is the reason why newborn babies have strangely shaped heads.
After a few days, the head returns to its natural shape.
All the movements during birth are generated by the muscle contractions of the uterus called labor.
While the fetus is moving downward, it turns clockwise from the effect of labor.
A few minutes after the infant is delivered, the placenta is expelled. The respiratory tract is
immediately cleared of the remaining amniotic fluid and mucus. The doctor provides the stimulation
for the infant to begin to breathe usually by gently patting the buttocks. The infant's first cry expands
the lungs with air for the first time and starts the process of respiration.

Figure 21. Normal Delivery, Lateral Flexion

An Example of Breech Fetal Position

From Childbirth: Family Centered Nursing
(3rd ed.) by J. Iorio, 1975, St. Louis: C. V. Mosby.
Copyright 1975 by the C. V. Mosby Co.
Reprinted by permission.

An Example of Transverse Fetal Position

From Childbirth: Family Centered Nursing (3rd ed.) by J. Iorio, 1975, St. Louis: C. V. Mosby. Copyright
1975 by the C V. Mosby Co. Reprinted by permission.
Figure 22. Abnormal Fetal Position

64
What can go wrong during the birth process?
The birth process represents another important time when potential risks to the fetus or infant are
high. The birth process is very complex and at times may not proceed smoothly. Difficulties can arise
that result to developmental disabilities.
1. Physical trauma or mechanical injury during birth may injure or damage the brain and impair
intellectual functioning.
• In precipitous birth where labor is short (less than two hours) skull molding that should be slow
and smooth may affect and injure the brain.
• In breech birth where the buttocks instead of the head presents itself first poses substantial
danger because the head reaches the pelvic girdle during the later stages of labor when there is more
pressure exerting on it.
The abnormal pressure generated in breech birth rapidly compresses the still soft skull which crushes
portions of the brain. Also, the rapid pressure and shifting of cranial bones can damage the circulatory
system around the brain and lead to hemorrhage in the skull and brain damage.
Usually, a fetus in breech position is delivered by caesarian section. Abdominal surgery is done and
the fetus is extracted from the uterine wall.
• In the transverse position where the fetus lies across the birth canal,
the same problems in breech birth are present.
-
2. Anoxia or asphyxia occurs in breech delivery and deprives the infant of adequate supply of
oxygen for a period long enough to damage the brain. The infant must depend entirely on the
umbilical cord as a source of oxygen until birth is completed. However, the breech position makes the
umbilical cord too short to remain attached while the head is being expelled. The placenta can
become partially or completely detached while the head is still inside the birth canal. This eliminates
oxygen supply and severe brain injury can happen.

Newborn Screening - Your Retarded Child Could Have Been Normal

(The Philippine Star, Monday, February 7, 2005)
A drop of blood can save your baby from mental retardation and death.
Republic Act No. 9288 otherwise known as the "Newborn Screening Act of 2004," is an act
promulgating a comprehensive policy and a national system for ensuring newborn screening. The law
was developed jointly by the Department of

65
Health and the National Institute of Health of UP Manila. The law institutionalizes the National
Newborn Screening System (NBS). It insures that every baby born in the Philippines is offered
newborn screening; the establishment and integration of a sustainable newborn screening system
within the public health delivery system; that all health practitioners are aware of the benefits of NBS
and of their responsibilities in offering it; and that all parents are aware of NBS and their responsibility
in protecting their child from any of the disorders.
What is newborn screening? Ask any expecting couple if they would want a boy or a girl and they
would usually answer: "We don't really care. We just want our baby to be normal." Expecting couples
(especially first timers) see to it that they visit their doctor regularly to ensure the health of their
unborn child. What a lot of people don't know is that a perfectly healthy looking child at birth may
grow up to be mentally retarded or could even die soon after if not given the proper tests
immediately after birth. A simple test given 24 to 72 hours after birth can mean the difference
between having a normal child or a mentally retarded child.
This test is aptly called Newborn Screening. After giving birth, parents should request their attending
health practitioner (if not prompted by them) to have their babies go through Newborn Screening.
Ideally the test should be a standard operating procedure for hospitals and other birthing facilities.
Newborn Screening is a very simple test that should be given to the baby 24 hours after giving birth.
Take note that if the test is given too late, the baby can either die or eventually be severely retarded.
It is a blood test wherein a blood sample will be taken from the heel of the child. The sample, which is
dropped in a special paper, is then sent by the hospital to a centralized testing center which is run by
the National Institute of Health at its head office in UP Manila.
The test primarily checks for five metabolic disorders that could affect the health of the child within
the first few weeks of life. If gone undetected, these disorders may cause severe mental retardation,
cataracts, severe anemia Kernicterus or even death for the child. However, if these disorders are
diagnosed early enough, the child can grow up as a normal healthy human being.
The, five metabolic disorders that Newborn Screening can detect are: Congenital Hypothyroidism,
Congenital Adrenal Hyperplasia, Galactosemia, Phenylketonuria, and Glucose Six Phosphate
Dehydrogenase deficiency.
It is estimated that newborn screening can save at least 33,000 babies annually from the disorders.
Currently, only 6 percent of the over 1.5 million births undergo newborn screening. There are about
1,700 hospitals in the country and currently, only 400 hospitals and birthing facilities implement NBS.
By 2006, all hospitals and birthing facilities must provide NBS services. It shall be a mandatory
requirement for licensure of hospitals and birthing facilities.
Lives can be saved by this simple test. If the baby is shown to be positive for any of the disorders, the
parents will be immediately informed and more tests will be done to the child to confirm the test.
Once properly diagnosed, proper treatment and care can be given to the baby to correct the disorder.
The baby can then go on to live a happy and normal life.

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Principles of Normal Development in Infancy and Early Childhood

When there are problems in prenatal development and birth as discussed earlier, deviations from the
normal developmental milestones in infancy and early childhood can be expected. The general
principles of normal development are useful guides in observing the presence of such deviations.
1. Normal development progresses in orderly step-by-step sequences.
2. All areas of development are interrelated.
3. The skills acquired earlier determine how well later skills will be learned.
4. Although there are developmental milestones in each of the growth areas, children manifest
individual differences in their rate of development. Each child develops at his or her own pace.
Gross Motor Skills
Activity Appr Activity Appro
ox. x. Age
Age
raises chin while Iying on 1 walks alone 18
stomach mo. unsupported mos.
raises chest while lying on 2 sits self in small chair 18
stomach mos. mos.
reaches for objects but 3 walks carrying large 20
misses mos. objects mos.
head set forward, steady 4 raises self from sitting 22
lumbar curvature mos. position with hips first mos.
turns over from lying to 4-6 runs well without falling 2 yrs.
supine position mos.
sits on lap, grasps objects 5 kicks ball without 2 yrs.
mos. overbalancing
sits on high chair, grasps 6 jumps with both feet on 2.5
objects mos. place yrs.
sits alone with good 10 picks up objects from 2.5
posture mos. floor without help yrs.
creeps and crawls, pulls to 11 stands on one foot 3 yrs.
standing position mos. without falling over
walks with help, walks 12 pedals tricycle 3 yrs.
alone mos.
climbs stairs steps 13
mos.
Receptive Language
understands few words 11 points to 5 body parts 1 yr.
mos. on self or doll 10
mos.
points to 1 named body 1 yr. follows 3-step command 2 yrs.
part on request given once
stops activity to name 1 yr. understands 200-400 2 yrs.
objects words
stops activity to respond 1 yr. understands 800 words 3 yrs.
to "no"
points to familiar persons, 1 yr. verbalizes past 3 yrs.
objects on request 3 experiences
mos
follows one-step simple 1 yr. points to big, little, soft, 3 yrs.
command 3 loud
mos
points to 3 named body 1 yr. follows commands with 4 yrs.
parts on request 5 2-3 actions
mos
follows two-step 1 yr. understands app. 1,500 4 yrs.
command 8 words
mos
points to 5-6 pictures of 1 yr.
common objects on 9
request mos

67
Expressive Language
says first word 10 uses plurals 2 yrs.
mos.
shakes head and says 11 asks questions 2 yrs.
"no-no" mos.
imitates sounds of 1 yr. uses negatives in 2.5 yrs.
others ("mama") speech
uses 3 words in 13 enunciates vowel 2.5 yrs.
speaking vocabulary mos. sounds
use of verbs appear 14 enunciates consonant 3 yrs.
mos. sounds
uses at least six words 17 speech is about 75 to 3 yrs.
mos. 80% intelligible
refers to self by name 21 uses 3 to 4 syllable 3 yrs.
mos. words
uses me and you 2 yrs. says 6 to 8 word 4 yrs.
sentences
says 50 to 200 words 2 yrs. speech is about 90 to 4 yrs.
95% intelligible
knows full name 2 yrs.
Eating Skills
sucks and swallows birth holds cup with two hands 1 yr.
liquids
gagging reflex birth chews table food 1.3
yrs.
sucks and swallows 2 mos. grasps spoon & places in 1.3
liquids from spoon mouth with some spilling yrs.
eats strained baby 3 mos. can manage spoon 1.5
foods from spoon without help with little yrs.
spilling
brings hands against 3 mos. requests for food when 1.11
bottle when eating hungry yrs.
sips from a cup that is 4 mos. requests for liquid when 1.11
held thirsty yrs.
gets excited at sound of 4 mos. can hold small glass with 2 yrs.
food preparation one hand without help
holds spoon with 5 mos. can use fork to get food 3 yrs.
assistance
can feed self soft food 6 mos. can spread butter on 3 yrs.
bread
begins to bite and chew 6 mos. can help set table 4 yrs.
food
holds own bottle 7 mos. can use a fork to separate 4 yrs.
food
can chew small lumpy 8 mos. can pour water from 4 yrs.
food pitcher to glass
Can take bottle out of 9 mos. can use a knife to cut food 5 yrs.
mouth & put it back
Can use fingers to feed 10 can set the table without 6 yrs.
self mos. assistance
Dressing Skills
can pull and tug at 3-4 attempts to place feet in 30
clothing mos. shoes mos.
holds out limbs when 1 yr. can choose own outfit 3 yrs.
dressing
can remove shoes by 1.2 yrs. can unbutton clothes 3 yrs.
self
can place socks on feet 1 mo.places clothing on in 3.6
by self correct direction yrs.
can pull up pants 1.6 yrs. can dress and undress 4 yrs.
with supervision
can unzip 1.7 yrs. can button front buttons 4.8
on clothing yrs.
attempts to put on own 2 yrs. can zip up and 5 yrs.
shoes down/snap simple snaps
pulls up pants 2 yrs. can tie shoes with bows 5.6
yrs.
undresses self 30 can unlace bows on 5.6
mos. shoes yrs.
can put on shirt and 30 dresses self completely 5.6
coat mos. yrs.

68
Grooming Skills
cries when removed 5 mos. can brush teeth with 3.6 yrs.
from bathroom assistance
splashes water with 6 mos. can wash and dry face 4 yrs.
hands and feet with towel alone
grimaces when face is 6 mos. can brush teeth alone 4 yrs.
washed with cloth
exhibits resistance to 8 mos. can put away toys with 4 yrs.
washing face supervision
can open and pull out 1.6 can hang up clothes on 4 yrs.
drawers yrs. hook
can wash hands and 2 yrs. brushes hair alone 5 yrs.
face but not well
can wash front of body 2 yrs. hangs up own clothes 5 yrs.
while in bath alone
can run a brush 2.5 washes self alone 6 yrs.
through hair yrs.
Toileting Skills
about 4 bowel 1 mo. climbs on to toilet by self 2.6 yrs.
movements a day
associated with waking
up
2 bowel movements a 2 can control bladder for up 2.6 yrs.
day either at waking up mos. to 5 hours
or after being fed
some delay shown 4 begins to develop a 3 yrs.
between feeding and mos. routine for elimination
elimination
stays dry for 1 to 2 7 attempts to wipe self but 3.6 yrs.
hours interval mos. fails
may awaken at night & 1.5 stays dry at night 4 yrs.
cry to be changed yrs.
may indicate wet pants 1.5 can toilet self without 5 yrs.
yrs. assistance
has only occasional 1.10 washes & dries own 5 yrs.
accidents yrs. hands after toileting
uses same words for 1.10 one bowel movement a 5 yrs.
both functions of yrs. day
elimination
begins to differentiate 2 yrs.
between elimination
functions
Figure 23. Developmental Milestones
When is a developmental disability present?
A deviation from the developmental milestones from four to six months is enough ground to suspect
that there might be a disability. For example, at six months the infant is still not able to raise his or her
chin when made to lie on the stomach, a gross motor skill that is observable at one month. At two
years, the child cannot walk alone with support. There is no receptive language yet at one-and-a-half
years of age, that is, the child does not respond to the adult's motivation. At 2 years, when the child is
expected to understand 200 to 400 words, the receptive vocabulary is less than 100. In the
development of expressive language, at age three, the child can say only a few words that are
mispronounced.
When deviations from the normal milestones of development are observed, the parents and
caregivers must seek the help of medical persons immediately. Many times, the situation worsens
when long periods of time are allowed to elapse

69
before seeking professional help. The medical doctor is the best person who can tell if there is cause
for worry in the presence of perceived deviations from normal development.
The Human Genome Project
The twentieth century is recorded in man's history as the age of physics and information technology.
The atom was split and silicon was turned into computer chips. But the twenty-first century will be
recorded as the age of biotechnology with the onset of new fields of medical science, the so-called
new genetics, genomics and neurogenetics. Research work in these young fields is strongly influencing
the current thinking about the link between genes and specific diseases, a number of which cause
developmental disabilities.
The Human Genome Project (HGP) is coordinated effort among scientists from the United States,
Japan, and other countries to map and characterize all human genetic materials by determining the
complete sequence of the DNA in the human genome. The project started in 1990 and was completed
in 2003. The ultimate goal was to discover and map the book of life, the precise biochemical code for
each of the thousands of human genes and make the information available for further biological
study. The findings on genetic mapping has revealed a wealth of information on how each gene
functions and malfunctions to trigger deadly diseases like cancer, AIDS, cardiovascular diseases,
diabetes and arthritis. Genes that undergo mutation, or changes in the original function have been
identified. Gene mutation causes many diseases that can now be studied better. The research findings
include data on genes related to mental retardation and other developmental disabilities. For
example, in Huntington's disease, which is an inherited disorder, nerve cell clusters in the brain
degenerate that result to rapid jerky movements. Niemann-Pick Type C disease is a hereditary
condition that leads to early death among infants. When the information on such diseases is
completed, drugs can be created based on people's unique molecular information. Drugs can be
customized or made suitable to individual genetic profiles so that each person can respond properly
to medical treatment. DNA tests can be developed to diagnose a disease, confirm a diagnosis, provide
information on the course of the disease, confirm the existence of a disease in a person without
symptoms and predict the risk of future diseases in healthy individuals and their offspring.
Another major benefit of genome mapping is that it will make possible an entirely new approach to
biological research. Instead of studying one or a few genes at a time, whole genome sequences can be
studied using new automated technologies. In the next twenty years, there will be a big number of
genome-related discoveries and new technologies that will introduce great changes in the field of
medicine.
Still another contribution to scientific progress is in the area of gene therapy and gene enhancement.
These new fields of medicine hold the potential of treating or even curing inherited and acquired
diseases. Normal genes can be used to replace defective ones that cause developmental disabilities.

70
Read and Respond
Test on Content Knowledge
Find out how much you have learned from this chapter by doing the following activities.
1. Fill in the matrix on prenatal development. Write the sequence of growth in each stage of development. Identify the
causes of developmental disabilities during this period. Define the terms specific to each stage.
Stages of Prenatal Development Causes of Developmental
Disabilities
I

II

III

The Birth Process

2. Definition of Terms: List all the significant terms and define each of them.
3. What is Newborn Screening? How are mental retardation and other developmental disabilities
detected after birth? What are the advantages of newborn screening?
4. Cite examples of deviations from the normal developmental milestones that you have
observed.
Reflection and Application of Learning
1. Revisit the class of children with special needs. Ask the teacher for permission for you to talk to
one mother. Ask her about the history of her child's disability.
2. Relate the information you have gathered to the content of the chapter.
3. Share your findings with each other.

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Part III CHILDREN AND YOUTH WITH SPECIAL EDUCATION NEEDS

Chapter 5 STUDENTS WITH MENTAL RETARDATION

Teresita G. Inciong

"There is no one who cannot find a place for himself in our kind of world. Each one of us has some
unique capacity for realization. Every person is valuable in his or her own existence -for himself
alone.”
- George H. Bender
To the Course Professors and Students:
The chapter on students with mental retardation starts with a discussion of the different perspectives
and viewpoints about the disability. A broad definition of mental retardation is presented together
with an explanation of the factors and the assumptions on the presence of the condition. The
classification, causes and etiological factors, and the learning and behavior characteristics of children
with mental retardation are presented. The identification and assessment procedures as well as the
educational approaches are described.
At the end of the chapter, the students should be able to:
1. explain why mental retardation is a complex developmental disability;
2. define mental retardation and explain the four factors and five assumptions in the definition;
3. enumerate and discuss the classification of mental retardation;
4. identify and explain the causes of mental retardation during the phases of prenatal development,
the birth process, infancy and early childhood;
5. name and describe the assessment procedures to screen and assess children with mental
retardation;
6. enumerate and describe the educational approaches in teaching children and youth with mental
retardation; and
7. appreciate the fact that special education enables children with mental retardation to develop
their skills and potential.
retardation to develop their skills and potential.
The professors are encouraged to arrange visits to special schools for children with mental
retardation.

73

Case Study of Raymond N.

Raymond is fourteen and a half years old, male, 5'3" tall, of medium build. His head is
disproportionately small for his body. He was diagnosed to have a small brain or microcephaly. The
mother reported that she had a normal pregnancy and that Raymond was a full term infant at birth.
She recalled that the only ailment she had when she was pregnant was a mild cough.
Early Development
Raymond's growth and development was observed to be different from normal babies. He did not
follow the normal course of psychomotor and language development during the first two years, the
milestones of which are walking alone at one year or earlier, and ability to talk and express one's
thoughts in simple words or phrases at age two or a few months later. He first sat with support and
crawled when he was already two years old. He was nonverbal and did not develop speech. The
diagnosis showed that Raymond had profound mental retardation. This means that he needs constant
and high intensity support all the time. He cannot manage himself independently even in simple
activities like daily living skills and would need the help of professional practitioners. Children with
profound mental retardation score below 20 to 25 IQ points in a mental ability test.
Behavior and Psychosocial Development
At present, Raymond attends a private school for children with mental retardation. It is his third year
in special education. He has a good disposition and displays a positive attitude towards the classroom
tasks and activities. He shows enthusiasm to learn and behaves well in circle time activities and school
programs with tolerable hyperactivity. He wears a smile every time he comes to school. He greets the
school principal, teachers and classmates with a big smile, and hug or he simply holds their hands.
There are days though when he shows slight tantrum and just lies on the floor for some time. The
teacher has to force him manually to get up and do his lesson.
Raymond is able to pay attention every time his name is called. He sits independently during tabletop
activities. He can help in class chores like arranging the tables and chairs. He enjoys being with his
teachers and classmates, holds their hands, waves at them or does a "nose to nose kiss." His attention
span is growing longer especially when he plays with his favorite colored 3D wooden blocks, or when
watching a movie.
74
Psychomotor Skills
With the help of the school's occupational therapist, he can now point to his head, nose, eyes, mouth
and hair with minimal to moderate assistance. He can do the basic gross motor activities like walking
with reduced assistance, going up and down the stairs alone, following instructions to roll, jump,
crawl and engage in balance beam activities with minimal help. He can grasp and transfer objects
from one hand to the other without dropping them. He can scoop objects from one container to
another by himself. He can sit for longer hours with minimal distraction and can go through varied
obstacle courses that require the use of the different parts of his body. He can follow instructions to
arrange the chairs with the teacher's verbal cues and gestures.
He is able to do fine motor activities like tracing vertical and horizontal lines with moderate physical
assistance and verbal prompts. He can string 8 to 10 beads, insert pegs into the board and build a
block tower with minimum assistance.
Cognitive Development and Communication Skills
When asked "Where is Raymond?" he would look at himself in the mirror and tap his image. He
identifies objects and gives them to the teacher when asked. He can repeat after the teacher the
words "mama, papa." He can identify, discriminate and sort colors by pointing to them and group
them by himself. He can do simple figure insets (squares, triangles and circles) and complete simple
puzzles. He can follow simple instructions and recognize common objects.
Books fascinate him no end and he loves to go over the pages of encyclopedias. He would point to
objects in the book and ask the teacher to name them by tapping her. Another activity that he likes to
do is look at the cars passing by.
With the special education teacher's patient use of special methods and behavior modification
techniques, Raymond learned to "say" good morning and good-bye through gestures. He can now
perform cognitive tasks like puzzle formation, activities with knobbed cylinders and beads, color
sorting and transferring objects from one container to another with minimal spillage. He can point to
the parts of the body and can write vertical and horizontal lines. He is still nonverbal and hardly
interacts with his classmates. The teacher is training him to express what he wants by tapping the
person's arm or shoulder.
Quantitative Skills
Raymond can identify the primary colors, sort and discriminate them using the Lego and 3D colored
wooden blocks with minimal verbal cues. He can identify the primary shapes and insert them in the
Tub 'O Shape Box. He can identify soe of the geometric shapes using the geometric form insets.

75
Daily Living Skills, Personal Management and Pre-vocational Skills
Raymond can remove and put on his clothes, slippers, shoes and socks, and fold garments. He can put
on the ankle weights to strengthen his lower extremities with or without or with minimal assistance.
However, he cannot tie his shoelaces yet.
In grooming, he can brush his teeth, apply powder, lotion and cologne on his face and body with
moderate verbal and physical prompts. He can do the basic self-help activities like zipping up, buckling
shoes, grooming (brushing his teeth, powdering his body, combing his hair). However, he is not yet
toilet trained.
Raymond can do simple laundry (handkerchief and towel) with maximum assistance. He can do some
of the household activities like washing the dishes (plastic or melamine plates, spoons, forks, glasses)
watering the plants, sweeping and mopping the floor and wiping the table with moderate physical
and verbal prompts. He can execute simple cooking procedures like slicing ham or hotdog with a
plastic knife, beating an egg and scrambling it, with moderate to maximal assistance. He can set the
table and respond to simple step-by-step verbal direction like, "please get the placemat, please get
the plate, spoon, fork, glass." He can mop the floor and wipe the table with moderate assistance and
verbal prompts. He can pour water into a glass alone, but he has to be prompted verbally on when to
stop or when to add some more water. He shows enthusiasm in scooping elbow macaroni from one
bowl to another and pouring water from a pitcher to glasses with minimal spillage.
Future Plans
The following activities will be integrated in Raymond's individualized education plan:
1. Include other basic self-care daily living skills and personal management activities.
2. Include more household chores to the school and home activities.
3. Introduce pre-speech training activities with the help of a speech pathologist.
4. Continue the activities on cognitive and communication development.
5. Continue the services of the occupational therapist.

Perspectives on Mental Retardation

The concepts and definition of mental retardation have changed and varied widely in the last fifty
years. Even today, the definition of mental retardation is described as "in transition." It is expected
that mental retardation will continue to be defined in many different ways. However, common
concepts are found in the various definitions.

76
1. Experts and authorities agree that mental retardation is a complex condition. In 1992, the
American Association for Mental Retardation stressed that the distinction between the terms trait
and state is central to the understanding of mental retardation. Mental retardation is not a trait that
exists separately from the other characteristics of the individual. Rather, mental retardation is a
condition or state that affects the manner by which a person is able to cope successfully with the
demands of daily living at home, in school, in the community and other environments. In general, the
different environments are built for normally functioning persons who have acquired the skills,
competencies and maturity through the years of normal development. The person with mental
retardation experiences difficulties in coping with the various environments because he or she lacks
the mental, emotional and social skills and competencies to function in environments meant for
normal people. But he or she has no choice but to live, cope and function in these environments. As a
result, his or her functioning is impaired in certain specific ways.
2. Mental retardation is a developmental disability. Unlike people with the same chronological age
and average or high mental ability, the person with mental retardation suffers from lags or delays in
his or her general development profile. As defined in Chapter 1, a developmental disability is
attributable to a mental or physical impairment or a combination of both factors that is likely to
continue indefinitely.
3. Mental retardation results in substantial limitations in three or more of the major activities of
daily life. These are self-care, receptive and expressive language, learning, mobility, self-direction,
capacity for independent living and economic self-sufficiency.
4. Mental retardation encompasses a heterogeneous group of people with varying needs, features
and life contexts. The previous belief was that mental retardation was an all-or-none phenomenon.
This means that either a person was normal or had mental retardation. Now mental retardation is
viewed to exist in a continuum. The condition is accepted to be changeable. Some persons may
manifest the condition at times and not at other times based on their needs for various levels of
support.
What Is Mental Retardation?
The American Association on Mental Retardation (AAMR) had spent more than five decades of study
on what mental retardation is. The AAMR 1992 definition is the most accepted in many special
education programs all over the world.

77
"Mental retardation refers to substantial limitations in present functioning. It is characterized by
significantly sub-average intellectual functioning, existing concurrently with related limitations in two
or more of the following adaptive skills areas: communication, self-care, home living, social skills,
community use, self-direction, health and safety, functional academics, leisure and work. Mental
retardation manifests before age 18." (Heward, 2003)
Clearly, there are four criteria in the' definition which are explained below.
• Substantial limitations in present functioning means that the person has difficulty in performing
everyday activities related to taking care of one's self, doing ordinary tasks at home and work related
to the other adaptive skills areas. The areas of difficulty include academic work, if the person goes to
school.
• Significantly sub-average intellectual functioning means that the person has significantly below
average intelligence. Intellectual functioning is a broad summation of cognitive abilities, such as the
capacity to learn, solve problems, accumulate knowledge and adapt to new situations. The person
finds difficulty in learning the skills in school that children of his age are able to learn. The intelligence
quotient score is approximately in the flexible lower IQ range 0 to 20 and upper IQ range of 70-75
based on the result of assessment using one or more individual intelligence tests.
The current IQ score cutoff is 70, though it is acknowledged that IQ scores are not exact measures,
and therefore, a small number of individuals with mental retardation may attain scores as high as 75.
Sub-average intellectual functioning indicates that intelligence, or at least intelligence test scores, are
not static or unchangeable. This current concept assumes that one's intellectual functioning can
change, and a person diagnosed to have mental retardation at one point in life may no longer meet
the criteria or may no longer be mentally retarded at a later time.
• Limitations in the adaptive skills or behavior show in the quality of everyday performance in coping
with environmental demands. Persons with mental retardation fail to meet the standards of personal
independence and social responsibility expected of their chronological age and cultural group. The
quality of general adaptation is mediated by the level of intelligence. Adaptive skills are assessed by
means of standardized adaptive behavior scales.
• Related limitations in the adaptive skills areas means that the person has difficulty in performing
the following tasks: (Beirne-Smith, 2002)
1. Communication or the ability to understand and communicate

78
information by speaking and writing through symbols, sign language and non-symbolic behavior like
facial expressions, touch or gestures.
2. Self-care or the ability to take care of one's needs in hygiene, grooming, dressing, eating, toileting.
3. Home living or the ability to function in the home, housekeeping, clothing care, property
maintenance, cooking, shopping, home safety, daily scheduling of work.
4. Community use or travel in the community, shopping, obtaining services.
5. Social skills in initiating and terminating interactions, conversations, responding to social cues,
recognizing feelings, regulating own behavior, assisting others, fostering friendship.
6. Self-direction in making choices, following schedule, completing required tasks, seeking assistance
and resolving problems.
7. Health and safety such as maintaining own health, identify and preventing illness, first aid,
sexuality, physical fitness and basic safety.
8. Functional academics or learning the basic skills taught in school.
9. Leisure such as recreational activities that are appropriate to the. age of the person.
10. Work or employment, appropriate to one's age.
Mental retardation manifests before age 18 to 22. This means that the condition can start during
pregnancy until the age of 18 to 22. A person who suffers from brain injury at age 23 or thereafter,
even if the other criteria are met, would not be considered to have mental retardation. The reason
that such individual is excluded from this category is that mental retardation is a developmental
disability.
It is important to understand that in the diagnosis of mental retardation, the person must meet all
three of the above criteria. Thus, an IQ score below 70 or 75, in and of itself, is not sufficient to
classify a person as with mental retardation. The person's adaptive behavior must also be impaired,
and the condition must have originated during pregnancy until the age of 18 to 22.
Mental retardation has been known by many different names that are no longer used at present. The
old labels are mentally defective, mentally deficient, feebleminded, moron, imbecile and idiot.
In the past, a person's IQ score was the only determinant of mental retardation. Today, several
associations and agencies define mental retardation in different ways. However, almost all of them
use the IQ score as only one criterion and usually pair it with an assessment of how well a person can
manage daily tasks which are appropriate for his or her age.

79
Heward (2003) cites five essential assumptions in using the AAMR definition:
1. The existence of limitations in adaptive skills occurs within the context of community
environments typical of the individual's age peers and is indexed to the person's individualized needs
for supports.
2. Valid assessment considers cultural and linguistic diversity, as well as differences in
communication, sensory, motor, and behavioral factors.
3. Specific adaptive limitations often coexist with strengths in other adaptive skills or other
personal capabilities.
4. The purpose of describing limitations often coexist with strengths.
5. With appropriate supports over a sustained period, the life-functioning of the person with
mental retardation will generally improve.

Classification of Mental Retardation

The criteria in the AAMR definition are very extensive, thus, a system of sub-categories or levels of
mental retardation was developed. Traditionally, subcategories have been based on IQ ranges. In the
previous AAMR classification system, there are four levels that are still widely used today:
1. mild MR with IQ scores from 55 to 70
2. moderate MR with IQ scores from 40 to 54
3. severe MR with IQ scores from 25 to 39, and
4. profound MR with IQ scores below 25.
Current books in special education use two classifications:
1. the milder forms of mental retardation, and
2. the more severe forms of mental retardation that cluster the moderate, severe and profound
types.
The classifications "educable mental retardation" (EMR) and "trainable mental retardation" (TMR) are
no longer used.
The AAMR has introduced a new system of classification that is based on the amount of support that
the person needs in order to function to the highest possible level. The four categories of mental
retardation according to the intensity of needed supports are: (Wehmeyer, 2002)
1. Intermittent supports are on "as needed" basis, that is, the person needs help only at certain
periods of time and not all the time. Support will most likely be required during periods of transition,
for example, moving from school to work.

80
2. Limited supports are required consistently, though not on a daily basis. The support needed is of a
non-intensive nature.
3. Extensive supports are needed on a regular basis; daily supports are required in some
environments, for example, daily home living tasks.
4. Pervasive supports are daily extensive supports, perhaps of a life-sustaining nature required in
multiple environments.
Classifying individuals with mental retardation on the basis of needed supports makes good sense
because it emphasizes the services needed by these individuals rather than a diagnostic criterion such
as an IQ score which actually cannot translate to specific needed services. However, this change
though radical and extensive, cannot be readily adopted. It may take many years for the classification
according to needed supports to replace the classification according to IQ scores.

Incidence and Prevalence

According to the AAMR 1973 definition, mental retardation can occur in 3% of a given population.
Only about 15% of these children have greater than mild disabilities. Compared to his or her peers,
the person passes through the milestones of development much later and learning rate and
development of physical skills are slower. Due to complications during pregnancy, birth and infancy,
concomitant conditions associated with mental retardation may occur such as Down Syndrome,
physical handicaps, speech impairment, visual impairment, hearing defects, epilepsy, and others.

Causes of Mental Retardation

There are more than 250 identified causes of mental retardation. The AAMR classifies the causes or
etiological factors based on time of onset, categorized as prenatal or biological (occurring before
birth), perinatal (occurring during birth, and postnatal and environmental (occurring shortly after
birth) (Ad Hoc Committee on Definitions and Terminology, 1992, cited in Heward, 2003).
The specific biological causes are known for about two-thirds of individuals with the more severe
forms that include the moderate, severe and profound types. It is important to understand that the
causes listed are conditions, diseases and syndromes that are associated with mental retardation.
These conditions may or may not result in mental retardation or deficits of intellectual and adaptive
functioning that define mental retardation. Some of the conditions may or may not require special
education services. The term syndrome refers to a number of symptoms or characteristics that occur
together and provide the defining features of a given disease or condition.

81
The environmental causes are traced to a psychological disadvantage which is a combination of a poor
social and cultural environments early in the child's life. The term developmental retardation is used
to refer to mild mental retardation thought to be caused primarily by environmental influences such
as minimal opportunities to develop early language, child abuse and neglect, and/or chronic social or
sensory deprivation. A number of studies illustrate the occurrence of "intergenerational progression"
in which the cumulative experiential deficits in social and academic stimulation are transmitted to
children from low socioeconomic status environments (Greenspan, 1992). The following factors are
found to contribute to environmentally caused mental retardation (Greenspan, et al. 1994):
1. limited parenting practices that produce low rates of vocabulary growth in early childhood;
2. instructional practices in high school and adolescence that produce low rates of academic
engagement during the school years;
3. lower rates of academic achievement and early school failure and early school dropout; and
4. parenthood and continuance of the progression into the next generation.
I. Some prenatal causes, or those that originate during conception or pregnancy until before birth are
chromosomal disorders such as trisomy 21 or Down syndrome, Klinefelter syndrome, Fragile X
syndrome, Prader-Willi syndrome, Phenylketonuria, and William syndrome.
• Down syndrome, named after Dr. Langdon Down, is the best known and well researched
biological condition associated with mental retardation. It is estimated to account for 5 to 6% of all
cases. Caused by chromosomal abnormality, the most common is trisomy 21 in which the 21st set of
chromosomes is a triplet rather than a pair. Trisomy 21 most often results in moderate level of mental
retardation, although some individuals function in the mild or severe ranges. DS affects about 1 in
1,000 live births. The probability of having a baby with DS increases to approximately 1 in 30 for
women at age 45. Older women are at "high risk" for babies with DS and other developmental
disabilities.
The characteristic physical features are short stature; flat, broad face with small ears and nose;
upward slanting eyes, small mouth with short roof, protruding tongue that may cause articulation
problems; hypertonia or floppy muscles; heart defects are common; susceptibility to ear and
respiratory infections; older persons are at high risk for Alzheimer's disease.
• In Klinefelter syndrome, males receive an extra X chromosome. Sterility, underdevelopment of
male sex organs, acquisition of female secondary sex characteristics are common. Males with XXY sex
chromosomes instead of the normal XY often have problems with social skills, auditory perception,
language, sometimes mild levels of cognitive retardation. This condition is more often associated with
learning disabilities than with mental retardation.

82
• In Fragile X syndrome a triplet or repeat mutation on the X chromosome interferes with the
production of FMR-1 protein which is essential for normal brain functioning. Majority of males
experience mild to moderate mental retardation in childhood and moderate to severe deficits in
adulthood. Females may carry and transmit me mutation to their children but tend to have fewer
disabilities than affected males. The condition affects approximately one in four thousand males. It is
the most common clinical type of mental retardation after Down syndrome. It is characterized by
social anxiety, avoiding eye contact, tactile defensiveness, turning the body away during face-to-face
interactions and stylized, ritualistic forms of greeting. Preservative speech often includes repetition of
words and phrases.
• William syndrome is caused by the deletion of a portion of the seventh chromosome. Cognitive
functioning ranges from normal to mild and moderate levels of mental retardation. The characteristics
are: elfin or dwarf-like facial features; the physical features and manner of expression exudes
cheerfulness and happiness; "overly friendly," lack of reserve toward strangers, often have uneven
profiles of skills, with strengths in vocabulary and storytelling skills and weaknesses in visual-spatial
skills; often hyperactive, may have difficulty staying on task and low tolerance for frustration or
teasing.
• Prader-Willi syndrome is a syndrome disorder caused by the deletion of a portion of chromosome
15. Initially, infants have hypertonia or floppy muscles and may to be tube-fed. The initial phase is
followed by the development of insatiable appetite. Constant preoccupation with food can lead to
life-threatening obesity if food seeking is not monitored. The condition affects one in ten to twenty-
five thousand live births. It is associated with mild retardation and learning disabilities. Behavior
problems are common, such as impulsivity, aggressiveness, temper tantrums, obsessive-compulsive
behavior, some forms of injurious behavior such as skin picking, delayed motor skills, short stature,
small hands and feet and underdeveloped genitalia.
• Phenylketonuria (PKU) is one of the inborn errors of metabolism.
PKU is a genetically inherited condition in which a child is born without
an important enzyme needed to break down an amino acid called
phenylalanine found in dairy products and other protein-rich foods.
Failure to break down this amino acid causes brain damage that often
results in aggressiveness, hyperactivity and severe mental retardation.
In the United States, PKU has been virtually eliminated through
widespread screening. By analyzing the concentration of phenylalanine
in a newborn's blood plasma, doctors can diagnose PKU and treat it with
a special diet. Most children who receive the treatment early enough
have early normal intellectual development.

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Developmental disorders of brain formation include cranial malformations:
In anencephaly, the major portions of the brain are absent. This is a major neural tube defect, that is,
it occurs in the brain or the spinal cord.
• In microcephaly, the skull is small and conical, the spine is curved and typically leads to stooped
portion and severe mental retardation.
• In hydrocephaly, blockage of cerebrospinal fluid in the cranial cavity causes an enlarged head and
undue pressure on the brain.
-
Environmental influences include maternal malnutrition, irradiation during pregnancy, juvenile
diabetes mellitus and fetal alcohol syndrome or FAS. FAS is one of the leading causes of mental
retardation. The mother's excessive alcohol use during pregnancy has toxic or poisonous effects on
the fetus, including physical defects and developmental delays. FAS is diagnosed when the child has
two or more craniofacial malformation and growth is below the 10th percentile for height and weight.
Children who have some but not all of the diagnostic criteria for FAS and a history of the mother's
prenatal alcohol exposure are diagnosed with fetal alcohol effect or FAE, a condition associated with
hyperactivity and learning problems. The incidence is higher than Down syndrome and cerebral palsy.
The characteristics are cognitive impairment, sleep disturbances, motor dsyfunctions, hyperirritability,
aggression, and conduct problems. Although the risk is highest during the first three months of
pregnancy, pregnant women should avoid drinking alcohol anytime.
II. Perinatal causes include:
• Intrauterine disorders such as maternal anemia, premature delivery, abnormal presentation,
umbilical cord accidents and multiple gestation in the case of twins, triplets, quadruplets and other
types of multiple births. Birth trauma may result from anoxia or cutting off of oxygen supply to the
brain. While mental retardation still may occur because of these conditions, improvements in fetal
monitoring and the subsequent increase in caesarean births have reduced the likelihood of perinatal
causation (Culatta et al., 2003).
• Neonatal disorders such as intracranial hemorrhage, neonatal seizures, respiratory disorders,
meningitis, encephalitis, head trauma at birth.
III. Postnatal causes include:
• head injuries such as cerebral concussion, contusion or laceration;
• infections such as encephalitis, meningitis, malaria, German measles, rubella;
• demyelinating disorders such as post infectious disorders, post immunization disorders;
84
• degenerative disorders such as Rett syndrome, Huntington disease, Parkinson's disease;
• seizure disorders such as epilepsy, toxic-metabolic disorders such as Reye's syndrome, lead or
mercury poisoning;
• malnutrition especially lack of proteins and calories;
• environmental deprivation such as psychosocial disadvantage, child abuse and neglect, chronic
social/sensory deprivation; and
• Hypoconnection syndrome.
Though accidents, particularly vehicular accidents, are the leading causes of childhood head injuries,
the shaken baby syndrome, which is a type of child abuse when a crying infant is violently shaken by a
frustrated caregiver, can result to head injury. Infants' heads are disproportionately large, their neck
muscles cannot support the stress of this shaking, causing the head to flop back and forth. This often
results in internal bleeding and brain damage or, in some cases, even death. Oftentimes, other
diagnoses are given such as traumatic brain injury (Beirne-Smith, 2002).
Authorities emphasize the importance of knowing the cause or etiology of mental retardation in
relation to the efforts to prevent it and in introducing educational intervention.
Cultural-familial retardation refers to the existence of lowered intelligence of unknown origin
associated with a history of mental retardation in one or more family members. Though there are
specific and known causes in some cases of mild mental retardation, typically it is thought to be
cultural/ familial. The condition results from the lack of adequate stimulation during infancy and early
childhood.
Diseases of the mother during pregnancy may also result in retardation. Infections caused by sexually
transmitted diseases such as syphilis, gonorrhea, AIDS, toxoplasmosis (blood poisoning) and rubella
can have negative effects on the developing fetus. Maternal rubella is most likely to cause retardation,
blindness or deafness when the disease occurs during the first trimester of pregnancy.

Learning and Behavior Characteristics

As discussed earlier, persons with mental retardation manifest substantial limitations in age-
appropriate intellectual and adaptive behavior. There are deficits in cognitive functioning that are
associated with poor memory, slow learning rates, attention problems, difficulty at generalizing what
has been learned and lack of motivation. Many individuals with mental retardation are able to acquire
the skills for adaptive behavior, but a larger number are not able to do so throughout their life span.
Studies show that many of these children are identified for the first time when they start going to
school. They find difficulties in doing school work and

85
fail the grade levels. Their classmates leave them behind in the achievement of the skills in the subject
areas. Those with moderate retardation show significant delays in development during the preschool
years. In general, as they grow older, the discrepancies in overall intellectual development and
adaptive functioning become wider when compared to normal age-mates. Many of them can learn
the academic skills up to the sixth grade level and master job skills well enough to be able to work and
support themselves semi-independently when they leave school.
Deficits in Cognitive Functioning
Sub-Average Intellectual Skills. As stated earlier, the first defining characteristic of persons with mental
retardation is below average mental ability as measured by standardized tests.
Figure 24. Children with mental retardation have short attention span.
Low Academic Achievement. Due to sub-average intellectual functioning, persons with mental
retardation are likely to be slower in reaching levels of academic achievement equal to their peers.
Difficulty in Attending to Tasks. The attention of these children tends to be distracted by irrelevant
stimuli rather than those that pertain to the lesson. Likewise, they have difficulty in sustaining their
attention to learning tasks. These attention problems contribute to the development of concomitant
problems such as difficulties in remembering and generalizing newly learned lessons and skills.
Deficits in Memory
These students have difficulty in retaining and recording information in the short term or working
memory. Information encountered a few seconds earlier cannot be recalled. Research shows that
many persons with retardation have good long-term memory, but they have difficulty remembering in
the short term, especially if the facts are complex.
Difficulty with the generalization of skills. The inability to generalize is related to the inability to think
abstractly. Students with mental retardation often have trouble in transferring their new knowledge
and skills into settings or situations that differ from the context in which they first learned those skills.
Low motivation. Some students show lack of interest in learning their lessons. Some of them develop
learned helplessness where they expect to continue to fail in doing certain tasks because they have
not been able to do the tasks in the past. To avoid failure, the person tends to set very low
expectations for oneself. Motivation is a problem for persons with any disability because it is learned.
Constant comparison to others who perform in many areas with apparent ease can

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be frustrating and diminish motivation and self-esteem, and sometimes create "learned helplessness"
and belief in consistent failure.
Deficits in Adaptive Behavior
Due to the fact that adaptation to one's social and physical environment requires intellectual ability,
persons with mental retardation are likely to demonstrate significant deficits in adaptive behavior.
Self-care and daily living skills. They are often taught basic self-care skills deliberately which normal
individuals learn by absorption and imitation. Direct instruction, simplified routine, prompts and task
analysis are used to teach self-care skills in hygiene and grooming, daily living skills in eating, toileting,
communication and the other areas of adaptive behavior.
Social development. Limited cognitive processing skills, poor language development, and unusual or
inappropriate behaviors can seriously impede interaction with others. Thus, making friends and
sustaining personal relationships are difficult for persons with mental retardation.
Behavioral excesses and challenging behavior. Compared to children without disabilities, students
with mental retardation are more prone to inappropriate behavior. They have difficulties accepting
criticism, limited self-control, as well as behavior problems like aggression or self-injury.
Psychological Characteristics. As in the case of speech and language problems, mentally retarded
persons have slower psychological development (e.g., toilet training, walking) and are likely to have
some forms of associated physical problems.
Positive Characteristics. Like everyone else, persons with mental retardation have their unique
characteristics. While they may have negative attributes like those described earlier, many of them
have positive characteristics like friendliness and kindness. They can be fun to be with and they can
get along well with others. Being with them makes one appreciate one's normal attributes.

Assessment Procedures
In general, in the Philippines where the educational system hardly provides for clinicians like school
psychologists or psychometricians, initial assessment is done by the classroom teacher in order to
identify who among the regular students are in need of special education. Initial assessment is done
through teacher nomination. For school-age children, teachers are an important source of informa-
tion about their learning and behavior attributes. A checklist of the learning and behavior
characteristics of children with special education needs is used. When a child manifests half or more
than half of the characteristics in the checklist, then the final assessment follows. Here, a guidance
counselor or special education teacher administers the appropriate assessment tools developed by
the Special Education Division of the Bureau of Elementary Education of the Department of
Education.

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When a child is suspected to have a developmental disability such as mental retardation a complete
diagnosis of the condition is necessary. A thorough assessment of the condition is critical in
considering a child's eligibility for special educational services, and/or aid in planning the educational
and other services he/ she and the family may need. The assessment process covers a more intensive
observation and evaluation of the child's cognitive and adaptive skills, analysis of medical history
especially of the mother's condition during pregnancy and other circumstances related to causative
factors and the child's current level of functioning. The use of more than one assessment procedure
provides a wealth of information about the child permitting the evaluation of the biological, cognitive,
social and interpersonal variables that affect the child's current behavior.
In the diagnostic assessment of children, parents and other significant individuals in the child's
environment provide a rich source of information. The components of assessment, informal and
standardized tests, home visits, interview and observation complement each other and form a firm
foundation for making correct decisions about the child. Certainly, major discrepancies among the
findings obtained from the various assessment procedures must be resolved before any diagnostic
decisions or recommendations are made. For example, if the intelligence test results indicate that the
child is currently functioning in the sub-average range, while the interview data and the adaptive
behavior characteristics suggest average functioning, it is necessary to reconcile these disparate
findings before making a diagnosis. An evaluation report that provides information relevant to
instruction and other services is useful to both teachers and parents. The inclusion of families in the
management of their children's education presents new challenges. Nevertheless, their participation
in arriving at important decisions about the children will ultimately be rewarding and beneficial to all
the members of the team.
Models of Assessment (Richey and Wheeler, 2000)
Three assessment models are used in Western countries. These are the traditional, team-based and
activity-based models of assessment.
Traditional Assessment
In the traditional assessment model, the parents fill in a pre-referral form about the family history and
the developmental history of the child. Then the child and parents are referred to a team of clinical
practitioners for thorough evaluation of the child's intellectual, socio-emotional and physical
development, health condition and other significant information. The members of the team are a
developmental psychologist, an early childhood special educator, an early childhood educator, a
speech/language pathologist (SLP), an occupational therapist, a physical therapist, a child psychiatrist
or clinical psychologist, a physician and nurse,

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an audiologist and other specialists contribute their own specialized skills to the evaluation process.
Team-Based Assessment Approaches
Because children with mental retardation often have other problems, it is necessary to involve a team
of practitioners from different areas like the specialists in the traditional model of assessment. The
team-based approach is described as multidisciplinary, interdisciplinary and transdisciplinary in
nature.
In multidisciplinary assessment, individual team members independently assess the child and report
results without consulting or integrating their findings with one another.
In interdisciplinary assessment, the members conduct an independent assessment and evaluation
individually the findings are integrated together with the recommendations.
Transdisciplinary assessment on the other hand, allows other team members as facilitators during the
assessment process. A natural extension of this approach is the involvement of the family in the
decision-making process.
Activity-Based Assessment
The activity-based model of assessment for young children with developmental delays or disabilities is
better than the other models because of parental involvement as well as the development of
meaningful, child-centered, positive behavioral supports and activity-based interventions. Assessment
findings are easily translated into the child's program plan. The assessment materials have a
curriculum and evaluation components, and do not require specialized materials or test kits. Examples
of criterion referenced assessment tools are the Assessment, Evaluation, and Programming System for
Infants and Children (AEPS) and the Infant-Preschool Assessment Scale (IPAS).
Cognitive/Developmental Assessment Tools
Some of the commonly used assessment tools for measuring the mental ability of children with
mental retardation are: The Differential Ability Scales (DAS), Wechsler Preschool and Primary Scale of
Intelligence-Revised (WPPSI-R), Wechsler Intelligence Scale for Children-Ill (WISC-III) and the Stanford-
Binet: Fourth Edition. (Beirne-Smith et al., 2002)
Adaptive Behavior Assessment Tools
Adaptive behavior is an important and necessary part of the definition and diagnosis of mental
retardation. It is the ability to perform daily activities required for personal and social sufficiency.
Assessment of adaptive behavior focuses on how well individuals can function and maintain
themselves indepen-

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dently and how well they meet the personal and social demands imposed on them by their cultures.
There are more than 200 adaptive behavior measures and scales. The most common scale is the
Vineland Adaptive Behavior Scales which assesses the social competence of individuals with and
without disabilities from birth to age 19. It is an indirect assessment in that the respondent is not the
individual in question but someone familiar with the individual's behavior. The student's social
competence can also be measured by the AAMR Adaptive Behavior Scale-School and the Scales of
Independent Behavior Revised (SIB-R).
Educational Programs Early Intervention Program
The provision of an early intervention program to children with developmental delays/disabilities has
gained wide acceptance in the past decades. The child with mental retardation benefits from an early
intervention program. The skills that are normally learned during early childhood are taught at a time
when the child is still young and more malleable than when he or she would have grown older and
less flexible. The opportunities to learn the adaptive skills early are enhanced and increase the
chances for the child to be able to cope with the demands of future environments. Trends in early
intervention emphasize the important role of the home and the participation of the parents and
family members who are the natural caregivers of their children. Effective early intervention takes
place in the natural setting at home when the parents and family members accept the fact that the
child has a developmental disability and can learn like his normal siblings in ways that are different.
The willingness on their part to be patient in teaching the child the basic adaptive skills on self-care
and daily living activities redounds to the benefit of both the child and the adults in the family. In
addition to the behavior skills, social and emotional bonds are developed as well that set a strong
base for future special education programs and activities.
The staff members of early intervention programs have formal training in early childhood education
and special education. They participate in in-service training programs and attend conferences and
workshops. Intervisitation among programs and agencies is held to update the staff's competencies
and learn from each other's experiences.
. Rationale for Early Intervention
There are at least five reasons why early intervention services should be provided. First, during
intervention secondary disabilities that would have gone unnoticed can be observed. Second, early
intervention services can prevent the occurrence of secondary disabilities. Third, early intervention
services lessen the chances for placement in a residential school since a child with the basic self-care
and daily living skills has a good chance of qualifying for placement in a special education program in
regular school. Fourth, as the family gains information about

90
the disability the members learn how to offer support and fulfill the child's need for acceptance, love
and belongingness very much like the ways they behave towards the normal children in the family.
Certainly, the parents and family members develop a sense of confidence as they gain the skills in
raising a child with mental retardation in less stressful conditions, Lastly, early intervention services
hasten the child's acquisition of the desirable learning and behavior characteristics for the attainment
of his or her potential despite the presence of the disability.
Models of Early Intervention
1. Home-Based Instruction Program
The Philippine Association for the Retarded (PAR) composed of special education specialists, parents
and medical practitioners initiated the development of the Home-Based Instruction Program for
Children with Mental Retardation in the 1970s. The goal is to provide a continuous program of
instruction both in school and at home for a more effective management of the handicapping
condition. The program utilizes the Filipino adaptation of the Portage Project. The Portage Guide to
Early Intervention is printed in Filipino and the dialect of some regions. The National Capital Region
and Region V are implementing the program. Davao has also implemented the project.
The key persons are the biological or surrogate parents who perform their primary role as caregivers.
All members of the family including the household helpers are trained to implement the program.
Monitoring and evaluation of the program show positive results.
2. Head Start Program
The Head Start Program in Manila City Schools Division addresses preschool education for the socially
and economically deprived children who are four to six years old. The program operates on the
principle of early intervention as a preventive measure against behavior problems among young
children that may lead ultimately to juvenile delinquency. The participants are children and siblings of
youth offenders, slum dwellers, street children and others of preschool age.
The Head Start Program was subsequently adopted by the Special Education Centers of Manila with a
group of parents serving as teacher-aides.
3. Community-Based Rehabilitation (CBR) Services
The World Health Organization (WHO, 1984) defines community-based rehabilitation as measures
taken at the community level that use and build on the resources of the community to assist in the
rehabilitation of those who need assistance including the disabled and handicapped persons, their
families and their community as a whole.

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The Community-Based Rehabilitation (CBR) has been acclaimed as the answer to the rehabilitation
needs in poverty-stricken areas where institution-based rehabilitation programs are not available.
Piloted by the National Commission for the Welfare of Disabled Persons (NCWPD) in Bacolod in 1981
and eventually expanded to selected communities in Luzon, Visayas and Mindanao, CBR services have
been successfully organized in many communities for preschool and school-age children and young
adults. The utilization of the services of volunteers is employed and maximized in providing
rehabilitation programs to urban and rural communities.
4. Urban Basic Service Program
An early intervention scheme based on the principle of home-based instruction was adopted by the
Urban Basic Service Program as its education component. The program also utilized the Filipino
adaptation of the Portage Guide To Early Intervention. Twelve (12) barangays or villages identified as
depressed and underserved were chosen as sites for the program. Children with disabilities who are
not receiving special education services were placed in the program. Twenty to thirty parents were
trained yearly to implement early intervention at home as a means of minimizing the effects of the
disabilities and increasing the children's readiness and response to rehabilitation programs. .
Educational Approaches The Curriculum
Students with mental retardation need a functional curriculum that will train them on the life skills
which are essentially the adaptive behavior skills. The goal and direction of a functional curriculum is
towards self-direction and regulation and the ability to select appropriate options in everyday life at
Vhome, in school and in the community. The functional curriculum fosters independent living,
enjoyment of leisure and social activities and improved quality of life.
A number of curricular programs for children with developmental disabilities are implemented in the
United States and other Western countries.
The Cognitive Curriculum for Young Children (CCYC) is a major curriculum effort that is based on
Piaget's theory of cognitive development, Vygotsky's zone of proximal development and Feuerstein's
concept of mediated learning. The CCYC builds its instructional program around the child's deficits in
cognition where mediated learning is applied. Estimates of a child's maximum learning potential are
derived from his zone of proximal development that is determined by comparing the child's actual
level of performance to his performance under the teacher's direct supervision.
Another intervention program is the Instrumental Enrichment program wherein the child is trained to
develop a sense of intentionality and a feeling of competence as a result of structured mediated
learning environments.

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The Montessori Method on the other hand, aims to develop the child's sense of self mastery, mastery
of the environment and independence by focusing on his or her perceptual and conceptual
development as well as in the acquisition of skills in self-care and daily living activities.
The curriculum and related instructional strategies in the Ypsilante Perry Preschool Project were
derived from Piaget's cognitive development theory. The cognitively oriented curriculum is used in
teaching disadvantaged children with mild retardation who are three to four years old.
The Portage Project uses the precision teaching model to deliver a home-based curriculum in
language, self-help skills, cognition, motor skills and socialization. The parents are trained to teach
their children using behavior modification procedures.
The Carolina's Abcedarian Project includes parent training, social work services, nutritional
supplement, medical care and transportation. Its curriculum is designed around the interaction of
consumer opinions or the goals that parents have for their children, Piaget's developmental theory,
developmental facts (language, motor, socio-emotional, and cognitive/perceptive), adaptive sets
(winning strategies that generate age-appropriate success) and high risked indicators (Hicksonet al.,
1995).
Methods of Instruction
Teaching children with mental retardation requires explicit and systematic instruction. One such
method of teaching is the Applied Behavioral Analysis (ABA) which is derived from the theory and
principles of behavior modification and the effect of the environment on the learning process.
Task analysis is the process of breaking down complex or multiple skills into smaller, easier-to-learn
subtasks. Direct and frequent measurement of the increments of learning is done to keep track of the
effects of instruction and to introduce needed changes whenever necessary. Active Student Response
(ASR) or the observable response made to an instructional antecedent is correlated to student
achievement. Systematic feedback through positive reinforcement is employed whenever needed by
rewarding the student's correct responses with simple positive comments, gestures or facial
expressions. Meanwhile incorrect responses are immediately corrected (error correct technique) by
asking the student to repeat the correct responses after the teacher.
The application of learned skills in the natural environment is emphasized in the Transfer of Stimulus
Control method of instruction. Correct responses are rewarded through positive reinforcement.
Conversely, generalization and maintenance of learned skills or the extent to which students can apply
correctly what they have learned across settings and over time are measured and recorded.

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Educational Placement Alternatives
In the past children with mental retardation were usually placed in self-contained classes. The special
curriculum emphasized the communication arts, mathematics, self-help skills, social and recreational
skills, motor skills, and prevocational and vocational skills. Though this traditional approach is still
relatively common, increasingly, students with mental retardation are now included in mainstream
schools and even regular classes. This is particularly the case for those with mild to moderate
retardation. Typically, these students receive their special education in either a resource room, where
they work with a special education teacher one-to-one or in a small group, or in the regular classroom
where the special education teacher works with them. In this model, the amount of time students
spend outside the regular classroom depends on their individual needs. Thus, some may spend nearly
the entire day in the regular classroom while others may be there for less than an hour.
Students with Mental Retardation in Inclusive Education
At present, many children with mild and moderate mental retardation are enrolled in the regular
classroom. They are mainstreamed in the academic subjects under the tutelage of the regular teacher
and the special education teacher. The special education teacher provides individualized instruction
on the school subjects and tasks recommended by the regular teachers and directs family members to
help with assignments and class projects.
When students with mild or moderate mental retardation are enrolled in regular classes, the regular
teacher and the special education teacher work together to help the child attain the goals and
objectives set for the school year. The educational placement is called inclusive education because the
regular class has a student with a disability who has been assessed to be capable of learning side by
side with normal students. The Individual Education Plan (IEP) is prepared by the teachers and parents
to identify and indicate the goals for the school year and the objectives and activities during the four
quarters or grading periods for successful inclusive education. As mentioned earlier, the child attends
the regular class and receives tutorial lessons from the special education teacher. Family members are
encouraged to help the child with assignments and class requirements.
Mainstreaming activities for children with the more severe forms of mental retardation are more
selective. They participate in social activities, sports and co-curricular activities like special Olympics,
camping, scouting and interest clubs. Often, the goals for students who need more extensive supports
are more social and behavioral than academic in nature. The activities center on peer interaction,
improving social skills, and helping non-disabled students become more comfortable when interacting
with persons with disabilities.
To teachers faced with the challenge of providing an optimal educational experience for those with
mental retardation, the justification for the students' presence in their classrooms is of little
consequence. Rather, their concerns focus on

94
the practical matter of how best to teach them. Fortunately, there is a growing body of knowledge
regarding appropriate techniques for teaching students with disabilities in regular classroom settings.

Figure 25. Children with MR and SPED Teacher

Here are some suggestions for the special education teachers and the regular teachers in whose
classes students with mental retardation are mainstreamed:
• Together, study the student's IEP and agree on the teachers' roles and responsibilities to make
inclusive education and mainstreaming work.
• Set regular meetings with each other, with the students or their families to assess how effective
the program is going and what else needs to be done.
• Encourage acceptance of the student by the classmates by setting an example and giving the
student the chance to show that he or she is more like the others than different.
• Use instructional procedures that will be of benefit to the student, such as demonstrating the
more complex and difficult tasks, and providing multiple opportunities for practice.
• When teaching abstract concepts, provide multiple concrete examples.

Figure 26. Playing with non-disabled peers improves the social skills of children with mental
retardation

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• Supplement verbal instructions with demonstrations whenever possible.
• Assign a peer tutor to assist the student during independent activities.
• Vary the tasks in drills and practice activities.
Encourage the use of computer-based tutorials and other appropriate computer-based materials.
In class lectures, utilize the 'lecture-pause technique.
• Have a volunteer tape-record reading assignments if the student is unable to read.
• Use cooperative learning strategies involving heterogeneous groups of students.
• Use multilayered activities involving flexible learning objectives to accommodate the needs of
students with diverse abilities.
• Pair students with mental retardation with non-disabled classmates who have similar interests.
Encourage regular students to assist the students with mental retardation as they participate in class
activities.
Regardless of a person's level of functioning, transition services will be an important part of his or her
special education program particularly at the high school level. These services provide the bridge to
life after school and help the individual in both community adjustment and employment. Typically
staffed by full-time, transition specialists, these programs not only provide vocational training, but
also focus on issues such as job responsibility, social interactions, and home and community living
skills.
Read and Respond
Test on Content Knowledge
Test how much you have learned about mental retardation by answering the following questions:
1. Explain the four elements in the 1992 AAMR definition of mental retardation.
2. What makes mental retardation a complex, rather than a simple, developmental disability?
3. List the labels used in the past to describe children with mental retardation. Why are these terms
not used anymore today?
4. What are the classifications of mental retardation? In what ways are they different from each
other?
5. Enumerate and describe the causes of mental retardation.

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6. What are the common characteristics of persons with mental retardation? Explain why they
manifest these characteristics.
7. What assessment procedures are used in the Philippines to identify children and youth with
mental retardation?
8. Enumerate the types of educational placement for students with mental retardation. Describe
each type.
9. Do you favor inclusive education for students with disabilities? Explain your stand on the issue.
10. What strategies are used in teaching students with mental retardation?
Reflection and Application of Learning
1. Before you studied this chapter, what were your ideas about persons with mental retardation?
How did such preconceived ideas come about?
2. What skills can the 14-1/2-year-old boy Raymond who has profound mental retardation do:
a. independently, or alone, by himself?
b. with minimal verbal and physical prompts?
c. with maximum verbal prompts and physical assistance?
3. How old were you when you learned to do those skills for the first time?
4. What skills can Raymond not do yet for a teenager his age?
5. How do you feel about being a person with a developmental disability like Raymond?
6. How can you take care of yourself so that you will continue to develop normally and be a
successful adult?

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Chapter 6 STUDENTS WITH LEARNING DISABILITIES

Julieta A. Gregorio
To the Course Professors and Students:
There are a number of students in regular classes whose mental ability is within the average range or
may even be above average but who do not learn the skills in the basic education curriculum that are
suitable to their chronological ages and grade levels. These students have learning disabilities. In the
United States, almost half or fifty percent of students in basic education are found to manifest the
characteristics of children with learning disabilities. These students receive special education services.
Documents from the Department of Education indicate the poor performance of elementary and high
school students in the national achievement tests. According to the reports, Filipino students learn
only half or even less of the skills and competencies in the basic education curriculum that their
teachers teach them. While there are many causative factors in the field of learning disabilities, the
poor performance of students in national achievement tests is a significant indicator that learning
difficulties do exist in the classrooms.
Another condition that is related to learning disabilities is Attention Deficit/Hyperactivity Disorder
(ADHD). The major areas in ADHD are inattention, hyperactivity and impulsivity.
At the end of the chapter, the students should be able to:
1. recall the concepts on the learning process and the different stages that a student undergoes
when efficient teaching and effective learning take place;
2. explain the concepts on mental ability and the measurement of intellectual functioning;
3. define the term learning disabilities; explain the criteria in determining the presence of learning
disabilities;
4. define Attention Deficit/Hyperactivity Disorder; explain the syndromes in the areas of inattention,
hyperactivity and impulsivity;
5. explain the causes or etiology of learning disabilities;
6. discuss the assessment procedures in identifying students with learning disabilities;
7. enumerate and describe the special education programs for students with learning disabilities;
and
8. manifest patience and understanding in teaching children with learning disabilities.

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Vignette About a Teener with Learning Disabilities

Peter is a typical, healthy, good-looking, middle class, 14 -year-old boy who studies in a private school.
Unlike his classmates in kindergarten eight years ago, Peter is still in third grade. According to the
results of the mental ability tests, his IQ score is within the average range. But he failed the school
subjects consistently. He did most poorly in Language, Reading and Mathematics. The teachers
complained about his inability to pay attention and to concentrate on the lessons. He also tended to
disrupt the class with his impulsive and hyperactive behavior which got him into fights with his
classmates and problems with the teacher and school administrators. Peter had spent the last five
years in five different schools.
A thorough psychodiagnostic examination showed that Peter has learning disabilities. He was
suffering from a condition called attention deficit/hyper-activity disorder or ADHD.
There are many other boys and girls in regular schools who are not learning as much as they should,
not because of low mental ability, poor vision or hearing, physical disabilities and other impairments,
but because of learning disabilities and ADHD. In Philippine schools, many of these children are
among the repeaters of the different grades, flunkers in local and national achievement tests and
dropouts from elementary and secondary schools. But what is difficult to understand about children
with learning disabilities is that their mental ability is within the average, even the above-average
range.
Basic Concepts on Learning, Mental Ability and Learning Disabilities
The Process of Learning
There are two main concepts in the term learning disabilities. The first concept describes the learning
process and the second explains the phenomenon about children who have average or even above
average ability to learn but who experience difficulties in learning.
What is learning?
Learning is the process by which experience and practice result in a stable change in the learner's
behavior. 'The permanent change in behavior is not the result of maturation or growing up through
the years, or because of increase in chronological age. Rather, learning results from efficient teaching
that develops the learner's genetic capacity to learn to the maximum in an environment that is
conducive to an effective teaching-learning process. Thus, the learner manifests an understanding of
content knowledge and demonstrates the ability to perform skills. Learning can be inferred to have
taken place when the student's performance and behavior indicate the achievement of the long term
goals set for the

99
school year and the quarterly short term objectives. The student's cognitive, affective, and
psychomotor skills and competencies are enhanced as indicated by knowledge gained and
performance of the activities in the instructional plans that are taught each day.
What are the stages of learning?
Learning is not a simple process of moving from a state of "not knowing" to a state of "knowing"
content or skills. The following figure illustrates that the stages of the learning process proceed from
the state of "not knowing" to the state of "knowing, using and inventing."

Figure 27. The Stages of Learning (L. Idol, 1989, Cited in Polloway, 1997)

100
Effective learning takes place when a teaching episode is planned very well. The objectives are
matched with appropriate activities and experiences together with suitable instructional materials.
The teaching strategies provide explicit attention and conscious effort to insure that the learner
moves satisfactorily through each of the three stages and five substages of learning, namely, (1)
"knowing" stage: (a) acquisition and reversion, (b) proficiency and automaticity; (2) "using" stage: (c)
maintenance; (d) generalization; and (3) "inventing" stage: (e) adaptation. Weak learning results when
the teaching procedures ignore the sequence of the learning process. The outcome is poorly learned
content and skills or no learning at all.
1. The "Knowing" Stage of Learning
Acquisition and Reversion
The initial objective of teaching is for the student to acquire knowledge and skills accurately and
meaningfully. Acquisition of knowledge and skills takes place when the instructional goals and
objectives, skills and competencies, strategies and materials match the learning ability of the student.
The teacher's ability to motivate the learner, his or her delivery of accurate content through explicit
and effective teaching methods, questioning techniques and evaluation strategies all contribute to the
acquisition of knowledge and skills in the learning areas. When the conditions for effective teaching
and learning are present the student can learn content and acquire skills from zero to basic mastery of
content and skills with about 85% accuracy. The use of relevant instructional systems and practical
experiences further increases the chances of achieving the expected percentage of accuracy in
executing the tasks learned.
In reversion the content and skills learned earlier are further strengthened to increase accuracy and
mastery. Correct practice, drill, review and similar strategies are used with immediate feedback and
reinforcement. Through continuous efficient and effective instruction, relevant practice, coaching and
feedback, the student is gradually helped to perform the skills with at least 85% accuracy during the
"knowing" stage of learning.
• Proficiency and Automaticity
Proficiency and automaticity are determined by the strength of prior learning. When mastery of a skill
or concept is attained, the learner moves on to the substages of proficiency and automaticity. The
student moves beyond the conscious recall of content knowledge thus mastered or the performance
of the skills. The goal is to attain fluency so that the skills are automatically applied to appropriate
situations in everyday life. The learner executes the tasks immediately and successfully without the
need to recall the procedures.

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2. The "Using" Stage of Learning
Maintenance
When the student continues to use the skills thus acquired with proficiency and automaticity over
time without explicit instruction, coaching, prompt, help or reinforcement, then maintenance is
achieved. Class activities are organized to allow the students to continue to experience meaningful
practice of the skills in practical contexts. Application of the skills at home and in other environments
outside the school is set up. Appropriate feedback and reinforcement are given to strengthen the
maintenance of the skills. The learning of new skills is built on the skills that are maintained. If the
learned skills are not used they will weaken even if they were learned earlier with proficiency.
* Generalization
Once a skill is learned proficiently, it should be available for use in any appropriate situation. The goals
of generalization are: (a) for the learner to recognize a new or different stimulus as a prompt to apply
the learned skills and (b) to use the acquired skills in various situations, behaviors, settings and time.
The ability to apply generalization is a major indicator of learning.
3. The "Inventing" Stage of Learning
* Adaptation
In the last stage of learning, the student recognizes the need to apply learned skills in situations
outside the school. He or she introduces changes or modifications in the skills and applies them to
meet the new situation without help or prompts. Although the basic skills have been learned earlier,
the student is able to think how they can be used to achieve a current objective in a new situation
with or without assistance or coaching and prompts.
The following vignettes illustrate how the stages of learning take place in the case of students with
learning disabilities. • John is a third grader with a language disability who spends most of his
day in the regular classroom. He is an enthusiastic learner, willing to try almost anything. He is one of
those students who seem to either "get it" quickly or not understand the lesson at all. He is frequently
the first one to respond to questions and to note similarities in content discussions, but he is also the
first one to jump to erroneous conclusions. As soon as a skill is introduced, he is most eager, almost
impatient, to apply it. Since his tendency is to attempt to quickly practice the skill he often appears to
think that he has achieved mastery of a new skill after only one or two practice sessions. It soon
becomes obvious that his accuracy and understanding are not as strong as his enthusiasm, indicating
that the learning is still at the reversion substage. Without careful monitoring, he is apt to end up
practicing skills incorrectly. He responds well to corrective feed-

102
back, but he seems to be amazed when it is pointed out to him that his responses are wrong. The
teacher will keep John at the acquisition stage longer to achieve accuracy of learning. Practice will be
carefully monitored to attain proficiency and automaticity.
Marie is a fourth grader with mild mental retardation. Expectedly, she moves through the stages of
learning fairly slowly when compared to typical fourth graders. She frequently needs to have
materials taught in a variety of ways and to have concepts retaught several times. She benefits from
extensive feedback during the acquisition substage. Achieving proficiency is also difficult, as Marie
needs a lot of repetition and practice activities. She tends to rely exclusively on rehearsal as a memory
strategy. Conscious attention to maintenance activities is necessary. In Mathematics, Marie has
achieved fluency with her multiplication facts after long periods of monitored practice. Now her goal
is to use the multiplication table to solve problems and do calculations.

Figure 28. The Special Education teacher follows the stages of learning in teaching a child with mental
retardation.

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Measures of Mental Ability

Another significant concept to understand in teaching children with learning disabilities is the level of
the learner's intellectual functioning or mental ability. Here are some concepts on mental ability.
Concept 1. Standardized tests of mental ability measure intellectual functioning.
Standardized tests of mental ability have been proven to be the best single predictor of school
achievement. When administered by a qualified and competent school psychologist, guidance
counselor or psychometrician, mental ability test results provide useful information about a student's
intelligence quotient (IQ) and his or her potential to gain mastery of the skills and basic learning
competencies in the curriculum.
A standardized mental ability test or IQ test consists of questions and problem solving tasks assumed
to require certain amounts of intelligence to answer

104
or solve correctly. An IQ test samples only a small portion of an individual's full range of skills and
abilities. The child's performance in intelligence tests is used to derive a score that represents his or
her overall intelligence.
Intelligence tests can be culturally biased. They tend to favor children from the population on which
the norms were derived. American intelligence tests were validated primarily among white middle
class children. Thus, some questions may tap learning that only middle class American children are
likely to have experienced. Likewise, tests written in English may be inappropriate for Filipino children.
Concept 2. IQ scores seem to be distributed throughout the population according to the normal
curve.
As shown in the figure below, to describe how one particular score varies from the mean or average
score, the population is divided into units called standard deviations (SD). A standard deviation is a
mathematical concept that refers to the amount by which a particular score on a given test varies
from the mean or average score of all the scores in the norm sample.
Each standard deviation includes a fixed portion of the population. Theoretically, 34.13% of the
population falls one standard deviation above the mean and another 34.13% is one standard
deviation below the mean. A person's IQ test score can be described in terms of how many standard
deviations it is above or below the mean. IQ scores can change significantly. Studies show that IQ
scores can change particularly in the 70 to 80 points range.

Figure 29. The Normal Curve

105
Concept 3. Intelligence testing is not an exact science.
Even though the major intelligence tests are among the most carefully developed and standardized of
all psychological tests, they are still far from perfect. There are many factors or variables that can
affect an individual's IQ score, such as, motivation, the time and location of administration and the
inconsistency or bias of the test administrator in scoring responses that are not precisely covered by
the test manual. Even the selection of the test to use can affect the individual's IQ score.
Concept 4. There are children whose IQ scores fall within the average as well as the above average
areas of the normal curve who experience learning difficulties.
These children are not learning like their peers not because their mental ability is below average. In
fact, most children with learning difficulties have average to above average intellectual functioning.
They do not belong to the group of children with mental retardation but they cannot learn most of
the basic learning competencies for average children. These children have learning disabilities.
Definition of Learning Disabilities
The category of learning disabilities in special education, its concepts and definition has been the
subject of much discussion, debate and research in the , United States during the past fifty years. The
term learning disabilities was introduced in 1963 by Dr. Samuel Kirk, a well-known American special
education expert. More than any other area of special education, the area on learning disabilities has
sparked misunderstanding and confusion, disagreement and controversy among professionals,
parents and the general public.
At present, the number of American children identified to be learning disabled has increased greatly.
These children now compose the largest number of children who receive special education services.
However, there are professionals who believe that the number of children includes the low achievers
who are doing poorly in school but do not have learning disabilities. The dramatic increase in the
number of children with learning disabilities in American schools may indicate the true extent of the
condition.
In the Philippines, special education for children with learning disabilities is only in its early years of
implementation. Unlike the special education programs for children with mental retardation,
giftedness and talent, visual and hearing impairments and behavior problems that date back to the
1950s, there are very few schools all over the country that have started to offer programs for children
with learning disabilities.
Children with learning disabilities have relatively average or even above average intelligence who
experience severe learning or academic problems in

106
school. As mentioned earlier, they are not children with mental retardation whose mental ability fall
within below average in the normal distribution curve. Three behavior problems are present:
inattention, hyperactivity, and impulsivity. In the toddler or early childhood stage, their parents may
think that they are simply naturally over energetic. Later, they notice that despite the increase in
chronological age, and, unlike their peers, these children fail to outgrow their inattention, hyper-
activity and impulsivity and generally poor school performance.
The American National Joint Committee on Learning Disabilities (NJCLD) which is composed of several
professional organizations issued the following definition in 1989:
"Learning disabilities is a generic term that refers to a heterogeneous group of disorders manifested
by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning
or mathematical abilities. These disorders are intrinsic to the individual and presumed to be due to
central nervous system dysfunction. Learning disabilities may appear across the life span. Problems in
self-regulatory behavior, social perception and social interaction may exist in learning disabilities but
do not themselves constitute a learning disability.
Although learning disabilities may occur concomitantly with other handicapping conditions, for
example, blindness, deafness, serious emotional disturbance, or with extrinsic influences such as
cultural differences, insufficient or inappropriate instruction, learning disabilities is not the result of
these conditions."
The group of disorders is heterogeneous, that is, there is not only one but several disorders that occur
at the same time. No two learning disabled persons are alike in mental and behavioral characteristics.
The significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning
or mathematical abilities show in the child's performance in the school subjects. These children
cannot learn the regular school subjects like his or her normal classmates although their mental
ability is average or above average. Reading is a subject where they meet many difficulties.
The phenomenon is explained by the factor called IQ achievement discrepancy. The child does not
learn knowledge and skills in accordance with his or her potential to learn as measured by a
standardized mental ability test. While his or her mental ability is appropriate to his or her
chronological age, the child's performance in school shows that achievement is two or more years
below the grade level. Thus, a ten-year-old with an IQ that is normal for a ten-year-old fails to pass the
grade level although he or she has the ability to do so.
Learning disabilities is intrinsic to the individual. This means that the causes of learning disabilities are
organic, biological, genetic or environmental. The organic and biological factors are traced to the
central nervous system particularly the brain. In most cases, the cause of learning disabilities remains
a mystery.

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Three Criteria in Determining the Presence of Learning Disabilities

The following criteria must be present when assessing children to have learning disabilities:
1. Severe discrepancy between the child's potential and actual achievement
Learning disabilities is present when mental ability tests and standardized achievement test results
show discrepancy between general mental ability and achievement in school. There are pieces of
evidence of a discrepancy score of two or greater than two in intellectual ability and achievement in
one or more of the following areas: oral expression, listening comprehension, reading compre-
hension, written expression, basic reading skills, mathematics calculation, reasoning.
Children may show learning difficulties that are minor or temporary, in which case a true learning
disability is not present. This means that when learning disabilities are present, they are neither minor
nor temporary. The degree of discrepancy is such that special education is needed. They manifest
specific and severe learning problems despite regular education efforts.
2. Exclusion or absence of mental retardation, sensory impairment and other disabilities
The exclusion criterion means that the child has significant problems that cannot be explained by
mental retardation, sensory impairment like low vision, blindness, hearing impairment, emotional
disturbance or lack of opportunity to learn. As explained earlier, mental ability is within the average
range or may even be above average. There are no sensory impairments like low vision, blindness,
deafness or behavior problems. While all the conditions for learning to take place are present, the
student experiences learning disabilities.
3. Need for special education services
Teaching the child with learning disabilities involves strategies that are unique, uncommon and of
unusual quality. The strategies supplement the organizational and instructional procedures used with
majority of the children in regular schools. This criterion is meant to keep children who have not had
the opportunity to learn from being classified as learning disabled.
Children with learning disabilities should progress normally as soon as they receive effective
instruction at a curricular level that is appropriate to their current skills. They need special education
services to remediate their achievement deficiencies.

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Learning and Behavior Characteristics of Children with Learning Disabilities

Results of studies (1999) show that there are at least ninety-nine separate characteristics of children
with learning disabilities. More than half a million combinations of cognitive or socio-emotional
problems associated with the condition are possible. The large number of learning characteristics
makes it difficult to interpret research findings that can provide the basis for recommending effective
teaching strategies. Learning disabilities may occur within the life span. The symptoms and
characteristics can be manifested immediately after birth, during infancy, through the school years,
and adulthood.
Likewise, there is a great deal of inter-individual differences and variations in their characteristics. No
two individuals with learning disabilities are found to be alike. There is also a great deal of intra-
individual variations within the profiles of groups of these children. Uneven profiles are found, that is,
a child who is two or three years above the grade level in reading may be two or three years behind in
mathematics.
1. Reading poses the most difficulty among all the subjects in the curriculum. It may be recalled
that the facets of communication are listening, speaking, reading and writing. Thus, reading problems
are ushered in by deficiencies in language skills especially the phonological skills. These skills develop
the ability to understand the rules of how various sounds go with certain letters to make up words
called grapheme-phoneme correspondence. The difficulty in breaking words into their component
sounds results to difficulties in reading and spelling.
Dyslexia refers to a disturbance in the ability to learn in general and the ability to learn to read in
particular.
2. Written language poses severe problems in one or more of the following areas: handwriting,
spelling, composition and writing which is illegible and slow. Studies (Englert et al., 1987) show that
these children are not aware of the basic purpose of writing as an act of communication. They
approach writing as a test taking task. Their writing lacks fluency. They write shorter sentences and
stories. They do not use writing strategies spontaneously. Their written work show lack of planning,
organizing, drafting and editing.
3. Spoken language poses problems on the mechanical uses of language in syntax or grammar,
semantics or word meanings and phonology or the breakdown of words into their component sounds
and blending individual sounds to compose words.
Developmental aphasia is a condition characterized by loss of speech functions, often, but not always
due to brain injury.
4. Pragmatics or social uses of language poses problems on the ability to carry on a conversation.
Children with learning disabilities are found to be unable to engage in the mutual give-and-take in
carrying on a conversation. While they are often agreeable and cooperative, many times they find it
difficult to

109
understand ideas. Conversations are marked by long silences and inability to respond to the other
person's statements or questions. They tend to answer their own questions before the other person
has the chance to respond. They also tend to make irrelevant comments that make the other person
uncomfortable.
5. Mathematics problems are recognized as second to deficiencies in reading, language and
spelling.
6. These children tend to fail and be retained in a grade level. The level of academic achievement
tends to decrease progressively as the grade level increases. They find their studies to be more
difficult as they go up the grades.
7. Behavior problems remain consistent across grade levels both in school, in the community and
at home. The common behavior problems are inattention, impulsivity and hyperactivity.
8. In general, social acceptance is low, but some can be popular.
Perceptual, Perceptual-Motor, and General Coordination Problems
1. Children with learning disabilities exhibit visual and/or auditory perceptual disabilities. The
problem is not lack of acuity or sharpness in vision or audition in responding to visual and auditory
perceptual stimulation. The disturbance is in organizing and interpreting visual and auditory stimuli.
Thus, they have problems in seeing and remembering visual shapes that lead to reversals of b and d,
for example. They have difficulties in discriminating two words that sound alike, such as meat and
neat, or in following oral instructions.
2. They have difficulty with physical activities that involve gross and fine motor skills. Thus, they
tend to drop things, as though they are "all thumbs" or have two left feet.
3. They have problems with attention and hyperactivity.
Memory, Cognitive, and Metacognitive Problems
Problems in memory, cognitive and metacognitive areas are related. If there is a problem in memory
then there are also problems in understanding or cognition. The problems show in difficulties in
remembering assignments and appointments. Though smart, the students forget the lessons easily
and show deficits in memory because they do not use memory strategies like rehearsal, categorizing
and use of mnemonics. There are problems in cognition that cover different aspects of thinking and
problem solving. Disorganized thinking occurs as a result of problems in planning and organizing their
lives at home and in school. Difficulties in metacognition result from lack of awareness of skills,
strategies and resources to perform tasks effectively.
A child with mild learning disabilities manifests deficits in cognitive functioning that show in poor
academic performance in the different areas of learning. Reading, language and mathematics are the
subject areas where they find the most difficulties.

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The areas in cognitive functioning that are most affected are attention, memory and thinking or the
executive functions of the mind.
Attention deficits. Selective attention, or the ability to focus on the relevant details of the lesson is the
first requirement for learning to take place. Children who cannot pay attention cannot focus on the
teaching episode for a particular subject. The deficit in attention results to inefficient learning or no
learning at all. Students with learning disabilities do not learn despite average cognitive ability
because of attention deficits. They cannot scan all the sensory stimuli, such as the instructional aids
used by the teacher, and instead are distracted by extraneous or unrelated things. They appear to lack
the ability to sort information as shown by the wrong responses that they often give when asked
questions about the lesson. Selective attention can be increased through coaching and efficient
selective attention strategies.
Poor memory. Poor ability to store and retrieve information or previous learning is very evident
among children with learning disabilities. They find difficulty in remembering mathematics facts,
spelling words, vocabulary meaning, content knowledge and information. Studies show that these
children lack the ability to organize information for recall. Common strategies for storing and recalling
information such as verbal or written rehearsal, coding or associating a new item with a concept
already in memory, imagery and mnemonics are either absent, immature or inefficiently used.
To help a student with attention deficits, the teacher frequently calls him or her back to attention.
Likewise, they provide the student with study guides and summaries of the lessons. The teachers have
yet to train the student to organize his time, his lessons and himself. He has to increase his ability to
process information, develop selective and sustained attention, use rehearsal memory strategies and
self-monitoring strategies to keep track and continue to improve his own learning.
Problems in Social Competence
Problems in relating with other people is not a characteristic of persons with learning disabilities.
Rather, it is an outcome of the different social climates created by people in school, at home, the
community and other places with whom persons with learning disabilities interact. Scores on tests in
social skills can change over time, as they gain competence in social situations. Social competence
may be related to social status. Thus, a learning disabled person may be popular, neglected or
rejected. They can have low social acceptance but can enjoy popularity, or they may have significant
deficits in social skills but enjoy acceptance by their classmates and friends. One thing sure, these
children can enjoy socially rewarding experiences in mainstream classrooms.

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Causes of Learning Disabilities

The causes of learning disabilities are attributed to genetic and environmental factors. As discussed in
Chapter 4, the genetic factors refer to the characteristics that are inherited through the genes,
chromosomes and deoxyribonucleic acid or DNA. Over the years, genetic researches show that
learning disabilities tend to run in families and heredity is a possible cause. Studies of identical or
monozygotic twins, where one fertilized egg cell splits and develops into two separate embryos, show
that when one twin has a reading disability, the other twin is more likely also to have a reading
disability. Identical twins possess the same physical and mental traits. However, research shows that
this is not true in the case of fraternal or dizygotic twins where two egg cells are fertilized and develop
into two distinct embryos. Fraternal twins carry different physical and mental traits.
The Body's Control System: Brain and Nerves
(Reader's Digest Book, Special Edition, 2004)
The Brain
The brain and nervous system control our perceptions, thoughts and voluntary actions, and also most
of the body's internal processes. The brain is contained within the hard bones of the skull and
cushioned against injury by surrounding membranes, while the spinal cord - the central pathway of
the nervous system - runs through a channel within the tough vertebrae of the spine. The brain makes
up just two per cent of the average adult's weight but uses 20 per cent of oxygen intake.
There are three major areas in the brain: the cerebrum, the cerebellum and the brain stem. The
cerebrum is the largest part of the brain, and is associated with conscious activities and intelligence. It
is divided into two hemispheres, and consist of grey matter or neuron cells and white matter or nerve
fibers. The left hemisphere controls the right side of the body and vice versa. Some 90% of the human
population is right-handed, which means that the left hemispheres of their brains are dominant. The
corpus callosum joins the two hemispheres of the cerebrum together.
The cerebral cortex is the outer surface of the cerebrum. It processes information from and for
different parts of the body. The somatosensory strip processes sensations, while the motor strip
controls the muscles.
The cerebellum coordinates movement and balance.
The thalamus acts as a sort of junction box, sending incoming nerve impulses to different areas of the
brain.
The medulla oblongata controls heart rate and breathing.
The brain stem connects the brain to the spinal cord.

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Forebrain structures
Cerebral cortex
Extensive, wrinkled
outer
layer of the
forebrain
governs higher
brain
functions, such
as thinking,
learning, and
consciousness
Thala Relays
mus information
between
lower and
higher brain
centers
Hypot Governs
halam eating, drinking,
us
and sex; plays a
 role in
emotion and
stress
Pituita Governs
ry endocrine
system
Midbrain structures
Reticular formation
Diffuse collection of
neurons
involved in
stereotyped
behavior such
as walking and
sleeping
Hindbrain structures
Pons Governs sleep
and arousal
Medul Governs
la breathing and
reflexes
Cereb Rounded
ellum structure
involved in
motor behavior

Figure 30. Structure and Regions in the Human Brain

Figure 31. The Brain's Four Lobes
Shown here are the locations of the four lobes of the cerebral cortex
(occipital, temporal, frontal, and parietal) and the cerebellum.
The brain is wrapped in three separate membranes. The space between these membranes contains
fluid which allows the brain to float and thus insulates it from knocks to the head. The same
membranes extend over the spinal cord.
Twelve cranial nerves emerge from the brain itself. These subdivide to reach the eyes, nose, ears and
mouth, as well as all the muscles of the face. One of the nerves extends down, independently of the
spinal cord, to the heart, larynx, lungs and stomach, while another goes to muscles in the neck, where
it helps to control the vocal apparatus.

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The brain has about one thousand billion nerve cells.
The average adult male brain weighs 1.4 kilograms or 3 pounds; the adult female brain weighs 1.25
kilograms or 2.75 pounds. The mass of brain tissue reaches a maximum at the age of 20 years and
thereafter decreases.
The Nervous System
A network of nerves extends throughout our bodies, carrying sensory information to the brain and
instructions from it. The brain and the spinal cord together form the central nervous system (CNS).
The rest of the network is known as the peripheral nervous system (PNS).
The Genetic Factors in Learning Disabilities
Learning disabilities constitutes a heterogeneous set of conditions with no single syndrome nor a
single cause or etiology. Thus far, research findings cite two genetic causes of learning disabilities.
These are brain damage and biochemical imbalance.
1. Brain Damage
An increasing consensus attributes learning disabilities to neurological dysfunction or central nervous
system pathology. The models on the causes of learning disabilities state that the condition can be:
a. hereditary, indicating the presence in the genetic make up of certain inherited diseases or
disorders that damage the brain.
b. innate, resulting from biological influences during the period of conception or pregnancy.
c. congenital or constitutional, indicating that biological influences may have originated during the
process of gestation or development in the prenatal (before birth), perinatal (during birth), or
postnatal (after birth) periods of development.
Some individuals with learning disabilities show definite signs of brain damage, which may well be the
cause of their learning problems. It is estimated that as many as 20% of American children with
learning disabilities have sustained prior brain injury, either before, during or after birth.
Some professionals believe that all children with learning disabilities suffer from certain types of brain
injury or dysfunction of the central nervous system. The brain damage may not be extensive enough
to cause a generalized and severe learning problems in all areas of intellectual development. In this
case, the child is described as minimally brain damaged.
In recent years, neurologists and other professionals use advance technology to assess brain activities
more accurately. Some of the new procedures are:

114
a. electroencephalogram or EEC This is a graphic measure and recording of the brain's electrical
impulses. The EEG is a digitally computerized recording and analysis of the brain waves. Many
students with learning disabilities have abnormal brain waves as shown by the encephalograph that
records the brain's electrical impulses.
b. computerized tomographic scans or CT. This is a neuroimaging technique whereby X-rays of the
brain are compiled by a computer to produce an overall picture of the brain. The CT scans enable the
neurologist to look at the underlying physiology or physical condition of the brain.
c. magnetic resonance imaging or MRI. This is a neuroimaging technique whereby radio waves are
used to produce cross-sectional images of the brain. CT scans and MRI results show that the brains of
those with learning disabilities suffered from a disruption in the development of the neural cells
during the early months of pregnancy. This means that
. the neurons in the brain area did not develop normally.
2. Biochemical Imbalance
Some researchers claim that biochemical disturbances in a child's body cause learning disabilities. A
study in 1975 (Feingold) suggested that artificial food colors, flavors, preservatives, salicylates and
megavitamins in many of the foods that children eat can cause learning disabilities and hyperactivity.
But a comprehensive review of diet related studies concluded that very little pieces of evidence
supported the statement. So, although it is possible, or even probable that biochemistry may affect a
child's behavior and learning in the classroom, no scientific evidence exists today to reveal the nature
or extent of that influence.
3. Environmental Factors
The environmental factors are difficult to study. There are pieces of evidence that show poverty,
malnutrition and inadequate learning experiences that include poor teaching and lack of instructional
materials as causes of environmental disadvantage that make children prone to learning problems.
Three types of environmental influences believed to be related to children's learning problems are:
(Lovitt, 1978)
1. emotional disturbance. Many children with learning problems have behavioral disorders as well.
Whether one causes the other or whether both are caused by some other factors remains uncertain.
2. lack of motivation. It is difficult to identify reinforcing activities for some students with learning
disabilities. It is possible that they may not simply be interested in any of the things that other
children like.
3. poor instruction. Although children are able to learn in spite of poor teaching and inadequate
strategies, other children are less fortunate. Some of them who have experienced poor instruction in
the early grades are not able to catch up with their peers.

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Assessment of Learning Disabilities

Learning disabilities is a complex condition. Therefore, a battery of three to five tests are used to
identify students who may have learning disabilities. These are norm-referenced tests, process tests,
informal reading inventories, criterion-referenced tests, and direct daily measurement of learning
(Heward, 2003).
The National Achievement Test, the Regional Assessment Test and the School-based Achievement Test
are examples of norm-referenced tests. The assessment tests are all designed to measure how many
of the skills in each learning area - English, Filipino, Mathematics, Science and Makabayan - have been
learned or mastered. Students with learning disabilities manifest deficits in the expected number of
skills for mastery in a particular grade level.
One area of difficulty that students with learning disabilities experience is in processing information.
The specific perceptual problems are in visual perception, auditory perception and visual-motor
coordination. Two widely used American process tests are the Illinois Test of Psycholinguistic Abilities
(ITPA, Kirk, McCarthy and Kirk, 1968) and the Marianne Frostig Developmental Test of Visual
Perception (Frostig, Lefever, & Whittlesey, 1964).
Criterion referenced tests in specific subjects such as Reading, Language and Mathematics are used to
determine the mastery level of a predetermined criterion that the student should be capable of
achieving. The specific skills already learned are identified as well as those that have yet to be
mastered. A widely used American criterion-referenced test is the BRIGANCE Diagnostic Inventory of
Basic Skills (Brigance, 1983).
Most school divisions have developed their own reading tests and inventories to determine the
student's reading ability. An informal reading inventory usually consists of a series of progressively
more difficult sentences and paragraphs for oral reading. The student's mistakes in reading skills are
recorded particularly in pronunciation of vowels and consonants, omissions, reversals, substitutions
and comprehension.
A useful method of determining a student's performance in learning a particular skill is through direct
daily measurement of his or her progress in learning the skill. For example, in a Mathematics lesson,
the teacher observes and records the correct rate or number of facts stated or written correctly per
minute, the error rate or how many times the student gives wrong responses and the percentage of
correct answers. Direct daily measurement of the mastery of the skill being taught informs the
teacher about the deficit in learning and allows him or her to make the necessary adjustments in the
lesson.
Specialists recommend that children in regular classes who have learning disabilities be identified as
early as possible through appropriate assessment procedures. Then, an individualized educational
plan or IEP can be prepared based on the learning and behavior characteristics found in the
assessment results. A special education teacher should assist the regular teacher in teaching children
with learn-

116
ing disabilities. Studies show that many of their learning problems can be lessened through direct and
systematic instruction. Behavior modification techniques can decrease their undesirable behavior of
inattention, impulsivity and hyperactivity.
In the absence of qualified school psychologists or guidance counselors, the school principal can
initiate a screening program to locate these children in the regular classes. Inquiries on assessment
and early intervention can be addressed to the Department of Education Bureau of Elementary
Education, Special Education Division. Early location, assessment and identification of these children
has the potential to prevent or reduce the occurrence of future learning problems.
Teaching Students with Learning Disabilities
Special education experts highly recommend the use of the diagnostic-prescriptive-evaluation
approach in teaching children with learning disabilities as well as those with mental retardation. Here,
the results of assessment are used directly to draw up an individualized education plan. The long term
annual goals that the student can achieve are identified, then the short-term quarterly objectives are
prescribed. Monthly, weekly and daily instructional plans are written to achieve the preset goals and
objectives of teaching. Formative and summative evaluation procedures are employed to track the
mastery of the skills.
Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD)
Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD) are conditions in
which children exhibit significant differences in the ability to pay attention and to engage in active
work compared to their normal peers. These children show lack of control in saying things, cannot
wait for their turn and often engage in dangerous activities. ADD and ADHD are common
characteristics of children with learning disabilities.
There is attention deficit when the child is not able to attend to a task expected of his or her age and
grade level. Hyperactivity is present when the child engages in high rates of purposeless movement.
Impulsivity is displayed through inappropriate behavior.
The essential feature of ADD/ADHD is a persistent pattern of a combination of inattention,
hyperactivity and impulsivity that is more frequent and severe, maladaptive and inconsistent with the
developmental level of the child.
The Diagnostic and Statistical Manual on Mental Disorders IV of the American Psychiatric Association
DSM IV, APA gives the symptoms and states that either of 1 or 2 are present.
1. Six or more of the following eight symptoms of inattention have persisted for at least six months:

117
a. often fails to give close attention to details or makes careless mistakes in schoolwork, work or
other activities.
b. often has difficulty sustaining attention in tasks or play activities.
c. often does not follow through on instructions and fails to finish schoolwork, chores or duties in
the workplace.
d. often has difficulty organizing tasks and activities.
e. often avoids dislikes or is reluctant to engage in tasks that require sustained mental effort such as
schoolwork or homework.
f. often loses things necessary for tasks or activities such as toys, school assignments, pencils, books
or tools.
g. is often easily distracted by extraneous stimuli. h. is often forgetful in daily activities.
2. Six or more of the eight symptoms of hyperactivity-impulsivity hyperactivity:
a. often fidgets with hands or feet or squirms in seat.
b. often leaves seat in classroom or in other situations in which remaining seated is expected.
c. often runs about or climbs excessively in situations in which it is inappropriate. In adolescents
and adults this is an expression of subjective feelings of restlessness.
d. often has difficulty playing or engaging in leisure activities quietly.
e. is often on the go or often acts as if driven by a motor.
Impulsivity:
a. often blurts out answers before questions have been completed.
b. often has difficulty waiting turn.
c. often interrupts or intrudes on others, butts into conversations or games. Some symptoms are
present before age 7.
The ADD/ADHD Iceberg
ADD/ADHD is a complex condition. The condition may range from mild, moderate, severe to profound
and may exist together with other disabilities. While there are observable symptoms and
characteristics, many of the signs are not visible. Compared to an iceberg where only one-eighth can
be seen in the surface of the ocean, most of the symptoms and characteristics are not observable and
remain hidden in the person's behavior. Figure 32 illustrates the obvious as well as the not so obvious
behaviors of children with ADD/ADHD.
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THE ADD/ADHD ICEBERG
Only 1/8 of an iceberg is visible! Most of it is hidden beneath the surface!
THE TIP OF THE ICEBERG:
The Obvious ADD/ADHD Behaviors
IMPULSIVITY
Lacks self-control Difficulty awaiting turn
Blurts out Interrupts
Tells untruths Intrudes
Talks back Loses temper
HYPERACTIVITY
Restless Talks a lot
Fidgets Can't sit still
Runs or climbs a lot Always on the go
"HIDDEN BENEATH THE SURFACE
The Not So Obvious Behaviors
INATTENTION Disorganized Doesn't follow through
Doesn't pay attention Is forgetful
Doesn't seem to listen Distractible Makes careless mistakes Loses things
NEUROTRANSMITTER DEFICITS
IMPACT BEHAVIOR
Inefficient levels of neurotransmitters, norepinephrine,
dopamine, & serotonin, result in reduced brain activity
on thinking tasks.
WEAK EXECUTIVE FUNCTIONING
Working Memory and Recall
Activation, Alertness, and Effort
Internalizing language
Controlling emotions
Complex Problem Solving
SLEEP DISTURBANCE (50%)
Doesn't get restful sleep
Can't fall asleep
Can't wake up
Late for school
Sleeps in class
Sleep deprived Irritable
Morning battles with parents
IMPAIRED SENSE OF TIME
Doesn't judge passage of time accurately
Loses track of time
Often late
Doesn't have skills to plan ahead
Forgets long-term projects or is late
Difficulty estimating time required for tasks
Difficulty planning for future
Impatient
Hates waiting
Time creeps
Homework takes forever
Avoids doing homework
TWO TO FOUR-YEAR
DEVELOPMENTAL DELAY
Less mature
Less responsible
14-yr.-old acts like 10
NOT LEARNING EASILY FROM REWARDS
AND PUNISHMENT
Repeats misbehavior
May be difficult to discipline
Less likely to follow rules
Difficulty managing his own behavior
Doesn't study past behavior
Doesn't learn from past behavior
Acts without sense of hindsight
Must have immediate rewards
Long-term rewards don't work
Doesn't examine his own behavior
Difficulty changing his behavior
COEXISTING CONDITIONS
2/3 have at least one other condition
Anxiety (37%)
Depression (28%)
Bipolar (12%)
Substance Abuse (5%)
Tourette Disorder (11%)
Obsessive Compulsive Disorder -
Oppositional Defiant Disorder (59%)
Conduct Disorder (43%)
SERIOUS LEARNING PROBLEMS (90%)
Specific Learning Disability (25-30%)
Poor working memory
Can't memorize easily
Forgets teacher and parent requests
Slow math calculation
Slow retrieval of Information
Poor written expression
Difficulty writing essays
Poor listening and reading comprehension
Difficulty describing the world in words
Difficulty rapidly putting words together
Disorganization
Slow cognitive processing
Poor fine motor coordination
Poor handwriting
Inattention
Impulsive learning style
LOW FRUSTRATION TOLERANCE
Difficulty Controlling Emotions
Short fuse
Emotionally reactive
Loses temper easily
May give up more easily
Doesn't stick with things
Speaks or acts before thinking
Concerned with own feelings
Difficulty seeing other's perspective
Way be self-centered
May be selfish
ADD/ADHD is often more complex than most people realize!
Like icebergs, many problems related to ADD/ADHD are not visible. ADD/ADHD may be mild,
moderate, or severe, is likely to coexist with other conditions, and may be a disability for some
students.
Figure 32. The ADD/ADHD Iceberg

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Read and Respond
Test on Content Knowledge
How much did you learn about learning disabilities? Find out by answering the following questions.
1. What are the major concepts in the NJCLD definition of learning disabilities? Explain each of
them.
2. In what way or ways is learning disabilities different from mental retardation?
3. Enumerate the learning and behavior characteristics of students with learning disabilities.
4. What are the causes of learning disabilities? Explain each of them.
5. What are the assessment procedures for learning disabilities? Explain each of them.
6. What are the special education programs for children with learning disabilities? How do the
methods of teaching differ from those used in teaching average students?
Reflection and Application of Learning
1. Can you recall one or two of your classmates in elementary or high school who had learning
difficulties? What were their learning characteristics? Their behavior characteristics? How did the
teachers react to the students' poor performance in class? Were they given special instruction? Were
they punished sometimes?
2. After gaining knowledge about learning disabilities, what do you think should have been done by
the school and the teachers to help your classmates with learning disabilities?

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Chapter 7 STUDENTS WHO ARE GIFTED AND TALENTED

Julieta A. Gregorio
To the Course Professors and Students:
As discussed in Chapter 6, intelligence quotient scores seem to be distributed throughout the
population according to the normal curve or bell curve. Approximately 34.13% of a given population
fall one standard deviation above the mean and another 34.13% fall one standard deviation below the
mean. The 68.26% of the given population are expected to have average mental ability. Meanwhile,
there are students who fall two or more standard deviations above the mean who compose 16% of a
given population. These students are described as above average, bright, superior and high achievers.
They belong to the group who are endowed with intellectual giftedness. It is not unusual for them to
graduate with honors, at the top of their classes, and receive awards for excellent academic per-
formance. Meanwhile, there are students who may not be as intellectually endowed but who,
nevertheless, manifest their talent in many ways.
This chapter covers the central concepts on giftedness and talent, the theories and definitions of
human intelligence with an expanded presentation on the multiple intelligences theory by Howard
Gardner. The groundwork for a lifetime of intelligence traces the essential concepts on the
development of the brain, the "seat" of man's intellectual capacity. The emerging paradigms and
various definitions of giftedness and talent, the characteristics of gifted and talented persons,
assessment procedures and instructional systems are presented as well.
At the end of the chapter, the students should be able to:
1. discuss the nature of the human intellect as expounded by philosophers, psychologists and
educators through the centuries;
2. enumerate and describe the theories and definitions of intelligence;
3. enumerate and discuss the multiple intelligences of a person;
4. discuss the concepts on brain development before and after birth;
5. enumerate the ways and means by which intellectual development may be enhanced;
6. compare and contrast the various definitions of giftedness and talent;
7. enumerate and discuss the characteristics of gifted and talented children;
8. describe the assessment procedures, curricular program and instructional systems for gifted and
talented students; and
9. derive inspiration from the achievements of the great people of the 20th century.

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Thirty Years of Enhancing Giftedness and Talent Among Filipino Children and Youth
Dr. Aurora H. Roldan, president of the Talented and Girted Philippines Foundation Inc. (TGP) and a
pillar in the education of gifted Filipino children and youth recalled the first step of faith in the Filipino
gifted that she took in December 1973 (Sunday Inquirer Magazine, February 20,1994). She hosted the
Children's Festival of Words, a creative writing workshop for verbally gifted youngsters. She wrote that
such a move seemed ordinary then when the word "gifted" was bandied about very casually. Many
schools, parents, government agencies and even private firms were jumping on the gifted
bandwagon.
Dr. Roldan did not use the term gifted in the early years of the Children's Festival of Words. She simply
invited private and public schools to nominate students as CFW participants on the basis of academic
excellence and writing ability. Through the years, CFW discovered a treasure trove of delightful
talents. For one, Lea Salonga joined the festival as a preschooler in 1977. Talented young writers with
exceptional young minds from a wide range of schools and social strata participated in the workshops.
Dr. Roldan recalled the turning point for gifted education in the Philippines when she organized and
hosted the Fifth World Conference on Gifted and Talented Children in Manila in August, 1983. Gifted
education specialists from all over the world exchanged views on the theories and practices on gifted
education. The event provided the impetus for the establishment of the Talented and Gifted
Philippines Foundation, Inc. (TAG-Philippines). From then on, TAG has actively sought to fulfill its
objectives of conducting research on the unique characteristics, needs and concerns of the Filipino
gifted child and his or her family, to help design and implement educational provisions, both in and
out of school, to best nurture such giftedness, and to develop and publish instructional and reference
materials for educators, parents and the gifted youth themselves.
Vignettes on Children and Youth Who Are Gifted and Talented
The following articles highlight the achievements of young Filipinos who show advanced cognitive
development, superior intellectual ability and talent in the arts. These children and youth are gifted
and talented. Find out what their characteristics are that make them different from children and
youth of the same chronological ages.
Meet the gifted
By Nathalie Tomada, The Philippine Star, May 19, 2003
Conversations have never been this interesting. Emil Justin Cebrian talks about his admiration for the
wisdom of Confucius, his thoughts on the spread of the SARS epidemic, and his disapproval on the use
of contraceptives - just like any learned, opinionated adult. Except that he is only 12 years old.

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Jon Bryan Santiago Tiosin, whose first words when he was about four months old is
supercalifragilis . . .(go figure!) has been ploughing through books at an age when others were just
getting past thumb-sucking. From middle earth and Tolkien, he claims to be now smitten with
Michaelangelo and the History of Art. Bryan is only seven years old.
Meet the gifted children. "Alam ko naman, higher level ang pag-iisip ko kaysa iba," Justin says,
insisting that "most of the time, I don't think about it. I'm really just an ordinary kid." Hardly.
According to parents, Fred and Ceres, Emil Justin, named after the great French sociologist Emil
Durkheim, was already talking before he turned one. He mastered the National Anthem, flags, capitals
and Philippine presidents before he turned two. After several accelerations, the award-winning
storyteller of Museo Pambata is now an incoming senior at Arellano High School and, as usual,
gunning for the highest honors. When that happens, he will perhaps be the youngest valedictorian in
the country.
Whiz kid
By Edmund M. Silvestre, The Philippine Star, July 23, 2003
Omar Parrenas Rizwan of East Hanover, New Jersey is a Microsoft Certified Professional (MCP),
recognized and promoted by Microsoft as an expert with the technical skills needed to design,
implement and support solutions with Microsoft products.
His MCP lapel pin, certificate of excellence and official ID card identifies his status to colleagues and
clients, certifying that he has the skill to work in network support for many companies.
The thing is, Omar just turned nine last April.
Omar is a computer whiz kind, the youngest Microsoft Certified Professional in the world. Presently,
he is taking a series of exams to become a Microsoft Certified Systems Engineer by the time he turns
ten in April 2004.
"I don't know where that amazing talent came from because there was never a genius in my family,"
says Rizwan's mother, Lea Parrenas-Rizwan, a registered nurse and native of Pototan, Iloilo. My
husband is a physician and he's smart and intelligent, but not that extraordinary like Omar."
Her Pakistani-American husband, Dr. Mohammad Rizwan, an internal medicine specialist at New
Jersey's Columbus Hospital, is also in awe of his eldest son's advanced computer skills.
"Maybe it's pure God-given talent," Dr. Rizwan says. "And he deserves it because he's a very good boy
and he works hard for it."
Omar, his parents recall, began reading his ABCs at 18 months. At age two and a half, he could identify
all car models. At three, he could read traffic signs and tell directions.

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His interest in computers began at age five when his father bought a computer book. Omar who was
already reading children's books since he was three, saw the computer book and the rest, as they say,
is history.
"His learning of the computer was gradual, but his being a fast reader helped a lot," says Mrs. Rizwan.
While other kids his age are throwing tantrums at Toys 'R Us outlets, Omar would rather be at Barnes
and Noble, quietly browsing through computer books.
"It's very seldom that he would ask for a toy. He'd rather read his computer books at home," says Dr.
Rizwan. But he does have the complete Harry Potter series.
A week before turning nine, Omar took the MCP exam at Infotech Research International, an East
Hanover testing facility. Omar passed the test in half the time - 45 minutes - leaving his fellow
examinees, all adults flabbergasted.
"Those are not ordinary exams. Omar must be a very brilliant young man. The exam is not the kind of
thing that you can just study for and regurgitate," says Dr. Merten, vice president of education for the
Chubb Institute, a reputable technical school. The multiple-choice tests ask very specific questions
about Windows XP, such as the best way to configure a computer to run a particular application.
Examinees must know all sorts of computer applications known only in the world of computer geeks.
Many testing centers offer preparation classes, but Omar did his own preparation in the confines of
his family's upscale home.
Omar is now preparing to become a Microsoft Certified Systems Engineer. The certification which
encompasses all kinds of subjects from computer hardware to database design and management and
network infrastructure design requires nine exams. Omar who eventually wanted to be a programmer
passed the second exams in ten minutes. He hopes to pass all nine tests before he turns ten.
His aunt says that despite his enormous talent, he's a very normal kid. He usually sits on her lap and
talks about computers. He also loves to tease his sisters. But he never brags about his talent. He is not
affected by all the attention he's getting. When asked about his favorite TV show, he said he does not
like TV and does not watch it.
Omar, who is a recipient of the 2000 Young Writers and Illustrators Award and a straight A student
also plays chess, piano and soccer. He had become too advanced for his class where he will be in
fourth grade this fall. As of now, even Bill Gates' men are unsure of what to make of Omar, who is still
years away from the legal working age.

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Figure 33. Gifted and Talented Filipino Youth

Aliw awards affirms Karel's exceptional gift
By Nestor U. Torre, Philippine Daily Inquirer, August 28, 2004
When the Aliw Foundation recently gave its Best New Female Artist award to Karel for "Magnificat,"
friends were especially thrilled, because they had practically seen the popular teen talent grow up in
front of their very eyes.
That was because, since 1995, the musical had been holding some of its rehearsals in the home of
lead singer-actress Pinky Marquez, Karel's mom.
Passion for theater
In some TV interviews, Karel has said that her love for performing bloomed during those rehearsals
and performances, during which she imbibed the passion for theater that her mother Pinky shared
with the musical's other original performers like Andy Bais, Rito Asilo, Jingle Buena, Dulce and Bodjie
Pascua.
For our part, we have always been struck by Karel's unique combination of "Frenchy" looks and husky
singing voice. We urged Pinky to give her young daughter opportunities to perform, but it took years
before Karel herself realized that she felt most fulfilled when she was singing and acting.
Once she had come to that realization, however, nothing could stop the already teenage Karel from
quickly making her mark in the biz.

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As an actress, she became a regular on some TV shows for teen viewers. Then, her singing talent got
noticed when she guested in some musical programs. Her unusual one-two punch in terms of acting
and singing made her stand out even more in a field of beautiful young talents - who could do neither
well!
Career boost
But Karel's biggest career boost came when she was chosen over many other auditionees for the
coveted slot of veejay.
Despite all these successes, Karel continues to dream of doing more than just walk-on roles in
theatrical productions. Which is why we sat down with Pinky and Karel to conceptualize a play that
will star Pinky and Karel in a story about a mother and daughter, to be mounted early next year.
Karel said she was thrilled to be playing her first major role onstage, and was especially delighted that
she was acting with her mother.
Karel's new Aliw award affirms what those who've known her for years have long been aware of: That
she's a young talent with a genuine gift and love for performing that will take her far in the field of
entertainment.
Great People of the 20th Century: Gifted and Talented All
In 1996, the editors of TIME, the weekly magazine, published a special edition that featured the
remarkable characters that influenced the forces and great events of the past one hundred years.
Titled "Great People of the 20th Century," the book presents the biographies and achievements of the
most memorable and unforgettable individuals. As stated in the book, the six sections "brim with
insights into the life and times of an unforgettable gallery of men and women: the diplomats and the
warriors, the scientists and the moguls, the explorers who surprised us and the artists who moved
us." These are:
• The Leaders - the diplomats and dictators who have shaped the destiny of nations: American
Presidents Theodore Roosevelt, Woodrow Wilson, Franklin Delano Roosevelt, Harry S. Truman, John F.
Kennedy, Lyndon B. Johnson and Richard Nixon; Russian Marxist Vladimir I. Lenin and Joseph Stalin,
Russian President Mikhail Gorbachev, Chinese Communist Leader Mao Zedong, German Chancellor
Adolf Hitler, British Prime Minister Winston Churchill, French President Charles de Gaulle.
• The Activists - the men and women who fought for change from outside the traditional halls of
power: Indian peace advocate Mohandas Gandhi, South African President Nelson Mandela, Israeli
President David Ben-Gurion, Ayatollah Khomeini of Iran, German Doctor Albert Schweitzer, the Dalai
Lama of Tibet, Yugoslavian Mother Teresa, American educator John Dewey, Italian educator Maria
Montessori, American Margaret Sanger, American preacher Billy Graham, Pope John XXIII, Pope John
Paul II, Polish President Lech Walesa, and Philippine President Corazon C. Aquino.

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The Pioneers - the men and women who have dared to explore new fields and break down
barriers: American pilot Charles Lindbergh who pioneered the first solo flight across the Atlantic
Ocean, American pilot Amelia Earhart, the first woman to fly the Atlantic solo, American pilots Wilbur
and Orville Wright, French Jacques Costeau who explored the depths of the oceans, mountain
climbers Edmund Hillary and Tenzing Norkey, American environmentalist Rachel Carson, Viennese
father of psychoanalysis Sigmund Freud, Swiss psychologist Carl Gustav Jung, French philosopher
Jean-Paul Sartre, American baseball player Jackie Robinson.
• The Innovators - the gifted few whose visions have changed our lives: American Henry Ford,
founder of Ford Motor Co., American Pilot Eddie Rickenbacker, American newspaper publisher
William Randolph Hearst, American cartoon filmmaker Walt Disney, British economist John Maynard
Keynes, Russian David Sarnoff, the father of mass media, American Ted Turner, founder of Cable News
Network or CNN, American industrialists Tom Watson Sr. and Jr. who introduced the International
Business Machines or IBM, American computer genius and founder of Microsoft, Bill Gates.
* The Scientists - the searchers whose work has revolutionized human society in the span of only
100 years. These are: German physicist Albert Einstein who revolutionized modern physics with his
work on the atomic nature of matter, Polish scientist Marie Curie who discovered radium, Scottish
doctor Alexander Fleming who discovered the antibiotic nature of penicillin, British Francis Crick and
American James Watson who identified the double helix structure of the deoxyribonucleic acid or
DNA, American Dr. Jonas E. Salk who discovered polio vaccine, American chemist Linus Pauling for his
work on chemical bond, British mathematician and theoretical physicist Stephen Hawking, wheelchair
bound due to a debilitating disease that paralyzed him, considered as the best-known scientist in the
world, American astronomer Edwin Hubble who proposed the theory of the expansion of the
universe, Kenyan born paleoanthropologists Louis and Mary Leaky who discovered bone fragments of
apelike prehumans called homo habilis, American anthropologist Margaret Mead.
• The Creators - the artists whose work has shaped and mirrored the century: Spanish visual artist
and painter Pablo Picasso, considered as the century's most significant artist who created the cubist
style of art, German architect Mies Van Der Rohe, American photographer Alfred Stieglitz, American
painter Georgia O' Keefe, American novelist James Joyce, British novelist Virginia Woolf, Irish playright
George Bernard Shaw, British stage and film actor Laurence Olivier, stage and film comedian Charlie
Chaplin, Russian neoclassical choreographer George Balanchine, Russian composer Igor Stravinsky,
American jazz band leader Louis Armstrong, American composer George Gershwin, American rock

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and roll legend Elvis Presley, British pop star's band called the Beatles composed of bassist Paul
McCartney, lead guitarist George Harrison, rhythm guitarist John Lennon, and drummer Ringo Starr.
The Central Concepts of Giftedness and Talent
The prominent men and women from different countries all over the world who have carved a name
for themselves in their respective fields of endeavor, as well as the many other people who have
excelled in their lines of expertise, have four things in common: they possess the central elements of
giftedness and talent, namely, intelligence or high intellectual ability, creativity, talent, and task com-
mitment.
Can you imagine what it is to be like Lea Salonga or Cecile Licad who attained international fame and
brought honors to our country through their outstanding achievements in the performing arts at a
very young age? Or Emil Justin Cebrian, Jon Bryan Santiago Tiosin and Omar Parrenas Rizwan whose
remarkable and impressive academic achievements at an early age accelerated their education? Their
performance in school indicates that their mental ages are far advanced than their chronological ages.
Average boys and girls would be much older than these young achievers before they can even
approximate their feats.
Or, how about our national hero, Dr. Jose Rizal, who is one among the few geniuses of renown in the
world? Not far behind are the other exceptional Filipino heroes whose intelligence and creative
talents showed in the roles they played in the attainment of our freedom from the foreign
conquerors. Likewise, worthy of recall are the many other compatriots and leaders, both rich and
poor, in various fields of endeavors, who pursued their commitment to serve the people through
significant leadership roles, innovative ideas, creative inventions and similar achievements.
Then there is the long list of philosophical thoughts, scientific theories, inventions and technological
advances through the centuries that intelligent and creative human minds evolved in the sciences, the
various fields in medicine, mathematics, the arts and other areas. The achievements introduced
dramatic changes in human lives such as increase in the life span, cure for diseases, more convenient,
comfortable and enjoyable life styles and information technology.
Human Intelligence
The nature of the human intellect has fascinated scholars and became the subject of debates, studies
and propositions as early as during the time of the Greek philosophers Plato and Aristotle. When the
field of psychology began to emerge in the 17th and 18th Centuries as a discipline separate from
philosophy, mathematics and biology, individuals such as John Locke, Charles Darwin, Francis Galton
and Charcot continued to influence the study of intelligence. A number of

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prominent European schools of psychology flourished until the early part of the 19th century. Some
American psychologists studied in Europe and returned home to establish influential psychology
programs in the United States. The study of intelligence gained popularity and greatly influenced by
the works of Wilhelm Wundt, James McKeen Cattell, G.S. Hall and Hermann Ebbinghaus.
As the students of the Great Schools began to form their own programs, the number of theoretical
and empirical investigations of intelligence increased. The prominent psychologists of the 20th
century were Edward L. Thorndike, Alfred Binet, Pearson, Charles Spearman, Goddard, Stern,
Theodore Simon, Yerkes, Lewis Terman, Hollingworth, Goodenough, Vigotsky, and Jean Piaget.
In the latter part of the 20th century, new statistical designs and modern experimental strategies were
developed that made psychological testing popular in most Western countries. The theory of multiple
intelligences began to appear, particularly in the work of Thurstone and Guilford. The prominent
theorists were Burt, Thurstone, P. Cattell, Wechsler, Guilford, Vernon, Hunt, Anna Anastasi, Thorndike,
Inhelder, Taylor and Eysenck.
Current trends in intelligence theory and research involve the formation of more complex multiple
intelligence theories. Standardized tests to measure intelligence are used only as one of the sources
of data about mental ability. The fields of genetics and neurological research methodologies on the
measurement of intelligence has generated a number of factors on intelligence. In addition to mental
ability, other data are considered simultaneously in determining the intelligence level of a person.
Data are derived from the environment, biological factors and psychological aspects of the intellect.
The prominent theorists in the present movement include R. Cattell (1905-1998), Carroll (1916 - ),
Jensen (1923 - ), Kamin (1924 - ), Renzulli (1936 - ), Gardner (1943 - ), and Sternberg (1949 - ).
While a big number of definitions of intelligence have been published, there seems to be no
consensus or agreement on what intelligence actually is. Cattell (1971) defines intelligence as a
composite or combination of human traits which includes the capacity for insight into complex
relationships, all of the processes involved in abstract thinking, and a capacity to acquire new
capacity.
Theories and Definitions of Intelligence
1. The Binet-Simon Scale (1890s)
The modern approach to understand the concept of intelligence began with the work of Alfred Binet,
a French psychologist (1857-1911) and his colleague, Theodore Simon (1873-1961). Binet was hired by
the Paris school system to develop tests that would identify children who were not learning and
would not benefit from further education. Together, Binet and Simon developed and co-authored a
test to roughly measure the intellectual development of young children between the ages of three to
twelve. They wanted to find a way to measure the ability of children to think and reason. Binet
developed a test that asked children

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to follow commands, copy patterns, name objects and put things in order or arrange them properly.
From Binet's work, the term "intelligence quotient" or IQ evolved. The IQ is the ratio of "mental age"
to chronological age with 100 as the average. So, an 8-year-old who passes the test for 8-year-olds has
an IQ of 100 which is the average for his or her chronological age. Meanwhile, an 8-year-old who
passes the test for 10-year-olds has an IQ of 10/8 x 100 or 125. This child's IQ is above the average for
his or her chronological age. He or she is brighter or more superior than other children his or her age.
Binet's and Simon's work influenced the growth of the intelligence testing movement.
2. Spearman's Two-Factor Theory of Intelligence (1904)
Charles Spearman, a British psychologist (1863-1945), advanced the two-factor theory of intelligence
"g" and "s." Thus, "the performance of any intellectual act requires some combination of "g" or
general factor which is available to the same individual to the same degree for all intellectual acts,
and of "s" or specific factors which are specific to that act and which varies in strength from one act to
another."
The theory explains that if one knows how a person performs on one task that is highly saturated with
"g," one can safely predict a similar level of performance for another highly "g" saturated task.
Prediction of performance on tasks with high "s" factors is less accurate. Nevertheless, since "g"
pervades all tasks, prediction will be significantly better than chance. Thus, the most important
information to have about a person's intellectual ability is an estimate of his "g."
3. Terman's Stanford Binet Individual Intelligence Test (1906)
Lewis Madison Terman, an American cognitive psychologist (1877-1956), published a revised and
perfected Binet-Simon Scale for American populations in 1906 while he was at Stanford University. In
1916 he adopted William Stern's suggestion that the ratio between mental and chronological age be
taken as a unitary measure f intelligence multiplied by 100 to get rid of the decimals. The resulting
intelligence quotient became known as the IQ. The classic formula for the IQ is: IQ = mental age
divided by chronological age x 100. By far, the Terman's Stanford Binet Individual Intelligence Test is
considered as the best available individual test of intelligence.
4. Thorndike's Stimulus Response Theory (1920s)
Edward L. Thorndike, an American psychologist (1874-1949), and his students used objective
measurements of intelligence on human subjects as early as 1903. During the 1920s he developed a
multifactored test of intelligence that consisted of completion, arithmetic, vocabulary and directions
tests (CAVD). The logic behind the CAVD tests eventually became the foundation of modern
intelligence tests.

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Thorndike drew an important distinction among three broad classes of intellectual functioning:
abstract intelligence that is measured by standard intelligence tests, mechanical intelligence which is
the ability to visualize relationships among objects and understand how the physical world works, and
social intelligence which is the ability to function successfully in interpersonal situations.
He proposed that abstract intelligence has four dimensions, namely, altitude or the complexity of
difficulty of tasks one can perform, width or the variety of tasks of a given difficulty, area which is the
function of width and altitude, and speed which is the number of tasks one can complete in a given
time.
Thorndike is cited for his work on what he considered as the two most basic intelligences: trial and
error and stimulus response association. His proposition stated that stimulus response connections
that are repeated are strengthened while those that are not used are weakened.
5. L.L. Thurstone's Multiple Factors Theory of Intelligence (1938)
Louis L. Thurstone was an American psychometrician (1887-1955) who studied intelligence tests and
tests of perception through factor analysis. His theory stated that intelligence is made up of several
primary mental abilities rather than a general factor and several specific factors. His Multiple Factors
Theory of Intelligence identified the seven primary mental abilities as verbal comprehension, word
fluency, number facility, spatial visualization, associative memory, perceptual speed, and reasoning.
He developed the Test of Primary Mental Abilities in 1938. Thurstone discovered later on that the
abilities are not completely independent of one another. Instead, there were modest correlations
among the abilities.
Thurstone was among the first to propose and demonstrate that there are numerous ways in which a
person can be intelligent. His multiple factors theory has been used in the development of intelligence
tests that yield a profile of the person's performance in each of the seven primary mental abilities.
6. Cattell's Theory on Fluid and Crystallized Intelligence
Raymond B. Cattell, a British-American psychologist (1905-1998), theorized that there are two types
of intelligence.
Fluid intelligence is essentially nonverbal and relatively culture free. Fluid intelligence involves
adaptive and new learning capabilities, related to mental operations and processes on capacity, decay,
selection and storage of information. This type of intelligence is more dependent on the physiological
structures or parts of the brain that are responsible for intellectual behavior. It increases until
adolescence, then goes through a

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plateau and begins to gradually decline with the degeneration of the brain's physiological structures.
Crystallized intelligence develops through the exercise of fluid intelligence. It is the product of the
acquisition of knowledge and skills that are strongly dependent upon exposure to culture. It is related
to mental products and achievements and highly influenced by formal and informal educational
factors throughout the life span. Crystallized intelligence continues to increase through middle
adulthood.
7. Guilford's Theory on the Structure of the Intellect (1967)
J. P. Guilford, an American psychologist, advanced a general theory of human intelligence whose
major application or use is for educational research, personnel selection and placement and the
education of gifted and talented children. The theory on the structure of the intellect (SOI) advances
that human intelligence is composed of 180 separate mental abilities (the initial count was 120) that
have been identified through factor analysis.
The mental abilities are composites of three separate dimensions, namely, contents, operations and
products.
The four types of contents are:
1. figural or the properties of stimuli experienced through the senses-visual, auditory, olfactory,
gustatory and kinesthetic. Examples are shapes and forms, sizes, colors, sounds, tastes, temperature,
intensity, volume;
2. symbolic or letters, numbers, symbols, designs;
3. semantic or words and ideas; and
4. behavioral or actions and expressions of thoughts and ideas.
The five kinds of operations are:
1. cognition or the ability to gain, recognize and discover knowledge;
2. memory or the ability to retain, store, retrieve and recall the contents of thoughts;
3. divergent production or the ability to produce a variety of ideas or solutions to a problem;
4. convergent production or the ability to produce a single best solution to a problem; and
5. evaluation or the ability to render judgment and decide whether the intellectual contents are
correct or wrong, good or bad.

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The six kinds of products are:
1. units that come in single number, letter or word;
2. classes or a higher order concept, for example, men and women = people;
3. relations or connections between and among classes and concepts;
4. systems or the process of ordering or classification of relations;
5. transformation or the process of altering or restructuring of intellectual content; and
6. implication or the process making inferences from separate pieces of information.

Figure 34. Guilford's Structure of Intellect

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Guilford developed a wide variety of psychometric tests to measure the specific mental abilities
predicted by the theory. The tests provided the operational definitions of the mental abilities
proposed by the theory.
The following examples illustrate three closely related abilities that differ in terms of operation,
content and product.
1. Evaluation of semantic units or EMU is measured by the ideational fluency test in which
respondents are asked to make judgments about concepts. For example: "Which of the following
objects best satisfies the criteria hard and round: an iron, a button, a tennis ball, or a light bulb?"
2. Divergent production of semantic units or DMU would require the respondent to list all the items
he or she can think of that are hard and round.
3. Divergent production of symbolic units or DPU involves a different content category. For example:
List all the words that end in tion.
8. Sternberg's Triarchic Theory of Intelligence (1982)
Robert Sternberg of Yale University theorized that intelligence is a fixed capacity of a person. Hence,
with higher intellectual capabilities, as in the case with children and youth who are gifted and
talented, almost every task can be achieved at a high level of performance. The capabilities that
underlie intelligence will enable a highly intelligent child at any age, to do better than his peers or age
mates. Intellectual abilities must increase with age, given the supportive environment and effective
teaching learning conditions.
The triarchic theory of intelligence seeks to explain in an integrative way the relationship between:
1. intelligence and the internal world of the individual, or the mental mechanisms that underlie
intelligent behavior;
2. intelligence and external world of the individual, or the use of these mental mechanisms in
everyday life in order to attain an intelligent fit to the environment; and
3. intelligence and experience, or the mediating role of one's passage through life between the
internal and external worlds of the individual.
Sternberg calls his theory triarchic because intelligence has three main parts or dimensions: a
contextual part, an experiential part, and a componential part.
Contextual intelligence emphasizes intelligence in its sociocultural contexts. Thus, intelligence for a
child requires adaptive behavior (children's basic cognitive skills according to Gesell) that is not
required of an older person. Similarly, it may be stated that intelligence for a Filipino child, especially
those who are deprived of the basic needs,

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requires adaptive behavior that is not required of an American child. Intelligence for children in rural
areas requires adaptive behavior not required of children who live in urban areas. Persons who are
high on the contextual dimension of intelligence quickly recognize what factors influence success on
various tasks. They are adept at both adapting to and shaping their environment so that they can
accomplish their goals.
Experiential intelligence emphasizes insight and the ability to formulate new ideas and combine
seemingly unrelated facts or information. Sternberg emphasizes the role of experience. He says that
the habitual, highly practiced ways of dealing with the environment are not the true indicators of
intelligence. Rather, it is the way a person responds to an event that is new, novel and even
unexpected that shows how smart he or she is.
Componential intelligence emphasizes the effectiveness of information processing. Sternberg defines
component as the underlying cognitive mechanisms that carry out the adaptive behavior to novel
situations. The cognitive mechanisms are equivalent to the skills, knowledge and competencies that a
person would have acquired mainly through education and experience. There are two kinds of
components: performance components and metacomponents.
Performance components are used in the actual execution of the tasks. They include encoding,
comparing, chunking and triggering actions and speech. The metacomponents are the higher order
executive processes used in planning, monitoring and evaluating one's working memory program.
Sternberg has identified six significant metacomponents. As he emphasized time and again,
"metacomponents form the basis for developmental changes in intelligence. All activation and
feedback are filtered through these elements, and if they do not perform their function well, then it
will not matter very much what the other kinds of components do."
1. Recognition of what has to be done; understanding the task at hand;
2. Selecting performance components and encoding important features of a task;
3. Selecting an appropriate mental representation visually or verbally;
4. Organizing performance components by formulating plans for organizing and sequencing the
steps or procedures in the process;
5. Deciding how to allocate attention and resources; and
6. Monitoring one's performance.
Persons who are high in componential intelligence do very well in abstract thinking and are able to
process information effectively. They think analytically, critically and creatively.

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9. Gardner's Theory of Multiple Intelligences (1983)
Howard Gardner is a psychologist and professor at Harvard University Graduate School of Education
and director of Project Zero. Based on his studies of many people from different walks of life in
everyday circumstances and professions, he developed his breakthrough theory of multiple
intelligences or MI. He did a massive synthesis of a lot of research including brain research,
evolutionary research and genetic research. He did brain research on stroke victims, prodigies, people
with autism and even idiot "savants." He had authored 20 books and hundreds of articles on MI.
Gardner was in Manila in April, 2005 for the first Philippine convention on MI with the theme
"Changing Minds: Teaching and Parenting for the 21st Century."
The Multiple Intelligences
The MI theory advances that in teaching anything, a parent or teacher can draw on a child's many
intelligences which are linguistic, logical-mathematical, bodily-kinesthetic, spatial, musical,
interpersonal, intrapersonal, and naturalist. The theory rejects the idea of central intelligence, rather,
as the author says, it subscribes to "each his own learning style."
Gardner emphasizes that MI is originally not an educational theory. It is a theory on how the mind is
organized and developed. As opposed to general intelligence which implies that there is one
"computer" in the brain that determines whether a person will be competent or incompetent at
everything, he describes the mind as having 7, 8, 9 or even a dozen different "computers." Some
people have better computers than others because of who their parents are, where they live and how
they were trained.
1. Linguistic Intelligence
Linguistic intelligence is the ability to use language to excite, please, convince, stimulate or convey
information. The indicators of linguistic intelligence are manifested by persons who:
• Ask a lot of questions, particularly "why" and "what if questions
• Have a good vocabulary, enjoy talking, can spell easily
• Pick up new language easily, bilingual, trilingual, etc.
• Enjoy playing with words, word games, word puzzles, rhymes
• Enjoy reading, love stories, jokes, riddles
• Like to write
Can talk about language skills

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Linguistic intelligence can be developed through the use of the following activities: reading fiction and
nonfiction, literary work, newspapers, magazines, reports, biographies, bibliographies, the Internet;
engaging in storytelling, debates, plays, listening to audiotapes, watching films; writing reports,
stories, speeches.
Practitioners who have high linguistic intelligence include novelists, poets, journalists, storytellers,
actors, orators, comedians, politicians.
2. Logical-Mathematical Intelligence
Logical-mathematical intelligence is the ability to explore patterns, categories and relationships by
manipulating objects or symbols and to experiment in controlled, orderly ways. The indicators of
logical-mathematical intelligence are manifested by persons who:
• Want to know how things work
• Are interested in "if. .. then" logic
• Oriented towards rule-based activities
• Play with numbers, enjoy solving problems
• Love to collect and classify objects
Logical-mathematical intelligence can be enhanced with the use of the following activities: mazes,
puzzles, outlines, matrices, sequences, codes, patterns, logic, analogies, timelines, equations, games,
formulas, theorems, calculations, computations, syllogisms, probabilities.
Persons who excel in the following professions have high logical-mathematical intelligence:
mathematicians, scientists, computer engineers and programmers, doctors, astronomers, inventors,
accountants, lawyers, economists, detectives, trivia champions.
3. Bodily-Kinesthetic Intelligence
Bodily-kinesthetic intelligence refers to the ability to use fine and gross motor skills in sports, the
performing arts, or arts and crafts production. The indicators of this component of the multiple
intelligences are observed among persons who:
• Have a good sense of balance, good eye-hand coordination Have sense of rhythm, graceful in
movement
• Communicate ideas through gestures, body movements and facial expressions "read" body
language
• Have early ease in manipulating objects and toys
• Solve problems through "doing"
The following activities develop bodily kinesthetic intelligence: role-playing, dramatization, skits,
mimes, body language, gestures, facial expressions, dancing, sports, games, experiments, laboratory
work.

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Persons who are successful in the following professions have high bodily-kinesthetic intelligence:
ballet and folk dancers, choreographers, sculptors, professional athletes, gymnasts, surgeons,
calligraphers, jewelers, watchmakers, carpenters, circus performers.
4. Spatial Intelligence
Spatial intelligence is the ability to perceive and mentally manipulate a form or object, perceive and
create tension, balance and composition in a visual or spatial display.
Some indicators of this aspect of MI are manifested by persons who:
• Like to draw, doodle, sketch
• Have a keen eye for detail
• Like to take things apart, like to build things
• Have a good sense of relating parts to the whole Enjoy puzzles, riddles
Remember places by description or image, can interpret maps
Enjoy orienteering, mechanically adept
Some of the activities that enhance spatial intelligence are: illustrations, constructions, maps,
paintings, drawings, mosaics, sketches, cartoons, sculptures, storyboards, videotapes.
Persons who are successful in the following professions have high spatial intelligence: urban planners,
architects, engineers, surveyors, explorers, navigators, mechanics," curators, map designers, fashion
designers, florists, interior designers, visual artists, muralists, photographers, movie directors, set
designers, chess players, cartoonists.
5. Musical Intelligence
Musical intelligence is the ability to enjoy, perform or compose a musical piece. The indicators of
musical intelligence are shown by persons who:
• Have sensitivity to sound patterns, hum or move rhythmically
Capture the essence of a beat and adjust movement patterns according to changes
• Have a good sense of pitch
Hum tunes, can discriminate among sounds
• Play with sounds, remember tunes and sound patterns
Persons who succeed in the following occupations have high musical intelligence: composers,
musicians, conductors, critics, opera artists, singers, rappers, instrument makers and players, sound
recording artists.

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6. Interpersonal Intelligence
Interpersonal intelligence is the ability to understand and get along with others. The indicators of this
component of the multiple intelligences are observed in persons who:
Demonstrate empathy towards others, feel so much for others
• Are sensitive to the feelings of others
• Act as mediator or counselor to others
• Relate well to peers and adults alike, like to be with other people
• Are admired by peers, make friends easily Display skills of leadership
Work cooperatively with others
• Enjoy cooperative and group activities
The types of activities that will develop interpersonal intelligence include group projects and charts,
communication, social interaction, dialogs, conversations, debates, arguments, consensus building,
group work on murals and mosaics, round robins, games, challenges and sports.
People who succeed in the fields of endeavor have high interpersonal intelligence: teachers, social
workers, doctors and nurses, anthropologists, counselors, priests/ministers, nuns, entrepreneurs,
ombudsmen, managers, politicians, salespersons, tour guides.
7. Intrapersonal Intelligence
Intrapersonal intelligence is the ability to gain access to and understand one's inner feelings, dreams
and ideas. The indicators of this element of multiple intelligences are evidenced by people who:
Are goal-oriented, develop plans carefully
Are aware of their strengths and weaknesses, confident of their own abilities and accept their
limitations
Are self-regulating and self-directing, do not need to be told what to do
• Motivate themselves to engage in projects
• Work towards the achievement of one's goals
• Express preferences for particular activities
• Communicate their feelings
Engage in creative thinking, novel and original ideas Keep hobbies, productive pursuits, diaries

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The activities that will enhance interpersonal intelligence include insight and intuition building,
creative and critical thinking, goal setting, reflection and self-meditation, self-assessment, affirmation,
keeping journals, logs and reflectionnaires, "I" statements, discussion, interpretation and creative
expression of values, philosophical thoughts and ideas, quotations.
8. Naturalist Intelligence
Naturalist intelligence is the most recent addition to the original list of seven multiple intelligences.
Naturalist intelligence refers to the person's ability to identify and classify patterns in nature. In
prehistoric times when people relied on hunting animals and gathering plants, naturalist intelligence
was used to sort what animals and plants were edible or not. At present, a person uses his or her
naturalist intelligence in the ways he or she relates to the environment. A person who has naturalist
intelligence abilities is likely to be sensitive to changes in flora and fauna, weather patterns and similar
environmental factors.
Laying the Groundwork for a Lifetime of Intelligence
There are essential concepts on brain development "in utero" or in the mother's womb that every
special education student must understand (Healy, 1996).
• Life begins in the mother's uterus eighteen to twenty-four hours after fertilization - the process
where the spermatozoa or sperm cell from the father and the ovum or egg cell from the mother unite
to form the zygote, the one-celled organism that will develop for the next nine months into the
embryo, the fetus, and finally will be born as the infant.
• The zygote undergoes meiosis or cell division from two, four, sixteen until there are millions of
human cells, clusters of which are predetermined to develop into the central nervous system, the
skeletal system.
• The brain cells begin to form as early as three weeks after fertilization had taken place.
• The pregnant mother's condition and the uterine environment exert tremendous influences on
brain development. Studies show that the growing brain is highly susceptible to changes in the
developing organism. There are pieces of evidence that specific academic abilities such as reading or
mathematics may be affected by hormones secreted during pregnancy. Poor maternal nutrition and
lack of protein retard brain growth. A pregnant woman's heavy use of alcohol, prohibited drugs, even
common drugs for headaches, heartburn, diarrhea without the doctor's prescription can affect brain
development.
• The natural pattern of brain development shows that the brain is organized in systems of
connections that do increasingly complex functions as they mature mainly from inside to outside and
from back to front.

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• The neurons or brain cells begin to form as early as three weeks after fertilization, multiplying
more rapidly than the other cells of the body. A thin layer of neurons in the developing embryo folds
inward and rises to a fluid-filled cylinder known as the neural tube. The cells produced in the neural
tube will migrate to other locations and accurately lay down the connections to link one part of the
brain to another. In addition, the embryonic brain must construct a variety of temporary structures,
including the neural tube that will eventually disappear. The instructions programmed into the genes
guide the neurons in their long migration to become specific parts of the body later on.
• Starting at the top of the spinal cord, the fetal brain first develops brain stem structures for
reflexes and basic motor coordination. Rocking movements help develop part of this complex. As the
mother moves about, the fetus is rocked and the movements add to the stimulation. The cerebellum,
and the vestibular system which is linked to the balance mechanism of the ear undergird the later
development of higher cognitive skills.
• Development of much of the brain's physical structure called "hard wiring" starts at this time
directed by a complex genetic program (Time Magazine, 1998). Neurons, the future thinking cells, are
produced in abundance. Many neurons migrate to particular sections of the brain to form part of the
subsystems that will later control reflexes, voluntary body movements, perception, language and
thinking. Some neurons fail to attach themselves to any area and disintegrate or disappear. No one
yet understands how these neurons know where to go, or why some disintegrate. What is known is
that the process of cell differentiation and migration determines the future structure of the brain.
• Ten to twelve weeks after conception during the first trimester or three months of pregnancy, the
neurons that carry electrical messages through the nervous system and brain send pulsing staccato
bursts of electricity. The distinctive coordinated waves of neural activity change the shape of the brain
and carve mental circuits into patterns that over time will enable the newborn infant to perceive a
father's voice, a mother's touch, a colorful mobile moving over the crib. Of all the discoveries in
neuroscience recently, the most breathtaking is the finding that the electrical activity of brain cells
changes the physical structure of the brain. For the rhythmic firing of neurons is no longer assumed to
be a by-product of building the brain but it is an essential process that takes place in utero.
• The growth spurts in the formation of the neurons or brain cells lasts . from the second trimester
of pregnancy (4th to the 6th month) until
the age of two. Meanwhile, glial cells begin to form and nourish the neurons and hold them together.

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The cell systems are the raw materials for the normal development of the brain. Any disturbance in
the process may cause cranial malformation, a learning disability of mental retardation.
Studies on the impact of the mother's emotional state on brain development suggest that
pregnancies marked by excessive fear, anger or stress may produce irritable infants. Intense feelings
release chemicals that are passed from the mother's bloodstream into the infant's circulatory system.
Children of depressed mothers have slightly altered patterns of brain activity that may put the infant
at risk for depression. Later on, these children may exhibit difficult disposition, im-pulsivity and
learning difficulties. Fortunately, the brain is malleable to experience and much can be done after
birth to prevent the occurrence of the problems.
Modern technology makes it possible to study the "seat" of intelligence, the human brain, directly.
Neurology or brain investigations that are noninvasive or harmless are done with the aid of
computerized scanners and techniques for measuring the intensity of electrical impulses or chemical
changes. The television screen shows detailed views of the brain in minute cross-sections. The brain
at work or the child's thinking in motion while reading, working on mathematics and science, and
emoting on stage can be viewed on the TV screen. At present, there is a large body of information
about the structure of the brain and how it functions. Future neurological research promises to
revolutionize the knowledge on how learning takes place.
Neurological studies show that conducive home environments correlate positively with school
achievement. Early childhood education influences better intellectual growth. Likewise, research
findings indicate that children need different types of learning at different ages. Early age-appropriate
experiences provide little children with a strong base for the acquisition of later skills.
The old debate on whether heredity/nature or environment/nurture play the major role in cognitive
development had long been laid to rest. Experts agree that the infant does not come to the world as a
product of heredity or a blank slate at the mercy of the environment. Rather, the focus of neurological
research centers on the ways in which genetics and environment should interact for intelligence to
develop to the highest possible level.
Studies show that the interaction between genetic traits and experiences is constant from the time of
conception. Every baby inherits a physical brain structure as well as certain chemical and electrical
response patterns that strongly influence the ways in which the brain responds to environmental
stimuli while in the mother's womb and after birth. A current study shows that a child's personal
tempo - the natural pace of responding and the speed of carrying out activities - seems to be
genetically determined.

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Definitions of Giftedness and Talent
Through the years, the concept on intellectual giftedness had changed as shown in the following figure (Heward, 2003).
Old Concepts Emerging Paradigm
Giftedness is high IQ Many Types of Giftedness
Trait-Based Qualities-Based
Subgroup Elitism Individual Excellence
Innate, "In There" Based on Context
Test-Driven Achievement - Driven, "What You
Do"
Is Gifted
Authoritarian, "You Are or Are Collaborative, Determined by
Not Gifted" Consultation
School-Oriented Field-and-Domain Oriented
Ethnocentric Diverse
Figure 34. Changing Concepts on Intellectual Giftedness
Federal or American Government's Definitions
The first federal definition of the gifted and the talented was contained in the 1972 Marland Report.
Gifted and talented children are capable of high performance and demonstrate potential ability in any
of the following six areas:
• General intellectual ability
• Specific academic aptitude
• Creative or productive thinking
• Leadership ability
• Ability in the visual or performing arts
• Psychomotor ability
The Gifted and Talented Children's Act of 1978 defined gifted and talented children as those
"possessing demonstrated or potential abilities that give evidence of high performance capability in
such areas as intellectual, creative, specific, academic or leadership ability, or in the performing or
visual arts, and who, by reason thereof require services or activities not ordinarily provided by the
school." The definition encompasses almost all of the areas where a person can demonstrate
outstanding performance. Almost all of the states have built their programs for gifted and talented
learners around the federal definition.
The 1991 "Report on National Excellence: A Case for Developing America's Talent" deleted the term
gifted and used outstanding talent and excep-

143
tional talent instead. The definition stated that talent occurs in all groups across all cultures and is not
necessarily revealed in test scores but in a person's "high performance capability" in the intellectual,
creative and artistic realms. Giftedness is said to connote "a mature power rather than a developing
ability."
Key Contemporary and Related Definitions
Renzulli's Three-Trait Definition. Renzulli's 1978 three-trait definition of giftedness continues to be
cited in special education literature. The definition states that giftedness results from the interaction
of: (1) above-average general abilities; (2) a high level of task commitment; and (3) creativity. Gifted
and talented children are those: possessing or capable of developing this composite set of traits and
applying them to any potentially valuable area of human performance. Children who manifest or are
capable of developing an interaction among the three clusters require a wide variety of educational
opportunities and services that are not ordinarily provided through regular instructional programs.
General Performance Areas >
Mathematics • Visual Arts • Physical Sciences • Philosophy • Social Sciences • Law • Religion •
Language Arts • Music Life Sciences • Movement Arts Specific Performance Areas
Cartooning • Astronomy • Public Opinion Polling • Jewelry Design • Map Making * Choreography •
Biography * Film Making • Statistics • Local History • Electronics * Musical Composition • Landscape
Architecture " Chemistry • Demography • Microphotography • City Planning • Pollution Control •
Poetry • Fashion Design • Weaving • Play Writing • Advertising • Costume Design • Meteorology *
Puppetry • Marketing * Game Design • Journalism • Electronic Music • Child Care • Consumer
Protection • Cooking • Ornithology * Furniture Design • Navigation • Genealogy * Sculpture • Wildlife
Management • Set Design • Agricultural Research • Animal Learning * Film Criticism * etc.

Figure 35. Renzulli's Three-Trait Definition of Giftedness

Piirto's Pyramid Model of Talent Development
Piirto's 1999 definition states that the gifted are "those individuals who, by way of having certain
learning characteristics such as superior memory, observational powers, curiosity, creativity and the
ability to lean school-related subject matters rapidly and accurately with a minimum of drill and
repetition, have a right to an education that is differentiated according to those characteristics." Piirto
further states that even if gifted students do not become producers of knowledge or makers of
novelty, special education should train them to become adults who will produce knowledge or make
new artistic and social products.

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As shown in Figure 37, Piirto's pyramid model is composed of: (1) a foundation of genetic
endowment; (2) personality attributes such as drive, resilience, intuition, perception, intensity, and
the like; (3) the minimum intelligence level necessary for function in the domain in which the talent is
demonstrated; (4) talent in a specific domain such as mathematics, writing, visual arts, music, science
or athletics and; (5) the environmental influences of five suns: the sun of home, community and
culture, school, chance and gender. Which talent is
Figure 37. Piirto Pyramid Model of Talent Development
developed depends on the "thorn" of passion, calling or sense of vocation.
Maker's Problem-Solving Perspective. Another definition of giftedness and talent advanced by Maker
in 1996 incorporates high intelligence, high creativity, and excellent problem-solving skills. He
enumerates the following characteristics of a gifted person: a problem solver - one who enjoys the
challenge of complexity and persists until the problem is solved in a satisfying way. Such an individual
is capable of (a) creating a new or more clear definition of an existing problem, (b) devising new and
more efficient or effective methods, and (c) reaching solutions that may be different from the usual,
but are recognized as being effective than previous solutions.

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Characteristics of Gifted and Talented Children and Youth

The previous discussions clearly indicate that giftedness and talent are a complex condition that
covers a wide range of human abilities and traits. That is why it must be clearly understood that
giftedness and talent vary according to social contexts. Some students may excel in the academic
subjects but may not show special talents in the arts. On the other hand students who show
outstanding talent in sports and athletics, visual and performing arts or those with leadership abilities
may show only average or above average performance in academic subjects.
Highly gifted students, according to Silverman's studies (1995) have IQ scores 3 standard deviations or
greater above the mean. The IQ score is greater than 145, or 35 to 55 points more or even higher than
the average IQ scores of 90 to 110. Among American children, there is only 1 child in 1,000 or 1 child
in 10,000. Silverman found the following characteristics among these highly gifted individuals:
Intense intellectual curiosity
• Fascination with words and ideas
• Perfectionism
• Need for precision
• Learning in great intuitive leaps Intense need for mental stimulation
• Difficulty conforming to the thinking of others Early moral and existential concern
• Tendency toward introversion
There are times when the characteristics of gifted and talented persons are misinterpreted as
bordering on abnormal behavior, aggressiveness, antisocial behavior, and the like.
Shaklee (1989, cited in Heward, 2003) listed the identifiers of young gifted and talented children as
follows:
• Exceptional learner in the acquisition and retention of knowledge:
a. exceptional memory
b. learns quickly and easily
c. advanced understanding/meaning of area
• Exceptional user of knowledge in the application and comprehension of knowledge
a. exceptional use of knowledge
b. advanced use of symbol systems - expressive and complex
c. demands a reason for unexplained events
d. reasons well in problem-solving - draws from previous knowledge and transfers it to other areas

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Exceptional generator of knowledge - individual and creative attributes
a. highly creative behavior in areas of interest and talent
b. does not conform to typical ways of thinking, perceiving
c. enjoys self-expression of ideas, feelings or beliefs
d. keen sense of humor that reflects advanced, unusual comprehension of relationships and meaning
e. highly developed curiosity about cause, future, the unknown • Exceptional motivation -
individual motivational attributes
a. perfectionism: striving to achieve high standards, especially in areas of talent and interest
b. shows initiative, self-directed
c. high level of inquiry and reflection
d. long attention span when motivated
e. leadership - desire and ability to lead
f. intense desire to know

Figure 36. Gifted and Talented Children as Generators of Knowledge

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Creativity as the Highest Expression of Giftedness
Creative ability is considered as central to the definition of giftedness. Clark (1986) refers to creativity
as the highest expression of giftedness. Sternberg (1988) suggests that creative, insightful individuals
are those who make discoveries and devise the inventions that ultimately change society.
There is no accepted definition of creativity. In his studies on creativity, Guilford (1988) enumerates
the following dimensions of creative behavior:
• Fluency - the creative person is capable of producing many ideas per unit of time.
• Flexibility - a wide variety of ideas, unusual ideas, and alternative solutions are offered.
• Novelty/originality - low probability, unique words, and responses are used; the creative person
has novel ideas.
• Elaboration - the ability to provide details is evidenced.
• Synthesizing ability - the person has the ability to put unlikely ideas together.
• Analyzing ability - the person has the ability to organize ideas into larger, inclusive patterns.
Symbolic structures must often be broken down before they can be reformed into new ones.
Ability to reorganize or redefine existing ideas - the ability to transform an existing object into one of
different design, function, or use is evident.
Complexity - the ability to manipulate many interrelated ideas at the same time is shown.
A foremost authority on creative thinking and author of psychological tests on creativity, Torrance
(1993) found in a 30-year longitudinal study that high-ability adults who were judged to have
achieved far beyond their peers in creative endeavors possess the following ten most common
characteristics:
1. Delight in deep thinking
2. Tolerance of mistakes
3. Love of one's work
4. Clear purpose
5. Enjoyment in one's work
6. Feeling comfortable as a minority of one
7. Being different
8. Not being well-rounded
9. A sense of mission
10. The courage to be creative

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Assessment of Gifted and Talented Children

Similar to the screening and location and identification and assessment of exceptional children, the
following processes are employed:
1. pre-referral intervention
Exceptional children are identified as early as possible. Teachers are asked to nominate students who
may possess the characteristics of giftedness and talent through the use of a Teacher Nomination
Form.
2. multifactored evaluation
Information are gathered from a variety of sources using the following materials:
Group and individual intelligence tests
• Performance in the school-based achievement tests
• Permanent records, performance in previous grades, awards received Portfolios of student work
Parent, peer, self-nomination
Differentiated Curriculum and Instructional Systems
The skills in the Basic Elementary Curriculum of the Department of Education are intended for average
learners and lack the competencies that match the learning characteristics of high-ability students. A
study of American gifted and talented students found that 60% of all grade four students in a school
district have already mastered much of the content of the curriculum. Majority of the students scored
80% in a pretest in mathematics even before the school year began. A differentiated curriculum that is
modified in depth and pace is used in special education programs for gifted and talented students.
Curriculum compacting is the method of modifying the regular curriculum for certain grade levels by
compressing the content and skills that high-ability students are capable of learning in a shorter
period of time. At the Silahis Special Education Centers of Manila City Schools, high-ability students
study the fourth, fifth and sixth grades in a span of two years.
Enrichment of the regular curriculum allows the students to study the content at a greater depth both
in the horizontal and vertical directions employing higher order thinking skills. The differentiated
curriculum goes beyond the so-called "basic learning competencies" or BLC and allows the students
access to advanced topics of interest to them. Meanwhile, acceleration modifies the pace or length of
time at which the students gain the skills and competencies in the regular curriculum to
accommodate the enrichment process.

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Horizontal enrichment adds more content and increases the learning areas not found in the regular
curriculum for the grade level. The students go beyond the grade requirements and move on to study
the subjects in the higher grades. For example, mathematics subjects like Algebra or Geometry that
are partly included in the regular curriculum, or, advanced subjects like Trigonometry and Calculus
may be included in the differentiated curriculum. Science, English and Filipino are enriched by
expanding the content covered in the same manner.
Vertical enrichment allows the students to engage in independent study, experimentation and
investigation of topics that interest them. Social Studies and Makabayan subjects lend themselves
well to vertical enrichment activities that will give the high-ability students opportunities to share
their ideas in solving related problems at home, the school and the community.
Most of the special education classes in the different regions of the country utilize the self-contained
class. High-ability students are enrolled in a special class that is taught by a trained special education
teacher. Mainstreaming activities are arranged so that the students can socialize with their peers,
share their knowledge and assist in peer mentoring the slow learners.
Read and Respond
Test on Content Knowledge
Test how much you have learned about giftedness and talent by answering the following questions:
1. What are the outstanding achievements of the talented children and youth in the vignettes?
What make them different from normal boys and girls?
Emil Justin Cebrian________________________________________
Omar Parrenas Rizwan____________________________________
Karel____________________________________________________

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2. Using the matrix below, compare and contrast the theories and definitions of intelligence as advanced by the
proponents.
Proponent Theory of Definition of
Intelligence Intelligence
1. Alfred Binet and
Theodore Simon

2. Charles Spearman
3. Lewis M. Terman
4. Edward L.
Thorndike
5. Louis L. Thurstone
6. J.P. Guilford
7. Robert Sternberg
8. Howard Gardner
3. What is creativity? Why is it considered as the highest expression of giftedness?
4. Quote the portion of the definition of giftedness by the authorities mentioned in the chapter
under the following headings:
a. intelligence
b. creativity
c. talent
d. task commitment
e. leadership role
Reflection and Application of Learning
1. Look for references and materials on the great people of the 20th century-the leaders, activists,
pioneers, innovators, scientists and creators. Write a brief paper about them. Share your work with
your classmates.
2. Visit a special class of gifted and talented pupils in a school near your home. Talk to them,
keeping in mind the characteristics that you have learned in the chapter. Write a report on your
findings. Share your paper with your classmates.

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Chapter 8 STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS

Adelaida C. Gines
To the Course Professors and Students:
There are students who make an indelible mark in school not for their good performance in academic
work but for their undesirable and unacceptable behavior that violates school rules and regulations.
These are the boys and girls who are often "sent to the guidance office" for various reasons: bad
conduct that disrupts class activities, aggressive behavior and physical attack on their classmates,
stealing, lack of manners and respect towards old people as well as peers and similar behavior
problems. These children and youth are referred to as emotionally disturbed, socially maladjusted,
with emotional and behavioral disorders or simply with behavior problems.
The usual reactions of most people to children who manifest behavior problems range from
reprimand, scolding, punishment, dislike, rejection, hatred to pity. These children find it very difficult
to maintain interpersonal relationships with their parents, siblings, school authorities, teachers and
classmates. They tend to violate home and school rules and regulations and often get into difficult
situations. They find it difficult to be around people.
The aforementioned labels are found in the area of emotional and behavioral disorders (EBD). As one
recalls certain experiences about children and youth who fit the above descriptions, a number of
questions and issues cross one's mind: What are emotional and behavioral disorders? When may a
child be described as with emotional and behavioral disorders? What are the characteristics, types
and potential causes of EBD? What assessment tools and procedures are used to determine the
presence of EBD? What educational interventions can help these children?
The chapter starts with a review of personality development and the factors that contribute to
adaptive or maladaptive behavior. The topics covered are definition, classifications, etiological factors,
psychological and behavioral characteristics, assessment and special education strategies in handling
children and youth with emotional and behavioral disorders.
At the end of the chapter, the students should be able to:
1. explain the concepts on personality development, adaptive and maladaptive behavior;
2. define the terms emotional and behavioral disorders and delinquency;

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3. enumerate and explain the etiological factors and potential causes;
4. enumerate and describe the classification of emotional and behavioral disorders;
5. enumerate and discuss the characteristics of children with emotional and behavioral disorders;
6. enumerate and discuss the etiological factors and causes of emotional and behavioral disorders;
7. describe the assessment tools and procedures in identifying this type of children;
8. enumerate and describe the educational approaches for this type of children; and
9. design a simple intervention program for a student with emotional and behavioral disorder.

Fear in the Playground (Reader's Digest, February 2003)

The following article on bullying written by Lam Lye Ching shows how serious the problem has
become in Asia. Research shows that bullied children often fail to focus on their studies.
Juan Reyes summoned up all his courage as he walked through the yard of his Manila secondary
school in November 2001. An older, larger boy had been picking on the 12-year-old for weeks. He had
teased Juan mercilessly, calling him "cry baby" in front of the other kids. When Juan had asked his
tormentor to stop, the bully had responded, "Why should I?"
Now, Juan finally decided to confront the bully. "Why do you keep insulting me?" he nervously asked
the bigger boy. The bully responded by grabbing him by the collar and shaking him. A brief fistfight
ensued before a school employee broke them up. Moments later, the bully clutched his chest and fell
to the ground dead.
An autopsy later revealed the boy had died of a heart attack, brought on by an undiagnosed heart
condition. Weeping and covered in bruises, Juan told an investigator after the fight: "He kept on
teasing me. This is the only time I stood up for myself, and look what happened." Juan was charged
with homicide and jailed for three days before he was released on bail (the case is pending).
The tragedy is that the boy's death, and Juan's anguish, could have been prevented. However, schools,
parents, and even the students themselves are not doing enough to address the problem of bullying.
According to an exclusive Reader's Digest poll of 2,500 parents of secondary-school children in five
cities, bullying is all too common in Asia. Nearly

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one in five respondents knew of bullying incidents at their child's school in the past year. Almost 60
per cent felt bullying was a serious problem generally.
The problem appears to be particularly pronounced in Manila, where one in four parents said there
had been bullying at their child's school in the past year. Indeed, one in eight Manila parents said their
own child had been bullied in the past 12 months, double the number for Singapore and Kuala
Lumpur.
Just as disturbing are the effects of bullying revealed in our poll. Fifteen per cent of the bullied
children suffered physical injuries, and 27 per cent needed counseling. Progress at school was affected
for one-third of the bullying victims.
While most respondents said their child's school was taking the problem of bullying seriously, experts
across Asia paint a different picture. "Bullying is often ignored or the school does not know about it
and so deals with it ineffectively," says Dr. Agnes Bueno, a child psychiatrist at St. Luke's Medical
Center in Manila.
Dr. Teoh Hsien-Jin, a consultant clinical psychologist in Kuala Lumpur who helps schools run anti-
bullying campaigns, agrees. "Not enough is being done, and there is still a lot of hard-core bullying
taking place."
Parents have every reason to be concerned. Bullies pick on any perceived difference: shyness,
plumpness, being too clever, too attractive, being the "wrong" color or simply in the wrong place at
the wrong time.
"Sustained bullying can leave children feeling depressed; they can lose confidence and have suicidal
thoughts," Bueno says. "They cannot focus on their studies and become defiant, and younger kids can
become hyperactive. So it's essential to solve the problem as soon as possible."
During recess one day, 12-year-old Singapore student Cecilia Chan was confronted by two classmates,
a boy and a girl. They taunted her, stole school supplies from her and demanded that she buy snacks
for them every day.
For three months, Cecilia bought the snacks with her own pocket money. She became depressed, and
her school work began to suffer. In desperation, she called Tinkle Friend, the only children's hotline in
Singapore. "We persuaded her to tell her parents and teachers, and taught her how to be confident
and strong about it," says Tinkle Friend coordinator Christina Appadoo.
Cecilia's parents called her school; and a meeting was arranged with the parents of the bullies. The
bullies later apologized, paid back the money for the snacks and underwent counseling. Cecilia and
the girl who tormented her even became friends.
"Instead of parents and teachers acting alone to help children being bullied, it's important to adopt a
whole-school approach to the problem," says James Nayagam, chairman of Shelter Home in Kuala
Lumpur, an organization that counsels children and helps victims of abuse.

154
Unfortunately, few schools in Asia take a comprehensive approach to bullying or have established
anti-bullying policy, says Dr. Toh Chin Lee, senior consultant child and adolescent psychiatrist with the
Institute of Pediatrics at Kuala Lumpur Hospital. "Schools need to take bullying more seriously as it
can cause both physical and psychological damage to children."
Experts agree we do bullies no favors by excusing them. "It's too easy to excuse children who bully.
However, if the problem is not dealt with, it could lead to worse behavior as they grow older," says Dr.
Teoh.
"Vicious bullies should be made to apologize or be punished in some way," says Nayagam. "They
should do community service or be suspended from school. In extreme cases, they should be
expelled."
With younger children, shaming tactics are often enough. Seven-year-old Anthony Lim of Sarawak,
Malaysia, hit a female classmate on the head and threatened to get his older sibling to beat her up. In
response, the principal talked to him about what he had done, made him apologize to the girl and
then lightly slapped him on the hand in front of his classmates to embarrass him. He never bullied
again.
Teachers should stress that speaking out about bullying is not telling tales. "It's important that
teachers encourage students to do so, otherwise they effectively condone the bully's actions," says
Bueno.
The challenge is to get your child to accept this. It was only when six-year-old Tan Ai Lin of Kuala
Lumpur refused to go to school, claiming she had a stomachache, and stopped talking and
participating in class that her mother found out that she has been bullied for two months.
. Ai Lin displayed some of the classic symptoms of the victim. Other warning signs parents should
watch out for are: frequent crying, torn clothing, unusual quietness at home, missing possessions,
bed-wetting and deteriorating school work.
Above all, parents need to feel confident that their child's school is taking bullying seriously. No one
wants to see a repetition of the terrible events at SM Bandar Penawar in Kota Tinggi, Malaysia, last
October. A large group of boys severely beat 13-year-old Muhammad Nor at the school's hostel
because they thought he was too close to his teacher.
Muhammad Nor was found unconscious by school staff and rushed to hospital, where he underwent
a six-hour operation to repair liver damage caused by a broken rib. The State Education Committee
Chairman later criticized the school for not preventing the bullying of younger students. Following the
attack, 13 students were expelled and another 18 were suspended for two weeks.
Every child has the right to a safe, protected school environment, says Appadoo of Tinker Friend. "No
matter how minor the case is, bullying needs to be tackled from the beginning. If we ignore the
problem, our children may suffer, both psychologically and physically."

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Effective Steps to Beat the Bullies
Children
Don't show distress. It gives the bully an emotional payoff. For three years, Kumar Singh of Kuala
Lumpur was called "Bombai," a degrading name for an Indian, by his classmates. "I felt angry and hurt
when they called me that," says Kumar. "Sometimes I got depressed and cried." That's just what the
bullies want. "Name calling is very common," says Christina Appadoo. "It is often used to test the
bully's power over the victim and see how far he can go. Stopping it early on can prevent it from
escalating into something more serious."
"My parents told me to ignore it," Kumar says. Whenever his tormentors made fun of his Indian
heritage, he would pray or sing a song inside his head to help him ignore the insults. Having lost their
free entertainment, the bullies soon stopped.
Don't be a witness. If you see bullying happening, walk away. It implies disapproval and weakens the
bully's position by removing an essential audience. The chances are he'll soon lose interest.
Meanwhile, report the incident to an adult.
Parents
Build self-confidence. A bullied child often feels somehow to blame for the situation. A healthy self-
esteem allows them to behave in a positive but controlled manner. Many children don't know how to
stand up for themselves without fighting back.
For weeks, some classmates had mercilessly taunted 14-year-old Mary Garcia of Manila because she
was smart, had many friends and was popular with boys. They called her names, including "bitch."
"I told her to walk away from these girls, avoid them and go to places where they wouldn't meet," her
mother says. "I also helped her to write a story in her school magazine on "Dangers of Envy." This
helped Mary understand how envy can lead to bullying and that she was not to blame for the taunts."
Strengthen friendships. Encourage children to make new friends who can give moral support. Going
for swimming or karate classes gives kids a chance to make new friends but can also build up a child's
social skills and confidence," says Appadoo.
Ten-year-old Ranjit Ramli of Singapore didn't want to go to school because he was being bullied. His
parents arranged for some friends to walk to school with him. When the bully approached, he
shouted, "If you bother me again, I'll tell the principal." The bullying stopped.
Seek expert help. First make an appointment to see your child's teacher. Bring a written report of the
bullying incidents and set a mutually agreed time limit for action to take effect.
Don't telephone the bully's parents or talk to the bully yourself - let the school do it. If the bullying
does not stop, see the principal. After this, a letter to the school's Board of Governors is in order.

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The Influence of the Physical and Sociocultural Environment on Personality Development

Why are there children and youth who are happy and contented with their lives, adjusted to their
home situations, enjoy their families, live the values of love and respect for others, abide by the rules
of the school, take their studies seriously as stepping stones to a good future, keep a lot of friends and
contaminate others with their good behavior? On the other hand, why are there children and youth
who show dissatisfaction with their lives, violate home and school rules and regulations, show
disrespect and hatred for their parents and teachers, get into the company of questionable characters
like neighborhood toughies, thieves, drug abusers and pushers and criminal elements in the
community?
The variations in human behavior are influenced by the basic determinants of personality
development: (1) the person's genetic background or heredity, (2) environmental factors, and (3) the
general patterning of development.
In the same way that a person's genetic inheritance dates back to centuries and even eras of the
evolution of the family tree, one's social traits are the end • products of centuries and eras of social
and cultural formation. Usually, the clan and family teach its members to conform to certain practices
and traditions. Parents teach their children to behave in ways that are appropriate to their social
status. Parents who are doctors, engineers, teachers, politicians and other professionals want at least
one of their children to follow their footsteps. Families tend to sustain and improve their social
classes, occupational and religious affiliations. Parents declare that they want a good life for their
children, better than their own.
A person is expected to follow various social roles demanded by society. The person matures in a
succession of roles in the life span from being a child, student, wage earner, husband or wife, parent,
parent-in-law and senior citizen. A person conforms to the role demands if he or she receives positive
reinforcement such as money, prestige and status. On the other hand, negative reinforcement like
punishment, deprivation of status and loss of prestige lead to nonconformist behavior.
The favorable and unfavorable elements in both the physical and sociocultural environments strongly
foster the person's value patterns and attitudes. As a result different environments shape different
personality characteristics.
Thus, a person continuously interacts with various groups and experiences varied interpersonal
relationships. He or she participates in the sociocultural environment in his own unique way
beginning with the nuclear and extended family members, gradually extending to peer groups,
classmates, friends and other significant others in his or her social world. Personality development is
very much influenced by a person's socialization experiences. He or she interacts with various modes
of behavior patterns that cover a wide range of both positive and negative experiences. His or her
behavior patterns reflect much of his or her

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personality traits which in turn generate either positive or negative responses from the social groups.
The social reactions vary from acceptance to rejection, inclusion to exclusion and similar reactions.
Ideally, social roles should be clear and comfortable for the person. However, social roles can be
conflicting, unclear and not understood so that the end results are misunderstanding, quarrel,
discomfort, negative feelings and unhealthy attitudes. In such cases, a person's personality
development and adjustment patterns may be impaired.
It is important to remember that while heredity or genetic endowment provides the potential for
favorable and positive biological and psychological environment, the person's way of thinking,
selecting options, making decisions feeling and acting are heavily influenced by the physical and
sociocultural environments.
Adaptive and Maladaptive Behavior
Adaptive behavior refers to a person's behavior patterns that have desirable consequences and foster
his or her well-being and ultimately that of the group. The term well-being means that the person
works towards growth, fulfillment and actualization of his or her potentials.
On the other hand, behavior is maladaptive if it results to negative and undesirable consequences and
interferes with the person's optimal functioning and growth. The use of the term maladaptive rather
than abnormal puts the focus on the behavior rather than the person thereby implying the possibility
for improvement. Maladaptive behavior includes any behavior that has undesirable consequences for
the individual as well as for the group. Behavior problems, emotional and behavioral disorders are
manifestations of maladaptive behavior.
The Patterning of Personality Development
Children's personality development is shaped differently in different sociocultural settings.
Nevertheless, there are specific and interrelated trends in development that are universal in nature.
(Coleman, et al., 1980)
1. Dependence to self-direction. The normal progression is seen in the fetus and the newly born
infant who are totally dependent on the mother and family members until the toddler begins to
explore the environment on his or her own. The child develops into the adolescent and into the
independent adult. Bound up with this growth toward independence and self-direction is the
development of a clear sense of personal identity and the acquisition of information, competencies
and values. The end goal of the individual is to be a person in his or her own right.
2. Pleasure to reality and self-control. Early behavior is governed by the pleasure principle advanced
by Sigmund Freud. The human tendency is to seek pleasure and to avoid pain and discomfort. As the
child matures,

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the reality principle takes over and the child realizes that he or she has to perceive and face reality.
This means distinguishing between fantasy and reality, controlling impulses and desire, delaying
immediate gratification in the interest of long-range goals, and learning to cope with the inevitable
hurts, disappointments and frustrations of living.
3. Ignorance to knowledge. Research data show that infants at birth are not like "blank slates." On
the contrary, the infant is born with certain reflexive and instinctive behavior patterns. The first two
years are characterized by the rapid acquisition of information about themselves and the world. With
time, this information is organized into coherent patterns of assumptions concerning reality,
possibility and value that provide a table frame of reference for guiding behavior. The patterns of
assumptions and frame of reference must be realistic, trustworthy, flexible and relevant to the kinds
of problems that the person will face.
4. Incompetence to competence. From birth onward to childhood and adolescence, the person
masters the intellectual, emotional, social and other competencies essential for adulthood. The
person acquires skills in problem solving and decision-making, learns to control his emotions and to
use them for the enrichment of living, and learn to deal with others and to establish satisfying
relationships. Likewise, the person learns about sexual and marital roles, occupational, parental and
other roles and relationships associated with adult life.
5. Diffuse to articulated self-identity. The core self-identity gradually emerges as the infant
differentiates himself or herself from the environment. The sex typing responses of parents and adults
produce an awareness of one's self as a boy or a girl. The reactions and feedback from people begin
to provide the child with a sense of his or her own characteristics from "good" to "bad." In the process
the child may suffer confusion because the input from the external sources of information may be
inconsistent. Self-defined identity must be in keeping with the person's "real" internal characteristics.
The significant achievements on one's self-identity should be the establishment of a confident gender
identity and a reasonable plan for one's future life by the end of the adolescent years. The individual
who fails to achieve an articulated self-identity, coherent selfhood and self-direction may bring
incompetencies and immaturities to his or her adulthood.
6. Amoral to moral. Children learn very early in life that certain forms of behavior are right, good,
correct, while others are bad, wrong and incorrect to do. As they mature, they learn a pattern of value
assumptions that operate as inner guides and controls of behavior which Freud calls the superego or
conscience in the psychoanalytic theory of behavior. Children tend to repel the good behavior taught
to them at the beginning, but soon with increasing maturity they learn to appraise them and to work
out a value orientation of their own. The child's moral orientation emphasizes a

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recognition and appreciation of the rights of others and of the differing views on the nature of reality
and decency.
Individual differences are observed in the rate and pace of personality development. Adults should
guide the children in going through the process of personality development so that they can grow up
to be self-regulating and self-directing persons well into adulthood. Individuals who are not able to
gain the skills and competencies at the right stage of development become at risk for developing
behavior problems, emotional and behavioral disorders.
Definition of Emotional and Behavioral Disorders
While a number of definitions have been proposed, psychologists and special education experts to
date have not agreed on a consistent and universal definition of emotional and behavioral disorders
for the following reasons: (Heward, 2003)
1. Disordered behavior is social construct. There is no clear agreement as to the criteria and
parameters of normal adaptive behavior and good mental health.
2. Different theories of emotional disturbance use concepts and terminology that do not present a
clear meaning of the condition.
3. Measuring and interpreting disordered behavior across time and setting is a difficult, exact, and
costly endeavor.
4. Cultural influence, expectations and norms across ethnic and cultural groups are often quite
different.
5. Frequency and intensity of disordered behavior is difficult to measure and control in view of the
fact that children behave inappropriately at times.
6. Disordered behavior sometimes occurs in conjunction with other disabilities such as mental
retardation and learning disabilities.
The definition that had the most impact on special education in the United States was written by Eli
Bower in 1957 (Zionts, 2002). However, Bower's definition was criticized for its vagueness and
subjectivity. Special education teachers asked for more specific indicators of satisfactory, normal,
inappropriate and pervasive interpersonal relationships. Later on, Bower's definition was revised and
adopted by the US Department of Education using the term seriously emotionally disturbed. Three
factors were considered in determining if a child is emotionally disturbed: intensity, pattern and
duration of behavior:
• Intensity refers to the severity of the child's problem. This factor is the easiest to identify if one is
guided with these questions: How does it get in the way of the child's or society's goals? How much
does it draw attention from others?
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• Pattern means the time when the problem occurs. Do problems occur only during the school
day? Only during math class? Science class? At home? At bedtime? Answers to these questions may
yield very helpful diagnostic and remediation information.
• Duration refers to the length of time the child's problem has been present. This implies that
continuous observation has to be made. Some special educators require a three-month duration
before they suggest that the child has an emotional or behavioral problem.
While there is no consensus yet as to its universal definition, those adopted in the Individuals with
Disabilities Education Act (IDEA (1997) and the Council for Children with Behavioral Disorders (CCBD,
1989) exert the most influence today.
IDEA Definition of Serious Emotional Disturbance (Heward, 2003)
IDEA, the public law on special education in America, defines serious emotional disturbance as:
(i) a condition exhibiting one or more of the following characteristics over a long period of time
(chronicity), and to a marked degree {severity), which adversely affects educational performance
(difficulty in schoot).
(a) an inability to learn which cannot be explained by intellectual, sensory, and health factors;
(b) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
(c) inappropriate types of behavior or feelings under normal circumstances;
(d) a general pervasive mood of unhappiness or depression; or
(e) a tendency to develop physical symptoms or fears associated with personal or school problems.
(ii) The term includes children who are schizophrenic (or autistic). The term does not include children
who are socially maladjusted unless it is determined that they are seriously emotionally disturbed.
The IDEA definition clearly specifies three conditions that must be met: chronicity, severity, and
difficulty in school. It lists five types of problems or characteristics that a child with serious emotional
disturbance exhibits. However, teachers found the definition to be vague and lacking in objectivity.
There were no specific behavior indicators of interpersonal relationships that were satisfactory and
normal as opposed to those that were inappropriate and pervasive. Likewise, there was no distinction
between serious emotional disturbance and social maladjustment. Children with social
maladjustment are not considered disabled and there-

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fore are not qualified to the special education programs supported by the American government. The
teachers felt that the IDEA definition left too much to the subjective opinion of authorities especially
the teachers who are involved in the assessment of children suspected to be seriously emotionally
disturbed.
CCBD Definition of Emotional and Behavioral Disorders
(Heward, 2003)
In 1989 the Council for Children with Behavioral Disorders (CCBD),
the major professional organization of special educators concerned with children with emotional and
behavioral disorders, and the National Mental Health and Special Education Coalition wrote the
following definition that is now incorporated in the public law on special education or IDEA.
Emotional and behavioral disorders is a disability characterized by:
(i) behavioral or emotional responses in school programs so different from appropriate age, cultural,
or ethnic norms that they adversely affect educational performance. Educational performance
includes the development and demonstration of academic, social, vocational, and personal skills.
Such disability is:
(a) more than a temporary, expected response to stressful events in the environment;
(b) is consistently exhibited in two different settings, at least one of which is school-related; and
(c) is unresponsive to direct intervention in general education or the child's condition is such that
general education interventions would be difficult.
(ii) Emotional and behavioral disorders can coexist with other disabilities.
(iii) This category may include children or youth with schizophrenic disorders, affective disorders,
anxiety disorders, or other sustained disturbances of conduct or adjustment when they adversely
affect educational performance in accordance with section (1).
The CCBD definition focuses on the characteristics and special education needs of children and youth
with emotional and behavioral disorders. All other proposed definitions agree that the behavior of
children with emotional and behavioral disorders differs markedly or extremely and chronically or
over time from the present social or cultural norms. Special education teachers focus on the child's
misbehavior and the environmental events that trigger such misbehavior.
Additional factors are considered in assessing a child who is suspected to be emotionally disturbed
(Heward, 2003):

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• Rate refers to the frequency of occurrence of behavior per standard unit of time (e.g., stands up six
times every ten minutes). Most children cry, get into fights with other children, and sulk from time to
time, yet they are not emotionally disturbed. The primary difference between children with
behavioral disorders and other children is the frequency with which the behavior occurs. Emotionally
disturbed children, unlike other children do the undesirable behavior too often and engage in
adaptive behavior too infrequently.
•' Latency refers to the time that elapses between the opportunity to respond and the beginning of
the behavior. The latency of the child's behavior may be long, that is, upon the prodding of the
teacher, he or she withholds an inappropriate behavior, thinks about an appropriate behavior
suggested by the teacher, and complies with the teacher's request all within a span of time, usually a
few or several minutes. On the other hand, the latency of the child's behavior may be very short, that
is, he or she may immediately scream, throw a tantrum, hit others, at the slightest provocation or
frustration, instead of taking time to consider more appropriate behaviors.

Classification of Emotional and Behavioral Disorders

Emotional and behavioral disorders fall under four systems of classification: (1) the Diagnostic and
Statistical Manual of Mental Disorders (DSM - IV) classification published by the American Psychiatric
Association (1994); (2) Quay's Statistical Classification; (3) the classification derived from direct
observation and measurement; and (4) the classification based on the degree of the severity of the
disorder (Heward, 2003).
1. The Diagnostic and Statistical Manual of Mental Disorders IV
(American Psychiatric Association, 1994)
The DSM-IV is an elaborate clinical classification system consisting of 230 separate diagnostic
categories or labels to identify the various types of disordered behavior as observed by psychiatrists,
psychologists, mental health personnel and other clinicians in their regular practice. The classification
system lacks reliability as shown in the way clinicians classify the clients in different categories.
Another criticism about the DSM-IV classification system is the lack of guidelines for education and
treatment. No useful information on intervention programs and therapies are available in the manual.
The American Psychiatric Association (1994, cited by Zionts, 2002) enumerates three criteria that
must be met in determining the presence of emotional and behavioral disorders, particularly among
adults:
The person experiences significant pain or distress, an inability to work or play, an increase risk of
death, or a loss of freedom in important areas of life.
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• The source of the problem lies within the person, due to biological factors, learned habits or
mental processes, and is not simply a normal response to specific life events, such as the death of a
loved one; and
• The problem is not a deliberate reaction to conditions such as poverty, prejudice, government
policy or other conflicts with society. While the APA addresses psychological disorders, the criteria are
certainly applicable to other possible causes of emotional and behavioral disorders as well. Therefore,
extra caution should be exercised to avoid hasty generalizations about who may exhibit some of these
characteristics.
2. Quay's Statistical Classification
Quay and his colleagues collected a wide range of data on hundreds of children with emotional and
behavioral disorders. They asked parents and teachers to accomplish rating forms and questionnaires
on the children's behavior and life histories. The statistical analysis of data revealed four clusters of
traits and behaviors among children with emotional and behavioral disorders:
a. Conduct disorder is characterized by disobedience, being disruptive, getting into fights, being
bossy and temper tantrums.
b. Anxiety withdrawal, sometimes called anxiety disorder, is manifested by social withdrawal,
anxiety, depression, feelings of inferiority, guilt, shyness, and unhappiness.
c. Immaturity shows in short attention span, extreme passivity, daydreaming, preference for
younger playmates, and clumsiness.
d. Socialized aggression is marked by truancy, gang membership, theft, and a feeling of pride and
belonging to a delinquent subculture.
Aggression and acting out are the major characteristics of Quay's conduct disorder and socialized
aggression categories.
A significant finding in the study showed that the above clusters of behavior appear in groups rather
than singly. Thus, there is a higher incidence of conduct disorder in a child who shows anxiety
withdrawal, immaturity or socialized aggression.
3. Direct Observation and Measurement
Five dimensions of the child's display of the disordered behaviors are observed, measured and
analyzed.
a. Frequency indicates the rate at which the behaviors occur and how often a particular behavior is
performed. Normally, disobedience, temper tantrums, shyness, clumsiness and unhappiness are
displayed by most children. However, a child with emotional and behavioral disorders engages in the
undesirable behavior most of the time and shows normal behavior less often.

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b. Duration is a measure of the length and amount of time a child exhibits the disordered behaviors.
The length and amount of time spent in the undesirable behaviors is longer and may last for an hour
or more. Normal children display temper tantrums for no more than a few minutes.
c. Topography refers to the physical shape or form of behavior. For example, running a race and
walking each has its own topography. Although the legs are used in both motor activities, running has
its own shape or topography that differs from walking. The topography of the behaviors displayed by
children with emotional and behavioral disorders deviate from the normal. They are maladaptive,
bizarre or dangerous to the child himself and others.
d. Magnitude refers to the intensity of the displayed behavior. For example, the magnitude of one's
aggressive behavior may have a high magnitude or intensity so that the whole class is affected. A
person who threatens to commit suicide by jumping off a tall building or hostages a victim displays a
disruptive behavior of high intensity. The police, fire department and people in the community all get
affected by the suicide incident.
e. Stimulus control refers to the inability to select an appropriate response to a stimulus. The child
has difficulty in selecting the correct behavior in a social situation. In the class where all the students
are expected to listen while the teacher explains the lesson, the child with emotional and behavioral
disorders engages in disruptive behavior such as shouting, hitting seatmates, and similar
inappropriate response to the class activity.
4. Degree of Severity
Studies conducted by Olson, Algozzine and Schmid (1980, cited in Heward, 2003) indicate that
emotional and behavioral disorders can be mild and severe. The children who respond positively to
therapy and intervention have a mild level or degree of emotional and behavioral disorders. They can
attend regular classes and work successfully with the regular and special education teacher and the
guidance counselor. Those who have severe emotional and behavioral disorders require intense
treatment and intervention.
Etiological Factors and Causes of Emotional and Behavioral Disorders
There are two factors in the etiology or causes of emotional and behavioral disorders: biological and
environmental.
Biological Factors
Authorities believe that all children are born with a biologically determined temperament. The inborn
temperament may not directly cause a behavior problem to occur but may predispose the child to
behavior disturbances. Certain events that easygoing children can handle may be problematic to
other children with a difficult

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temperament. However, studies show that even when a biological impairment exists, there are no
proofs to link the physiological abnormality to the occurrence of emotional and behavioral disorders.
Environmental Factors
Home and Family Influences
Studies present pieces of evidence on the correlation between parent-child interaction patterns and
the development of positive and normal behavioral characteristics in the child. The relationship that a
child has with the parents during the early years is critical to the way he learns to behave. Frequent
parental involvement in providing for the child's physical and psychological needs is a significant factor
in developing a healthy self-concept. Parents who create situations in a loving and caring atmosphere
to meet those needs teach their children about norms of conduct and acceptable behavior. Attention
and reinforcement of positive behavior as well as appropriate discipline for negative behavior in an
atmosphere of love and caring help shape desirable patterns of behavior.
School Experiences
There are experiences in school where children spend a large part of the day that can precipitate the
occurrence of behavior problems. A child who gets all the attention at home suddenly finds himself
competing for the teacher's attention with thirty other children. There are class rules to obey unlike at
home where he or she can do as he or she pleases. It is common for bigger classmates to bully the
small ones leading to fights and quarrels. When a child is not ready to handle these events he or she
resorts to externalizing or internalizing behaviors. School experiences can contribute to the
development of emotional and behavioral disturbances.
Research data show that classroom experiences can maintain and strengthen behavior problems even
though the teacher tries to control the situation. The child's behavior pattern learned in school is a
composite of behavior and attitudes learned at home that interact with his or her experiences with
different teachers and classmates. However, studies show that teachers can help children develop
acceptable behavior without knowing the original causes of the behavior problems.
The causes of emotional and behavioral disorders are related to predisposing, precipitating, and
sustaining factors in the occurrence of the said behavior. Predisposing factors refer to the tendencies
and risks to develop emotional disturbances. Examples are physical illness or disabilities, shyness,
hyperactive behavior that may come about as a result of heredity or emotionally dysfunctional home
environments. Precipitating factors refer to specific incidents that may trigger the display of emotional
disturbances. Examples are death in the family, abandonment, separation of parents and other crisis
situations. The continuous presence of the predisposing and precipitating factors in the person's
environment leads to the recurrence of the emotional disturbances.

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Both predisposing and precipitating factors may or may not trigger emotional disturbances because of
individual differences in the manner by which a person is able to handle problems and crisis
situations.

Characteristics of Children and Youth with Emotional and Behavioral Disorders

Intelligence, Intellectual Characteristics, and Academic Achievement
Research on American children with emotional and behavioral disorders that used national samples
revealed that these children have average IQ scores with a mean score of 86 points with more than
half of the samples scoring between 91 and 90 points (Valdes et al., 1990). In another study (Cullinan,
et al., 1992) concluded that a higher mean score of 92.6 was achieved by these children because they
attended regular classes and received special education services. The research data disprove the
popular thinking that these children are poor in academic work and slow learners.
However, specialists advance the concept that it is difficult to conclude with certainty if these,
children have average or above average intelligence. IQ tests measure only how well a child performs
certain tasks at a given time. But IQ test scores cannot account for the effect of the disordered
condition on the child's intellectual functioning. It is possible that the condition lowers the
performance in academic tasks as shown by below average IQ scores. Kauffman (1993) concluded in
his study that there are enough research data to support the concept that although the majority fall
slightly below average in IQ, a disproportionate or smaller number, compared to the normal
distribution, score in the dull normal and mildly retarded range, and relatively few fall in the upper
ranges. Rhode et al. (1988) estimate that the average student actively attends to the teacher and the
assigned work approximately 85% of the time. On the contrary, students with behavioral disorders are
on task only about 60% of the time or less of the time. Hyperactive Filipino children were found to
stay on task only about 40% of the time (Bautista, 2003).
Comparative data on actual school achievement test scores and IQ scores reveal that they achieve
below the levels suggested by their IQ scores. The estimate is that less than half or only 30% of
American students are performing at the grade level expectation or at an above level. Summarily, the
following general outcomes describe the intellectual and academic abilities of these children.
(Heward, 2003)
• Two thirds could not pass competency examinations for their grade level.
• They have the lowest grade point average of any group of students with disabilities.
• Forty-four percent failed one or more courses in their most recent school year.
• They have a higher absenteeism rate than any other disability category, missing average of 18
days of school per year.

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• Forty-eight percent drop out of high school, compared to 30% of all students with disabilities and
24% of all high school students.
• Over 50% are not employed within 2 years of exiting school.
Social Skills and Interpersonal Relationships
Studies confirm the observation that students with emotional and behavioral disorders often
experience great difficulty in developing and maintaining interpersonal relationships as early as during
early childhood. The problems in acquiring social skills and in maintaining healthy interpersonal
relationships persist through the adolescence period and adulthood. In secondary schools, research
findings show that these children tend to have low empathy for others as evidenced by their "I don't
care" attitude towards people they inflict pain on. They participate in fewer curricular activities, have
fewer contacts with friends and show lower quality interpersonal relationships.
Antisocial Behavior
These children manifest consistent and frequent disordered patterns of behavior that violate the rules
and regulations at home, the laws of the community and the country. They show their disdain for
society and its norms by engaging in activities that go against others and property. In the classroom
where students are expected to follow certain standards, these children maintain an out-of-seat
behavior, do not complete school work, run around, hit and pick up fights, disturb their classmates,
ignore, talk back to and argue with the teachers and school authorities, complain excessively and
distort the truth. They steal, engage in vandalism by destroying public and private property, and keep
the company of known goons and criminal elements. Other characteristics are willingness to commit
rule infractions, defiance to adult authority, and violation of the social norms and mores of society.
Deviant behavior tendencies among secondary Filipino students revealed five components of
antisocial behavior (Ibañez, 2003): defacing school property, creating assult or abuse toward students
and school authorities and personnel, wearing or displaying unacceptable attire and grooming, and
engaging in activities that interfere with academic performance, and violate school legal norms and
policies.
Antisocial behavior patterns form the foundation for the clinical diagnosis of conduct disorders
(American Psychiatric Association, 2000) which are aggressive forms of behavior towards people and
animals, destruction of property, deceitfulness, theft, and serious violation of rules. In school setting,
antisocial behavior and conduct disorders are categorized as social maladjustment.

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Oppositional Defiant Disorder (ODD)
As the name implies, students or individuals with oppositional defiant disorder consistently go
against, oppose, defy, and show hostility towards authority figures. The symptoms are (APA, 1994):
Often loses one's temper
• Often argues with adult's requests or rules
• Often actively defies or refuses to comply with adult's requests or rules
• Often deliberately annoys people
• Often blames others for one's mistakes or misbehavior
• Often touchy or easily annoyed by others
• Often angry and resentful
• Often spiteful and vindictive
Children who display patterns of antisocial behavior very early in life are at risk for developing more
serious and long-standing behavior problems in adolescence and adulthood.
Externalizing and Internalizing Behavioral Disorders
Some children with emotional and behavioral disorders display externalizing behavioral disorders that
violate the rules and norms of society and annoy and disturb other people. Some common examples
are: out-of-seat behavior, making unnecessary noise, truancy, constant talking to self and others,
disobedience, inattention, persistent lying, constant blaming of others.
On the other hand, too little social interaction of children with internalizing behavioral disorders
create a serious impediment to their development. They manifest withdrawn behavior, lack social
skills, often daydream, tend to be fearful of things and events without reason and may experience
serious bouts of depression. Internalizing behavioral disorders involve mental or emotional conflicts
that may go unnoticed.
Aggressive and Violent Behavior
Aggression refers to acts that are abusive, that severely interfere with the activities of other people or
objects and events in the environment. Examples of the milder forms of aggression are teasing,
clowning around, tattling, and bullying. Severe aggression includes threat of physical harm, physical
attack, destruction of property and cruelty.

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Delinquency
The word delinquency is a legal term that refers to the criminal offenses committed by an adolescent. Delinquency is a
behavioral disorder. Studies show that a pattern of antisocial behavior early in a child's life is a strong predictor of
delinquency in adolescence. Criminal careers start at an early age, usually by age 12. The adolescents commit more serious
offenses and continue a pattern of antisocial behavior until adulthood. Oftentimes, they are beyond the control of their
parents, family and friends. Many offenses are brought to court, but others remain unreported and unknown. Examples of
delinquent acts and the crimes they can lead to include:
Juvenile Offenses Crime
1. breaking in and destroying 1. robbery
private property, attempted
burglary, stealing, shoplifting
2. brutality - beating up a person 2. attempted homicide,
until he or she is black and blue, murder
burning a house or a person,
shooting a person
3. lascivious acts, touching the 3. rape
private parts of a person, attempted
rape especially of children, those
with disabilities
4. early smoking and drinking, 4. committing crimes under
experimenting habituation to the influence of liquor,
prohibited drugs drugs, drug dependency,
drug pushing
5. carrying a knife, ice pick 5. carrying deadly weapons
6. disorderly conduct 6. shooting incidents,
murder
Figure 38. Juvenile Offenses and the Crime they Can Lead To
When a young person is brought to court for committing certain offenses, charged and found guilty,
he or she is described as a juvenile delinquent. Almost half of all juvenile delinquents are recidivists or
repeat offenders who go in and out of jail.
Identification and Assessment
The procedures are similar to those used in the other types of disabilities. Teachers, parents, peers
and other persons report cases of simple offenses like being beaten up, stealing, smoking, sniffing
rugby, and similar juvenile offenses. Screening is done to eliminate children who do not have behavior
problems. The children who show the early signs or who seem to be at risk for developing emotional
and behavioral disorders are identified.

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Direct observation is done to determine the frequency, duration, topography, magnitude and stimulus
control of the behavior. The cases that are found to be beyond the help of the school and home
authorities are referred to professional clinicians for assessment.
Assessment Procedures
The identification of very young children with emotional and behavioral disorders is more difficult
than that of the older ones. The behavior patterns of younger children are usually unstable due to the
maturation process itself.
In the same manner that children with other forms of disabilities are assessed, the Special Education
Division of the Bureau of Elementary School, Department of Education has developed assessment
materials for this particular type of children. Prereferral intervention consists of teacher nomination,
parent and peer nomination through the use of checklists of behavior and learning characteristics at
home, in school and other typical environments. A battery of assessment materials are used in the
multifactored evaluation that covers achievement and intelligence tests, social development and
personality tests.
A number of assessment materials are locally available. Bautista (2003) developed a Behavior
Checklist for the Identification of Pupils with Hyperactivity from Grades I to IV. The 45 items measure
the extent of hyperactive behavior based on the time and frequency rates of temper outbursts,
restlessness, shifting from one task to another, bullying and teasing, fidgeting, oversensitivity and
other related behavior. Rigonan (2002) developed an Aggression Inventory Scale for Adolescents that
measures hostility, disobedience, destructiveness, antisocial tendencies and dominance. Ibañez
(2003) developed the Deviant Behavior Tendencies Scale that determines the range of deviant
behavior as manifested in acts such as defacing school property, assaulting or abusing students and
school authorities, wearing or displaying unacceptable attire and grooming, engaging in activities that
interfere with academic performance, achievements, and violate legal norms and policies.
Educational Approaches
While there are several conceptual models for understanding and treating emotional and behavioral
disorders, research shows that a single model alone is not used. Instead, it is the practice of special
educators, therapists and psychologists to combine certain features of the conceptual models and
develop an eclectic approach in developing a program for particular groups or individual students.

Applied Behavior Analysis

The regular teacher and the special education teacher work collaboratively in developing an
individualized education plan or IEP. The aim is to decrease the

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undesirable and maladaptive behavior and increase the occurrence of desirable behavior. The
behavioral theory and model of personality development is applied. The theory assumes that the
behavior problems have been learned from his or her history of interactions with the environment.
Applied behavior analysis strategies are employed to help the child learn new, appropriate responses
and eliminate the inappropriate ones.
Teaching Social Skills
Stephens (1992) has developed a curriculum that covers 132 specific social skills for school-aged
children grouped into 30 subcategories under four major areas:
1. self-related behaviors: accepting consequences, ethical behavior, expressing feelings, positive
attitude toward self
2. task-related behaviors: attending behavior, following directions, performing before others, quality
of work
3. environmental behaviors: care for the environment, dealing with emergencies, lunchroom
behavior
4. interpersonal behaviors: accepting authority, gaining attention, helping others, making
conversations

At present, a large number of social skills curricula and training programs are commercially available
in the United States. The skills are clustered in three age-developmental levels - preschool,
elementary and secondary levels. They focus on resolving interpersonal problems, getting along with
others, following directions, handling name calling and teasing and offering to help, preventing antiso-
cial behavior, increasing self-esteem, developing competence in dealing with peers, family and
authority figures.
Alternative Responses
Knapczyk (1992, cited in Heward, 2003) developed the alternative responses strategy in training four
students with behavior problems to handle or defuse provocative incidents. Instructions consisted of
individualized videotape modeling and behavior rehearsals. Two male students who were leaders in
the school served as actors. One played the role of the subject, simulating his usual reactions to
provoking situations and demonstrating appropriate alternative responses. The other actor acted out
the usual reactions of classmates. After watching the videotapes, the subject students discussed the
circumstances of the incidents with their special education teacher and practiced specific alternative
responses. The treatment decreased the frequency of aggressive acts of the four students across
several settings. A concurrent decrease in the number of provoking incidents was also noted.

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Teaching Self-management Skills
Research findings show that children with behavior problems have low self-concept and believe that
they have little control over their lives. The only way they know to handle their problems is to act out
their disruptive behavior. The result is always a feeling of worthlessness and frustration.
A number of programs on teaching self-management skills have been developed by specialists that
aim to enable students with behavior problems to have some control over their own behaviors and
over their environment. The special education teacher plays the role of the external control agent
who teaches appropriate behaviors in the resource room that the student needs to apply in
appropriate settings. The teacher cannot be with the student at home, in the classroom or in places in
the community and other settings where the student needs to exhibit the learned behaviors. But the
one person who is always with the student is his own self. The student learns to observe and record
his own behavior in different settings. The records are analyzed together with the teacher so that the
student sees for himself the negative effects of his acting out behaviors. Effective ways of handling the
situations are learned and practiced. Good work is reinforced with physical and social rewards.
An example of teaching self-management skills is seen in the work of Drabman, Spitalnik and O'Leary
(1973). They taught a group of 9-and-10-year-olds to record and evaluate their social and academic
work behavior. The teacher did his own recording and evaluation against which the students
compared their work. Initially, the students were rewarded with tokens when their own evaluations
matched those of the teacher. Then praise alone was used as reward for accurate evaluation. Later on,
the students rated themselves and decided how many tokens they had earned during the day. Spot
checks showed that the children evaluated themselves accurately and honestly. Disruptive behavior
decreased and academic achievement increased. The greater gain of this strategy is the fact that
students with emotional and behavior problems learned to be responsible for their negative
behaviors and they learned self-direction in managing their social and academic work.
Intervention Procedures that Minimize Behavior Problems
Ecological intervention (Culatta, et al. 2003) is built on the principle that behavior problems exist
within the child's environment where a constant global interaction between the child and the
environment occurs. In ecological intervention, initially, the point of encounter between the child and
people or events in the environment are identified. Then, the cultural source of the problem is traced
in terms of the people, the cultural practices and other influences in the community. Finally, an
intervention procedure that focuses in the person and the environment is developed and applied to
the problematic situation.
Positive reinforcement is a universally accepted intervention designed to increase the display of
desirable behavior and to decrease or reduce the opportu-

173
nity for negatively viewed behavior to occur through a system of rewards. External reinforcers are
immediately applied when the desirable or preferred behavior is manifested. When the preferred
behavior is exhibited regularly, the reinforcers are removed following a systematic schedule. On the
other hand, negative reinforcement involves the removal of a negative stimulus contingent upon the
desired behavior. Thus, a child is allowed to have recess when he or she finishes the seatwork. In
extinction the reinforcer for a behavior that has been previously reinforced is withheld. Extinction is
useful in reducing the number, intensity or duration of an undesirable behavior. For example, when a
teacher consistently ignores inappropriate talk, the student may at first talk louder to get the
teacher's attention. Eventually, if the behavior is consistently ignored, the student will cease talking
because he or she is not getting any reinforcement from the teacher.
Rule setting is an easy and effective way to manage behavior in the classroom. A few, simple, realistic,
and easy-to-follow rules are set together with the consequences if they are followed or violated.
Positive reinforcement is applied when the rules are followed. When a rule is broken, the teacher uses
body language to send the message by stopping the lesson, eye contact, and other ways of showing
displeasure. The agreed upon negative reinforcement is applied as a consequence of the violation.
Pacing the lesson and using a variety of activities are simple yet effective ways of managing behavior.
Some activities use games, humor, proximity control and letting others follow the examples. The
teacher can model the desired behavior without verbal cues.
Other educational strategies found to be effective are cognitive strategy and cognitive model. In
cognitive strategy, self-monitoring, self-instruction, and self-control strategies are utilized. The goal is
to help the students develop self-awareness and self-direction by using positive reinforcement for
social development and improved academic performance. The student records his or her own
behavior or academic scores. Sometimes the teacher does the recording and they compare notes of
their ratings. If the ratings are consistent with each other, the student receives an extra reinforcer. The
charts and record sheets frequently function as reinforcers, thereby removing the need for other
reinforcers. One advantage of the self-management cognitive strategy is that it allows the student to
generalize the intervention from one setting to another. The student brings the self-monitoring sheets
to the teacher for approval. The self-evaluation sheets help the students understand what the
undesirable behavior is, when and where it had occurred and what the consequences are.
The cognitive model is also called information processing model and emphasizes strategies for
memory, storage, retrieval and metacognition. A good example is the use of mnemonics or acronyms
to remember a list of concepts thus taught. Another cognitive strategy is learning prefixes and suffixes
to assist the students in learning the meaning of words. For example, if the student knows the
meaning of ante or before and anti or against, then the meaning of words with these prefixes like
anteroom and antipoverty can be analyzed.

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Read and Respond
Test on Content Knowledge
How much did you learn about children and youth with emotional and behavioral disorders? Find out
by answering the following questions:
1. Explain how the person's socialization experiences in the following socioculrural environments
influence personality development:
• home and the nuclear family members of the extended family
• school administrators, teachers and peers church, religious beliefs and practices
• neighborhood and community
2. How do the following trends shape a person's personality pattern? Write the significant developments in each of the
trends listed in the matrix.
TRENDS AND PATTERNS IN PERSONALITY DEVELOPMENT
FROM TO

1. dependence

2. pleasure:

3. knowledge:

4. incompetence: 4. competence: -.....

6. amoral: 6. moral:

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3. Explain how the following reasons have led to disagreements among experts and specialists on
the definition of emotional and behavioral disorders:
• Normal or abnormal behavior is shaped by social conditions, thus, disordered behavior is a social
construct.
• It is not easy to measure and interpret behavior problems in the different stages and setting of
growth and development.
There are cases of dual disabilities where emotional and behavioral disorders exist together with
other disabilities such as mental retardation and learning disabilities.
4. Cite the definitions of emotional and behavioral disorders according to:
a. Eli Bower (1957)
b. Council for Children with Behavioral Disorders (CCBD, 1989)
Compare and contrast the two definitions by filling in the matrix below:
Bower's Definition CCBD's Definition
1. characteristics: 1: characteristics:

2. chronicity: 2. chronicity:

3. severity: 3. severity:

4. difficulty in school: 4. difficulty in school:

5. need for special 5. need for special education:

education:

Write your own definition of emotional and behavioral disorders.

5. Describe each of the following classifications of emotional and behavioral disorders. Write the
significant indicators of the disordered behavior.
• The Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
• Quay's statistical classification
• Direct observation and measurement
• Degree of severity

176
6. Enumerate and describe briefly the biological and environmental factors that cause emotional
and behavioral disorders.
7. What are the characteristics of children with emotional and behavioral disorders? Describe
each briefly.
8. Enumerate and describe the educational approaches in teaching children with emotional and
behavioral disorders. How do they differ from the approaches and strategies used in teaching normal
children?
Reflection and Application of Learning
1. Every person has his or her own historicity - the so-called Banig ng Buhay, which is like a tapestry
where one's life history is woven. Recall your own historicity by looking back at your banig and the
significant events woven therein, positive or negative, in the following stages of your life:
• Stories that mom and dad told me about themselves, their families, their joys and sorrows, their
success and failures.
• My recollection of childhood, life with my family, school, happy and sad events.
• My present life, the lessons I have learned from past experiences, how I am coping with the
challenges.
• The near future - how I see myself five years from now; how I am preparing myself today to
become the person I want to be.
Get a partner and share your banig with each other.
Look forward to the time when you would be a teacher of children with behavior problems. How will
you make use of the knowledge that you learned from this chapter?
2. Read a research paper on EBD. Summarize the content knowledge and insights that you have
gained which are not found in the text.

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Chapter 9 STUDENTS WHO ARE BLIND OR HAVE LOW VISION
Julieta A. Gregorio

To the Course Professors and Students:

Man's capacity to use his or her visual mechanism places him or her on top of all other creatures in
the world. There is no doubt that in the list of the basic human senses, vision is number one, followed
by audition or hearing, kinesthesia or touch, olfaction or smell and gustation or taste. Authorities
state that although man uses all his senses simultaneously in gathering varied stimuli from the envi-
ronment nearly eighty percent (80%) of all knowledge and information that man acquires in his or her
lifetime are gained through the visual modality. With the use of human intelligence mainly through
vision, man has attained superiority over all other species in the world as shown in the tremendous
advances in technology through the centuries. A writer poses two questions on how much man values
human sight: "Through the centuries, how many have really appreciated God's greatest gift to man?
Even in this day of modern scientific miracles and educational opportunities, how many really know
what the eye really is and what makes it work?" To which a third question is added: "How much and
how well does man take good care of his or her vision?"
This chapter takes the student to the world of persons who cannot see or who can see only a part of
the real world. Blindness changes a person's perspectives and concepts about the seeing world where
he lives. The chapter covers the definition and concepts on blindness and low vision, the learning and
behavior characteristics of persons with blindness and low vision, causes of visual impairment, the
special education provisions for these types of students and the special adaptations that enable them
to learn side by side with their seeing classmates.
At the end of the chapter, the students should be able to:
1. describe the anatomy and physiology of the human eye and how the process of vision takes
place;
2. define legal and educational blindness;
3. differentiate low vision from blindness;
4. enumerate and describe the types and causes of the problems of vision;
5. enumerate and describe the advances in technology for blind persons;
6. describe the educational provisions for students with visual disabilities; and
7. gain inspiration from the abilities of persons who are blind or have low vision.

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Vignettes About Children and Youth Who Are Blind or Have Low Vision
The following vignettes and success stories about young people who are blind or have low vision
illustrate that a disability need not be a stumbling block in acquiring an education. With
determination and patience, skills and competencies can be acquired through the remaining non-
visual sense modalities.
Losing her eyes, gaining a purpose
Young Achievers by Lorenzo Z. Manguiat Philippine Daily Inquirer, June 12, 2005
Minnie Juan may have been blind since she was 4, but that didn't stop this jolly major from graduating
as college valedictorian. Knowing the odds firsthand, she made it her mission to inspire visually
impaired children to set their sights higher.
Born seven months premature and weighing a mere 2.2 pounds, Minnie Juan's name derives from her
dimunitive size at birth. But the tiny infant has made it big, overcoming her physical limitations and
handicap with outstanding academic achievements.
The visually impaired Minnie, 20, graduated as Trinity College batch 2005's valedictorian and magna
cum laude, with a degree in English.
As a premature baby, she was placed in an incubator for more than a month and suffered
complications that led to partial blindness.
One night when Minnie was four, she was rushed to the hospital because she felt a burning sensation
in her eyes. Her retinas had hemorrhaged due to oxygen toxicity. After three unsuccessful operations,
she completely lost her sight.
"I felt really frustrated at first because when I was still able to see, I loved looking at picture books and
at different colors," Minnie reveals. "Then suddenly everything went black. I cried because of the pain
in eyes, but I didn't feel any pain in my heart," she recounts. "Young as I was, I didn't feel any anger. If
I became blind at a later age, then maybe that would have been more painful emotionally."
Growing up in San Carlos, Pangasinan, Minnie attended a regular elementary school together with
other able bodied children. Her parents Angelo and Maria Lilia, both doctors, had wanted her to
experience a normal childhood. But the road was a lot tougher for her. After regular classes at the
Birhen Milagrosa Child Learning School in the morning, Minnie took braille classes in the afternoon.
Like a game. "It was tough but I found enjoyment in what I was doing. Learning braille was like a game
to me. It was much easier to learn because I was having fun," admits this second of four children.

179
Showing a passion for learning, Minnie became a consistent honor student from fourth grade
onwards. She eventually became valedictorian of her high school class, but soon she had to face the
tough decision of choosing which college to attend and what course to take up.
School hunting was far from being a pleasant experience, however. Though Minnie passed one
school's requirements, it refused to admit her because she was blind. Another school was willing to
accept her but wanted one of her parents to accompany her in class.
Eventually, Minnie enrolled at Trinity, having learned about its Disabled Enabled and Empowerment
Program (DEEP).
Love for reading. "I always wanted to teach, and I love writing and reading anyway, so why not AB
English?" recalls Minnie.
The transition from being a high school student in the countryside to college student in the city was
difficult, especially for visually impaired Minnie. Adjustment was difficult and she got homesick. She
went to class with guide, Anson Taladtad.
Although Minnie wasn't the first visually impaired student to attend Trinity, some professors were
admittedly wary of having her as their student.
Recalls Alona Guevarra, Minnie's professor in seven English subjects: "I felt some hesitation at first
because I didn't have any training in teaching blind students," she said. "But after a few months, I
found Minnie to be more brilliant than other students who were supposed to be normal. She was one
of the most driven students I've ever had. She never used her condition as an excuse."
Thanks to technological advancements, Minnie was able to do most of her paperwork on a computer
program that allowed her to hear what she typed. "The quality of work she submitted was
outstanding and had minimal errors," reveals Guevarra.
Sharp mind. More than just being a visually impaired girl with a sharp mind, Minnie was also
considered one of the nicest people on campus. "She's so jolly and pleasant, it doesn't seem like she
has a mean bone in her body," says Guevarra.
Apart from excelling academically and being one of the friendlier students around, Minnie was
involved in several extracurricular activities. She became active with DEEP and the Youth for Christ,
and sang during school presentations, and concerts outside of school.
In her thesis, Minnie tackled the subject of blind writers and how they knew the world through their
literature. She took five short stories from blind writers and analyzed them.
Now that she has graduated, Minnie is determined to take her path she had wanted to tread all along.
She wants to teach, specifically blind children.

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Minnie is planning to go back to Pangasinan to take courses on special education. "My mission is to
inspire other people, blind or sighted. I want to be of service to blind people by educating them.
Hopefully, that's what God wants me to do."
Minnie Juan might have lost her sight as a child, but she has her eye on a bright future ahead.
With hands that guide
By Margaux C. Ortiz
Philippine Daily Inquirer, November 27, 2004
. Eleven-year-old Mary Jane Vinas has a big responsibility: to help three of her blind classmates climb
four floors. Using the "trailing system" she learned in special education class, Jane guides her
classmates' hands on the banister and walks behind them to make sure they do not stray from the
line. When they reach the top floor safely, Jane takes her classmates' hands and places them on each
other's elbow to form a "train." The lively 11-year-old smiles contentedly while walking, glad to be of
help to her classmates although like them, she is also blind.
"I always feel happy when 1 get to help my other classmates," says Jane, smiling brightly. "1 do not
feel tired because I know they need my help to do things which I could do better."
Jane is part of Pio del Pilar Elementary School's Busilak na Paglingap program which attends to the
educational needs of visually impaired kids in Makati City. SPED teacher Salvacion Calabucal says
fifteen blind and low vision kids attend the program every day.
"I realized that it was impossible to teach all these children at the same time," explains Mrs. Cabucal.
She adds, "In order to maximize the children's learning, 1 conceived of the buddy system."

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Mrs. Cabucal explains that the buddy system involves an able-bodied child helping a lesser-bodied
classmate perform school activities. The 51 -year-old teacher says low vision kids, who could still make
out shadows, are tasked to help and guide totally blind classmates.
"Jane, who is also mentally retarded, used to have a buddy to help her do things, but she eventually
learned to perform her responsibilities without any help," Mrs. Cabucal says proudly.
Jane, a kindergarten level student, is now a regular "ate" or big sister to three totally blind classmates
who depend on her for their daily activities. "I help my classmates Annie Girl, Tata and Kuya Kim water
the plants, buy food from the canteen, and go to the gate when it is time to go home," Jane says. "It
was a little hard to do at first because I was responsible for their safety, but I got used to it," she adds
with a grin.
Mrs. Calabucal says her ultimate goal is to make the other children, who had multiple disabilities aside
from blindness, become independent.
"The buddy system as also taught them to be more caring, cooperative, respectful and responsible,"
the teacher says. "The lesser-bodied children, like Jane, could also get the chance to serve their other
classmates by practicing what they learned from their buddies," Mrs. Calabucal says with a hopeful
smile.

Even those without sight can use the computer

By Alexa H. Bacay
Philippine Daily Inquirer, June 29, 2003
What use is a computer to a blind person if he cannot see the screen nor point the mouse to a desired
icon? Some may think that learning how to read and write in braille is enough for the visually
challenged, and complicated tasks requiring sight such as the use of a computer should be left to
those who can see. Believe it or not, because of recent technology, the visually challenged can now
make full use of the ubiquitous PC, just like any sighted person.
Resources for the Blind Inc. (RBI), a nonprofit charitable organization, in cooperation with IBM
Philippines and Nippon-Overbrook Foundation, has come up with an annual national computer camp
for blind students dubbed "Computer Eyes."
Twenty blind high school students from different parts of the country are chosen to undergo intensive
two-week computer training. This workshop focuses on topics such as word processing, e-mail,
Internet surfing and even Web publishing.
Through the use of software that employs a speech synthesis program called JAWS (Job Access With
Speech), blind students can learn the basics of operating a computer. Instead of the mouse, keyboard
commands are used allowing the visually challenged to choose from menus, commands or icons. A
headset connects the user to the computer allowing him to "listen to the monitor." This is

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possible because the application translates what one sees on the monitor into synthesized speech.
If one thinks that the computer has to have a special keyboard for the blind, think again. The
computers are just like what everybody uses plus a headset. The keys and the commands are
memorized by the students, bringing them one step ahead of the not-so-computer-literate sighted
individual. A computer for the blind should not cost more because JAWS is a software. It is just a
matter of installing it into the computer.
Computer Eyes is a workshop that began three years ago when RBI asked IBM if they can provide
facilities for the project. Without hesitation IBM immediately extended assistance by providing the
use of their state-of-the-art computer laboratory for training. This project is part of IBM's citizenship
advocacy.
"The access technology that enables a blind person to make full use of computers is well developed
and readily available in the Philippines. By providing training in this access technology, blind students
can have a new avenue for personal development and greater employment opportunities created by
the explosion of computer technology in the country," says Joaquin Quintos IV, IBM Philippines'
country general manager and president.
Carlo Flores, one of the blind students, was very enthusiastic about the recently concluded "Computer
Eyes III." His hobbies lie in programming, and he fondly informed the INQUIRER that he sometimes
experiments and sets up simple telephone programs similar to voice mail that we use today. He plans
to take Computer Science when he goes to college.
Gloribeth Dano, a senior high school student was doubtful at first because she didn't have much
training with computers. The other students seemed well-oriented with the tool compared to her. But
she tried to cope and later on realized that she can do it.
The initial plan was to make this year's workshop an international computer camp for the blind.
However with the onset of Severe Acute Respiratory Syndrome or SARS, which affected many
countries in Asia, the plan didn't push through. Hopefully, the international computer camp would be
realized in the coming years, said IBM Philippines' country marketing manager, Bernadette Nacario.
Turning darkness into light for blind children
In the dark world of blindness, seeing is believing. By Tina Arceo Dumlao
Philippine Daily Inquirer, October 17, 2004

It takes roughly two hours for this six-year-old child and his mother to get to his school in Cubao,
Quezon City, from their modest home in Sta. Maria, Bulacan. But it is always a trip worth taking. Renz
Miguel Mauricio who is blind is learning his alphabet, reading a few words, making many friends and
gaining confidence that he would get a college degree someday.

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It was not so long ago that Renz's parents felt that the world was crashing around them. The second
of three children, Renz was born prematurely. Doctors managed to keep him alive, but overexposure
to oxygen damaged his retina, leaving him completely blind at the age of three months.
The Mauricios were at a loss on how to care for their handicapped child -until Renz's doctor at St.
Luke's Hospital handed his mother Evelyn the phone number of Resources for the Blind, Inc. (RBI). It
turned out to be a ray of hope. Renz is one of over 200 students who are learning to cope in the
sighted world on RBI campuses in Quezon City and Cebu City.
He and 165 others from RBI-Cubao Kindergarten I and II visited the Inquirer Office on his birthday.
They sang some songs and performed a dance number to celebrate World Sight Day and mark the
launch of the next phase of Standard Chartered Bank's "Seeing is Believing" campaign. The global
program is aimed at restoring sight to one million people in countries around the world, including the
Philippines where an estimated 100 children lose their sight every week because of poor nutrition,
measles and premature birth.
Over 1,000 have graduated from RBI. Many have found gainful employment; others have set up their
own businesses such as hog-raising, rug-making and running sarisari stores. Parents are also trained
and counseled to help them care for their children better. Teachers from other schools, on the other
hand, are taught skills in special education.

Figure 39. BIRTHDAY boy Renz

Miguel Mauricio, 6, learns to
cope in a sighted world.

Figure 40. SONGS and dances in the INQUIRER newsroom on Friday by 17 students of the Resources
for the Blind Inc. in Quezon City marked World Sight Day and the launch of Standard Chartered Bank's
campaign to restore sight to a million people around the world

Figure 41. BLIND scholars of President Macapagal-Arroyo assert their right to be educated at the
Polytechnic University of the Philippines. (From left) Andrea Adremesin, Aideline Versoza, Joel
Rescobar and Rene Albao.

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GAMES that students from the Philippine School of the Blind play during its "Spectacular Sportsfest"
at the Cuneta Astrodome on Friday include ping-pong with customized balls.

CARLOS IBAY was in Manila with his proud parents Carmencita and Roman (left) for a benefit concert
at the CCP on Feb. 27, 2004.
Figure 42. Young people who are blind are concerned about their rights. Their condition allows them
to develop their innate talents in sports and the performing arts.
The blind tenor, pianist and linguist - Carlos Alberto Ibay
By Jeffrey F. Despabiladeras
Sunday Leisure, Manila Bulletin, February 22, 2004
A tragic situation happened to Ramon and Carmencita Ibay 24 years ago when Carmen conceived her
son Carlos. Due to a difficult and complicated pregnancy, the doctors suggested that the baby be
aborted to save her own life.
Despite the odds, she refused to give him up. She entrusted her life and her baby to God. Somehow,
she knew that the baby she was carrying was special and that she had been chosen to be his mother.
Carlos was born prematurely and weighed only two pounds. Placed inside a nursery incubator for
weeks, Carlos was exposed to too much oxygen which caused him to lose his eyesight.
Today, 24 years later, this boy who lost his vision has been captivating international concert audiences
with his talents for singing and playing the piano.
At seven he auditioned to play at the Levine School of Music. There he met his mentor Thomas
Schumacher who taught fine techniques of the piano to bring the expressive interpretation of music
beyond the standard method.
By the age of 12, Carlos won first place at the Peabody Conservatory Spring Festival and second place
at the Steinway Piano Conservatory Scholarship Competition of the Mid-Atlantic as well as in the
Merlin-Engle Piano Competition at the Levine School of Music.
The astonishing blind pianist has won many awards from other competitions. In 2000, he performed
at the opening of the Rachmaninoff Center of Music

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Culture in Navgorod, Russia, the birthplace of the acclaimed composer Sergei Rachmaninoff. That
same year, he played with the Bessler Quartet and Brazilian pianist Virginia Hogan for the Saint-Saens'
Carnival of the Animals in Rio de Janeiro.
Aside from playing the piano, Carlos evidently has been blessed with an exceptional singing voice. He
possesses the voice of a "Bel canto" tenor. His repertoire includes sacred songs, opera arias, songs
from Broadway, classical Jazz, Italian classics and popular music. "My music ranges from Bach to
Rock," he says.
The artist is also a natural born linguist. This ability has enabled him to easily master French, German,
Italian, Spanish, Russian and Japanese languages.
Carlos, together with his parents Ramon and Carmencita, flew in from West Manhattan, New York, for
a concert performance at the Tanghalang Nicanor Abelardo, Main Theater of the Cultural Center of
the Philippines on Friday, February 27, 2004. The concert aims to campaign for and raise awareness
about the value of life through the example set by the Ibay family when they fought for Carlos' life
twenty-four years ago.
The articles tell us that children with visual disabilities have the same opportunities to study in regular
schools like seeing children. With the services of a special education teacher, the absence of sight
does not have to be a hindrance to the blind persons' desire to get an education to prepare
themselves for a better life in the future. Despite blindness or low vision, they can learn to be
computer literate through the auspices of international corporations like IBM.
Blindness and Low Vision
There are two general definitions of blindness. The first is the legal definition that is based on
measurement of visual acuity, field of vision and peripheral vision. Visual acuity is the ability to clearly
distinguish forms or discriminate details at a specific distance. Normal visual acuity is measured by
reading letters, numbers and other symbols from a chart 20 feet away. The Snellen chart is commonly
used for this purpose. The sizes of the letters in the chart correspond to the appropriate distances
where they can be read with normal vision. Thus, when a person can read the row of letters marked
20/20 correctly, he or she has normal vision. His/her visual acuity is 20/20, that is, he or she can read
the letters that normal vision permits to be read 20 feet away when seated 20 feet away from the
chart. On the other hand, if a person can read the row of letters marked 20/70 only when seated 20
feet away from the chart, his visual acuity is poor. Normally, the larger letters can be read at a distance
of 70 feet. Or, when a person can read the rows of letters marked 20/200 only when seated 20 feet
away from the chart, his visual acuity is so poor that it falls within the range of blindness. However,
there are people whose visual acuity in one eye is better than normal at 20/10. This means that the
better eye can see at 10 feet away what normally can be seen at 20 feet away.

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The field of vision refers to the area that normal eyes cover above, below and on both sides when
looking at an object or when gazing straight ahead. The field of normal vision covers approximately a
range of 180 degrees. When looking directly at an object, the central field of vision is used. Peripheral
vision covers the outer ranges of the field of vision. A person may have poor central vision but good
peripheral vision. Tunnel vision results from an extremely restricted field of vision. It is like looking at
the objects in the environment through a narrow tube or tunnel. The field of vision can decrease
slowly undetected among children and adults over a period of years. A complete eye examination
should include both visual acuity and field of vision.
Legal blindness refers to the condition where visual acuity is 20/200 in
the better eye after the best possible correction with glasses or contact lenses. The field of vision,
whether central or peripheral is limited to an area of 20 degrees or less from the normal 180-degree
field. A legally blind person with his or her eyeglasses or contact lenses on can see or read only at 20
feet objects and letters that those with normal vision can see or read 200 feet away. The person
experiences difficulties in everyday activities especially in discerning fine details of objects and things
in the environment. In the United States, persons who are legally blind are eligible to receive a wide
range of benefits from the government. These include special education or vocational rehabilitation
services, free mail service and income tax exemption.
Educational Definition. Not all legally blind persons are totally blind. In total blindness the person is
absolutely without sight but may have light and movement perception and travel vision. The degrees
of blindness include light perception (person can differentiate between light and dark, day and night),
movement perception (person can detect if an object or person is in motion or in still position) and
travel vision (field of vision is enough to travel safely in familiar areas). Although classified as blind,
the person can still use his or her residual vision.
In special education, children who are blind are differentiated from those who have low vision. Blind
children use their sense of touch to read braille and train in orientation and mobility to move around
and travel independently. A child with low vision learns to read materials in large print. Corn's
definition of low vision (cited in Howard, 2003) emphasizes the functional use of vision. Low vision is a
level of vision that with standard correction hinders an individual in the visual planning and execution
of tasks, but which permits enhancements of the functional vision through the use of optical or
nonoptical aids and environmental modifications or techniques.

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The Process of Normal Vision

The sense of vision is a complex and intricate physiological system. There are three elements
necessary for good vision to take place. These are a pair of healthy, intact, and efficiently functioning
eyes with complete parts, well-lighted objects and images and a healthy brain.

Anatomy and Physiology of the Human Eye

The parts of the eye that we see on the face are only a small part of the total mechanism for seeing.
The eye is a complex part of the human body that no other organ can equal. There are five
physiological or physical systems in vision, namely, (1) the protective structures, (2) the refractive
parts, (3) the muscles, (4) the retina and the optic nerve, and (5) the brain where vision takes place.
The protective structures surround the eye to protect it from harm. These are the bony eye socket in
the skull and the protruding bones in the cheeks and forehead, the lacrimation system or tear ducts,
the eyebrows, eyelids and eyelashes. The eye socket which contains the eyeball where most of the
parts of the eye are found, is comparable in size to a ping-pong ball. It protects the sensitive
mechanism for vision from trauma, together with the bones of the cheeks and forehead. The tear
ducts or lacrimation system protect the eye by secreting fluid or tears that clean and keep the eye
moist. The eyelid moistens and cleans the cornea through blinking. The eyebrows and eyelashes catch
foreign bodies that may enter the eyes.
The refractive structures bend or refract light rays so that the image of the object focuses on the
retina. These are the cornea, aqueous humour, pupil, iris, lens and vitreous humour. The cornea is the
curved transparent membrane that protects the sensitive parts of the eye. It is the front window of
the eye that starts the process of vision by bending the light rays into patterns or images. Then the
light rays pass through the acqueous humour chamber which is one of two fluid-filled chambers. The
acqueous humour is a watery liquid that fills the front chamber of the eye to keep the eyeball
properly inflated. The pupil is a circular hole in the center of the colored iris. The pupil constricts or
dilates to regulate the amount of light entering the eye. It constricts or closes to a tiny circle in bright
light and dilates or opens wide in darkness to allow as much light as possible to enter the eye. The
lens is a transparent and elastic little envelope of fluid suspended by tiny strong muscles. The lens
adjusts its thickness so that both near and far objects can be brought to focus on the retina. The fluid
fattens the lens for near vision and makes it flat for far or distant vision. The lens moves at an average
of one hundred thousand times a day, which is equivalent to a fifty-mile hike to the leg muscles. Like
the acqueous humour chamber, the vitreous humour chamber is filled with fluid. The vitreous
humour is a jelly-like substance that has the consistency of an eggwhite but still clear enough for light
to pass through. The vitreous humour fills most of the eye's interior.

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The muscles function to coordinate and balance the movements of the eyes. They turn, raise and
lower the eyes in response to cranial or brain nerve impulses.
The retina is a multilayered sheet of nerve tissues at the back of the eye. The retina is the last part of
the neural receptor system for vision. It is likened to the film in the camera: for a clear image to be
transmitted to the brain, the light rays must come to a precise focus on the central portion of the
retina. The retina contains some one hundred thirty-seven million light receptor cells called rods and
cones. One hundred thirty million of these receptor cells are shaped like rods for black and white
vision and seven million are shaped like cones for color perception. The rods are responsible for night
vision or for seeing objects and images under conditions of low illumination. All thirty-seven million
light sensitive receptors are contained in an area that is less than a square inch. The most sensitive
part of the retina is the macula, at the center of which lies the fovea, the area that is vital to the exact
discrimination of the details of an image or object. The optic nerve is connected to the retina and
conducts visual images to the brain. The optic nerve is capable of transmitting messages from the
retina to the brain at a speed of three hundred miles per hour.
Vision takes place in the occipital lobe of the brain located at the back of the head. The occipital lobe
is one of the four lobes of the brain that are named for the major skull bones that covers them.
Audition or hearing takes place in the temporal lobe found behind the forehead. The parietal lobe at
the top of the head toward the rear processes body sensations. The frontal lobe is a part of the
cerebral cortex in the cerebrum or forebrain which is the largest part of the brain that governs the
highest functions associated with conscious activities and intelligence. The frontal lobe also controls
the movement of voluntary muscles.
How Vision Takes Place
The basic function of the eye is to collect visual stimuli and information in the form of mechanical
energy from the environment through the psychological process called sensation. The eye has tens of
millions of electrical connections that are capable of handling as many as one-and-a-half million
messages at the same time. During the process of vision, the stimuli are converted into electro-
chemical form or nerve impulses through the process of transduction. The nerve impulses are
described as the "language form" that the brain understands. The optic nerve conveys the nerve
impulses to the occipital lobe of the brain where perception takes place in the form of visual images.
There are three conditions for vision to take place. First, the eyes are stimulated by light rays or
illumination which are in the form of mechanical energy; second, the light rays are reflected from
objects in the visual field and lastly, the mechanical energy is converted into nerve impulses which the
brain processes into visual images.

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The light rays pass through the cornea, then the acqueous humour chamber, then the pupil, the lens
and the vitreous humour. The light rays come to a clear focus on the retina. The optic nerve conducts
the visual images to the brain where perception of the visual experience takes place.
Figure 43. Parts of the Human Eye
Types and Causes of Problems of Vision
The inability of the eyes to function efficiently may be traced to (1) errors of refraction; (2) imbalance
of the eye muscles; (3) diseases; and (4) trauma or accidents.
1. Errors of Refraction
After the light rays enter the cornea, acqueous humour and pupil and the lens fails to refract or bend
the light rays to focus on the central part of the retina, errors of refraction occur. In hyperopia or
farsightedness, the lens fails to focus the light rays from near objects on the retina. The point of focus
falls behind the retina because the eyes are too short from front to back. The eyes attempt to correct
the condition by fattening the lens as much as possible. To correct hyperopia, convex lenses are
prescribed to converge the light rays on the retina. In myopia or nearsightedness, the opposite takes
place. This time, the eyes are abnormally long from front to back and the lens fails to refract the light
rays from distant objects on the retina. The point of focus falls in front of the retina. The eyes try to
correct the condition by making the lens as flat as possible. To correct myopia, concave lenses are
prescribed to diverge the light rays from far objects on the retina. In astigmatism, the cornea which
normally forms a portion of a spherical lens is deformed, the refraction of light rays becomes faulty
and blurred vision results. Astigmatism is corrected by the use of a cylindrical lens which corrects the
direction of the spherical lens.

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2. Imbalance of the eye muscles
When the muscles of both eyes do not work together in a coordinated way, imbalance of the eye
muscles occurs. In strabismus, different images are cast on each retina resulting to cross-eyedness or
squinting. Diplopia or double vision results when the brain cannot fuse the differences in the images
cast on the retina into a single image. The condition can be corrected by prescription lenses, exercises,
surgery or a combination of the three.
Amblyopia occurs when vision is suppressed in one eye and it becomes weak or useless. Nystagmus is
a condition in which there are rapid involuntary movements of the eyeball that can result to nausea
and vomiting and dizziness. In some cases, nystagmus is a sign of brain malfunction or inner ear
problems.
3. Diseases of the eye
Among the diseases of the eye that cause blindness, cataract is the most common in the Philippines.
Cataract is caused by the clouding of the lens which results to progressive blurring of vision and
eventually blindness occurs. The disease is associated with the aging process but it can occur early
among persons with diabetes mellitus. Children can suffer from congenital cataract. Some babies are
born blind because of congenital cataract. Distance and color vision are seriously affected. Surgery can
remove the diseased lens and replace it with prescription lenses. Diabetic retinopathy occurs when
diabetes mellitus interferes with the flow of blood to the retina causing it to degenerate. Diseases of
the cornea are the second leading causes of blindness in the country. Injuries and infections due to
accidents and malnutrition scar the cornea which shows as a whitish spread. Corneal scar is
commonly called "pilak." Diseases that destroy the cornea cause blindness. The cornea can be
removed and changed with a healthy one through corneal transplantation.
Diseases of the retina, the most sensitive part of the visual mechanism, can be congenital or present
at birth. Many of the diseases are due to prenatal causes, that is, they occur during pregnancy.
Coloboma is a degenerative disease in which the central and or peripheral areas of the retina are not
completely formed. This results to impairment of the visual field and the central visual acuity and
blindness. Retinitis pigmentosa is a hereditary condition that results in the degeneration of the retina.
The field of vision becomes narrow and eventually results to blindness. Glaucoma is a condition in
which there is excessive pressure in the eye.
4. Trauma or accidents
A 24-year-old teacher usually goes to sleep in the minibus that he takes every day from his home to
school. One afternoon, the minibus was bumped from behind by a jeepney, shaking the passengers
and bruising some of them. Unfortunately, the teacher who was fast asleep hit his head hard against
the seat's wooden back. Since then, he complained of dizziness, severe headache and blurring of

191
vision. After a thorough examination, the ophthalmologist diagnosed the condition as retinal
detachment. The severe blow on the head traumatized the eyeball and caused the retina to break off
from it. The teacher became totally blind since then.
Another traumatic accident involved a successful blind supervisor at the Department of Education.
She recalled how she lost her vision at the age of seven. She was playing "espada-espadahan" with
friends when one of them hit her left eye with the wooden stick. The eye became infected and she
suffered from monocular blindness in the left eye. Before long, the right eye "sympathized" with the
left eye and the girl became totally blind.

Normal Sight
Rays focus on retina (a)

No correction necessary

Nearsightedness
Rays focus in front of retina (b)

Concave lens corrects nearsightedness

Farsightedness
Rays focus behind retina (c)
Convex lens corrects farsightedness

Astigmatism
Rays do not focus
(d)

Uneven lens corrects astigmatism

Figure 44. Errors of Refraction
In a normal eye (a), parallel rays of light are brought to a focus on the retina by refraction in the
cornea and lens. If the eye is too long, as in myopia (b), the focus is in the front of the retina. This can
be corrected by a concave lens. If the eye is short, as in hyperopia (c), the focus is behind the retina.
This is corrected by a convex lens. In astigmatism (d), light refraction is uneven due to an abnormal
shape of the cornea or lens.

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Rubella or German Measles
Rubella is a mild disease in most people. The danger is that pregnant women who come in contact
with someone with rubella especially during the first three months of pregnancy risk having a
"rubella" baby. A rubella baby can have serious problems such as permanent damage to the eyes and
ears, including blindness and deafness, heart disease and brain damage. In fact, rubella is responsible
for 95% of deaf and blind babies.
These problems can be prevented by immunizing all girls aged between 10 and 16 years with the
rubella vaccine. Also, women planning to become pregnant, whether or not they have had rubella or
the vaccine should discuss the need for immunization or a booster shot with their doctor.
Since February 1989, rubella has been added to the measles/mumps vaccine to make the 3 in 1
measles/mumps/rubella vaccine.
Parents who have their children immunized at the recommended 12 to 15 months of age or older if
they have not been previously immunized against measles, will help reduce the number of people
who get rubella. This will reduce the chance of an unprotected pregnant woman coming in contact
with the virus. Childhood immunization against rubella is also important because the rubella infection
is sometimes so mild in children that there are no visible signs of illness. But they are still able to pass
the infection onto unsuspecting pregnant women.
Symptoms
Rubella is usually a mild illness with a rash and a fever. A mild headache, accompanied by a slight
fever and swollen lymph glands of the neck may appear about two days before the rash.
The rash appears as blotchy brownish-red spots on the face and neck. Pink spots like the rash or
scarlet fever may also be seen. The rash spreads to other parts of the body, tending to disappear from
one site as it appears in another. As many as half of the infections may occur without an obvious rash.
An attack lasts from two to five days and may be accompanied by mild catarrh and fleeting pains in
the hands and feet. These joint pains may occur after the rash has disappeared.
Children may have such a mild attack that there are no noticeable symptoms so it is possible to be
exposed to the disease without knowing it and even to be unaware of contracting it.
Rubella is sometimes mistaken for the more serious ordinary measles, or other viral infections.
Obvious differences are that the rubella rash fades more quickly and does not leave the brown
discolorations caused by ordinary measles.

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How it spreads
The virus is present in an infected person's nose and mouth. It spreads to others through droplet
infection in cough and sneezes, by direct contact such as kissing, by handkerchiefs, towels, beddings,
eating and drinking utensils, and other items contaminated by the virus.
Incubation period is from 14 to 23 days. The contagious period is from one week before to as long as
four days after the rash appears when an infected person can pass on the disease.
Protecting others
Because others in the same house as an infected person could contract the disease or become
unsuspecting carriers of it, an expectant mother who comes in contact with them should be warned
that rubella is in the house.
If a mother-to-be contracts rubella, or is exposed to it, she should see her doctor immediately so that
steps can be taken to minimize the effects of the disease on her developing baby. Children with
rubella should be kept away from school until they are fully recovered.
Who should be immunized?
• All children aged between 12 and 15 months should be immunized with the
measles/mumps/rubella vaccine. Older children who have not previously been immunized against
measles or have not had measles diagnosed by a doctor should also have the vaccine.
• Girls aged between 10 and 16 years should be immunized with the rubella vaccine. It is
recommended even for girls who may have previously had rubella, unless they can produce evidence
of immunity proven by a blood test.
• Women of childbearing age who have not previously been immunized.
• Women who are planning to become pregnant. It is wise to discuss the need for immunization
with her doctor. Because having had rubella or the rubella vaccine does not necessarily give lifelong
immunity a check on immunity should be carried out prior to a woman becoming pregnant, especially
if it has been 10 years since receiving the vaccine. Women who receive the vaccination should ensure
that they do not become pregnant for three months.
• Rubella immunization should NOT be given to: women who are already pregnant; women who
may be pregnant or who may become pregnant within 3 months of receiving the vaccine; people
suffering from fevers or serious diseases like cancer, and people taking cortisone-like or immuno-
suppressive drugs.
• Before immunization, the doctor must be told about anychronic illness, infections or allergies,
whether the person is taking medication or has received immunization within the past month.

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Special Adaptations, Aids and Technology for Students Who Are Blind and with Low Vision
The absence of sight leads to the reorganization of the sensory mechanisms. While vision is the major
sense that gathers stimuli in the environment for processing in the brain, blindness makes the person
dependent on other senses like audition or hearing, feeling or touch, olfaction or smell and gustation
or taste. Persons who are blind make use of special adaptations to learn about the world that they do
not see.
1. Braille is the primary means of literacy for blind persons. Braille is a system of reading and writing in
which letters, words, numbers and other systems are made from arrangements of raised or embossed
dots. Braille was invented in 1830 by Louis Braille, a young blind Frenchman who played the organ in
church, as a means of recording church hymns and music.
The braille system is complex as shown in Figure 45. A braille cell has six dots that are arranged two
wide and three deep and numbered thus: The letters of the alphabet and numerals zero to ten are
assigned specific combinations of the six dots. Abbreviations called "contractions" help save space
and permit faster reading and writing. Some dot combinations are used to represent whole words,
part-word contractions, word abbreviations, number and letter signs and others. All printed
textbooks, books, music, foreign languages and scientific formulas can be transcribed into braille.
Blind students learn to read and write in braille by using a brailler which operates like a typewriter
with six keys. The slate and stylus is another device for braille writing. It consists of a flat board to
which braille paper is clipped, a braille guide where the braille dots are punched one at a time from
left to right with the pointed hand-held stylus.
A portable laptop computer called VersaBraille II+ (Telesensory System Inc.) is available for use in
doing written work, taking notes and tests.

Figure 45. The Braille Alphabet

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2. Blind students use the regular typewriter to communicate with their teachers, classmates and
friends. Handwriting is taught so that they can sign their own names, handle bank accounts, fill up
forms and vote.
3. Manipulatives and tactile aids are used in learning mathematics, sciences and social studies. The
Cuisenaire rods with tactile markings developed by Belcastro (1989) enable the student to quickly
identify by touch the different values associated with the numbers. The Cranner Abacus is used in
teaching number concepts and in doing the four fundamental operations. The Speech-Plus Talking
Calculator is a small electronic instrument that performs most of the operations of any standard
calculator. It talks by "voicing" entries and results aloud and also presents them in visual form.
Blind students follow braille and verbal or taped instructions to do their lessons in social students and
experiments in science. Embossed relief maps and diagrams, three dimensional models and electronic
probes that give an audible signal in response to light enable blind students to participate actively in
regular class activities side by side with their seeing classmates.
4. Technological aids are available for blind persons. The Optacon (optical-to-tactile converter) is a
small electronic device that converts regular print into a readable vibrating form for blind people. The
Optacon converts print into a configuration of raised "pins" representing the letter the camera is
viewing. Through extensive training and practice, the blind person can read regular print effectively.
The blind person can also work with typewriters, calculators, computer terminals and small print.
The Kurzweil Personal Reader is a sophisticated computer with an optical character recognition (OCR)
system that scans and reads via a synthetic voice typeset and other printed matter.
5. Assistive technology enables blind persons to access to personal computers. Computer access
opens to them countless opportunities for education, employment, communication and leisure
activities. There are devices that magnify screen images through specialized hardware or software and
computer screen-access systems that use speech recognition software to enable the user to "tell" the
computer what to do.
Students who have potentially useful vision are taught to develop their ability to use their residual
vision as effectively as possible. Special education teachers and other professionals are guided by
certain premises about teaching students with low vision (Corn, 1989, cited in Heward, 2003).
• Those with congenital low vision view themselves as "whole"; they do not have remaining or
residual vision. Although it may be proper to speak of "residual vision" in reference to those who
experience adventitious low vision, those with congenital low vision do not have a "normal" vision
reference. They view the world with all of the vision they have ever had.
• Those with low vision generally view the environment as "stationary" and "clear." Although there
are exceptions, this premise tries to dispel

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the misconception that people with low vision live in an impressionistic world where they
continuously want to "clear" the image.
• Low vision offers a different aesthetic experience. Low vision may alter an aesthetic experience but
does not necessarily produce a lesser one.
• 20/20 visual acuity is not needed for visual function for most tasks or for orientation and mobility
within most environments.
• Clinical measurements do not dictate visual functioning. Such measurements provide a "ballpark" in
which to anticipate visual functioning.
• Those with low vision can enhance visual functioning through the use of optical aids, non-optical
aids, environmental modifications and/or techniques.
• The use of low vision is not in all circumstances the most efficient or preferred method of
functioning. For some individuals or tasks, the use of vision alone or in combination with other senses
may reduce one's ability to perform. For example, using vision while pouring salt on food may not be
the most efficient method for determining how much salt has been poured.
• Low vision has unique psychological aspects. Those with low vision have life experiences not
encountered by those without such a condition. Much can be learned about the adjusting processes
for those who are visually impaired congenitally or adventitiously.
• Those who have low vision may develop a sense of visual beauty, enjoy their visual abilities and use
vision to learn.
1. Students with low vision use special optical devices to enlarge or magnify regular print. Examples
are corrective eyeglasses and contact lenses for reading large print, a magnifier stand for reading
smaller print, a monocular (one-eye) telescope for viewing the chalkboard, small hand-held telescope,
magnifier placed on top of the printed page, field widening lenses and devices to increase the visual
field, prisms and fish-eye lenses to make the objects appear smaller so that a greater area can be
perceived, and others.
2. Books and other materials are available in large print. These books are set in 10-point type.
3. The special education teacher introduces classroom modifications that would enable the student
to use vision. Desks with adjustable or tilting top allow the student to read and write at close range
without bending over. Special lamps provide increased illumination on the reading material. Special
writing paper with a dull finish and off-white color reduces glare.
4. Recorded books, magazines and other materials come with the synthetic speech equipment that
plays the tapes at a faster rate.
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Figure 46. The braille typewriter and cane are examples of technological aids for persons who are
blind.
The Education of Students with Visual Disabilities
The integration of blind students in regular classes started in the 1960s as a component of the teacher
training program for selected public school teachers. Thus, blind boys and girls with average or better
mental ability were enrolled in regular classes at the School Divisions of Pasay City, Manila and the
Teacher Training Department of the then Philippine Normal College. The next ten years saw the
organization of integrated programs in the different regions of the country as the teacher training
program continued at the Philippine Normal College. At present, the Resources for the Blind
Incorporated collaborates with the Department of Education in training teachers during the summer
term and in mainstreaming blind and low vision students in public schools all over the country.
The special education teacher teaches skills and concepts that most children learn visually through
the remaining senses: audition, touch, olfaction, gestation and other non-visual experiences. Blind
students learn to read and write in braille. Two braille codes are learned: the Filipino Braille Code and
the English Braille Code American Edition. The Philippine Printing House for the Blind at the
Department of Education transcribes most of the regular textbooks and materials in braille. The books
and learning materials are distributed to students who are enrolled in residential schools, special
schools and regular elementary and secondary schools where they are mainstreamed. The Resources
for the Blind Incorporated, a foreign-funded nongovernment organization assists the Department of
Education through teacher training, preparation of instructional materials and other related projects.
Blind children receive instruction in orientation and mobility. Orientation is the ability to establish
one's position in relation to environment through the use of the remaining senses. Mobility is the
ability to move safely and efficiently from one point to another (Lowenfeld, 1973, cited in Heward,
2003). Instruction in orientation and mobility begins at an early age to understand the basic concepts
about their bodies and their environment so they can move about effectively and safely. The special
education teacher uses appropriate methods and procedures to teach travel techniques at home, the
school and the community. The long cane enables blind persons to travel independently and gain self-
esteem.
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The special education teacher uses manipulatives and tactile aids in teaching mathematics, science
and the other subjects in the curriculum. He or she constantly plans, creates and implements
activities that will enable the students to gain as much knowledge and skills as possible through their
remaining senses. He or she is always on the lookout for the many opportunities for the students to
participate in the regular school program. Truly, an efficient special education teacher "opens doors to
a world from which his or her students who are blind or have low vision are more removed than
seeing children" (Lowenfeld, 1973).
When a Student Who Is Blind or Has Low Vision Is Mainstreamed in Your Class
With the advent of inclusive education for children and youth who have disabilities, more and more
students who are blind, deaf, with mental retardation, or with orthopedic impairments are enrolled in
regular classes. A special education teacher works closely with the regular teacher so that the child
with disabilities can participate fully in most of the class activities. They discuss how the two of them
can help the special child learn in the regular class side by side with his or her regular classmates.
As a future regular teacher, you should know the basic expectations from you as a partner of the
special education teacher in inclusive education. And as the child's regular classroom teacher, you will
soon become sensitive to the individualized needs of the child who has a visual impairment. Your
partner, the special education teacher, will be there for consultation, for special instruction in braille,
mobility and orientation or travel techniques, and provision of materials adapted for the use of
students.
It is important to know that children with visual impairments differ in their ability to use their
remaining vision. While they rely on their other senses like audition, touch, smell, or taste, one may
show preference for one sense over the others.
How can you make your student with visual impairment feel comfortable in your classroom? The
following rules will help you.
1. It may sound odd to us who can see, but we use the words "look" and "see" when
communicating with a blind person. These words are much a part of the vocabulary of the student
with visual impairment as they are of any of your seeing students. He or she uses these words to
connote his or her methods of seeing, either by manipulating or touching an object or looking very
closely at it. It is absolutely acceptable to use expressions in daily conversations, such as, "see you
later," or "look here."
2. Introduce him or her as you would any of your students. Instruct the seeing classmates to talk to
him or her directly and not through you. Encourage the blind child to answer his or her classmates'
questions directly too.

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3. Include him or her in all class activities. The special education teacher can offer suggestions on
how you may go about the child's full and active participation in class activities.
4. All children want to be a leader in class activities. Extend the same opportunity to the blind child.
5. The same disciplinary rules that apply to the rest of the class should apply as well to the child
with visual impairment. He or she may not be excused from school rules and regulations because of
his or her condition.
6. Encourage the blind child to move about the classroom to get the materials or to do certain
activities. You can assign a classmate to be his or her buddy in going about the class activities.
7. Give verbal instructions or oral cues, since the blind child does not see facial expressions like a
nod (say yes instead), knitting of the brow (say please explain it further), or an arm movement
suggesting that he or she come over to you.
8. Provide space to accommodate his or her special materials like bulky braille books and large print
books, braille typewriter, tactual aids, and others.
9. Motivate the seeing classmates to become interested in topics related to vision and visual
impairment. You may integrate these topics in the different subjects. For example, in science, light and
optics may be a topic for discussion. In English or Filipino, use of the braille code may be
demonstrated by the blind student.
10. Your acceptance of the child with visual impairment will serve as a positive example to his or her
seeing classmates.
11. When approaching the blind student, unless he or she knows you, always say who you are
instead of asking him or her to guess who you are. Voices are not always easy to identify, particularly
in crowds or stress situations.
12. The blind student may exhibit certain mannerisms like rocking, flapping the fingers in front of
the eyes, or poking the fingers into the eye. Consult the special education teacher on how to deal with
these behaviors.
The special education teacher will explain to you how the blind student can get around the classroom,
school building grounds, and the community by himself without accidents. The special education
teacher will teach the blind student orientation and mobility techniques. Orientation strategies enable
the blind student to be familiar with the classroom, the school building, the ground and surrounding
areas. At home, the blind student becomes oriented to the house, neighborhood and community.
Meanwhile, mobility strategies allow the blind student to travel from a point of reference like the
door, to the other parts of the room. The

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classroom is the point of reference in traveling to the different parts of the building and ground. The
school gate is the point of reference in traveling to the community. The blind student uses hand
techniques to travel safely in small and familiar places like the classroom. A seeing classmate may be
requested to act as sighted guide. When negotiating less familiar places like the school building,
ground and the community cane to travel techniques are applied.
How about his or her textbooks? The Philippine Printing House for the Blind located at the Philippine
National School for the Blind in Pasay City and the Resources for the Blind Incorporated in Quezon City
transcribe printed books into braille. If some books are not available in braille, a reader can help the
blind student.
How about board work, tests, and homework? A classmate can dictate the print materials to the blind
student so that he or she can write them down in braille. If tests and other print materials are given to
the special education teacher a few days ahead of schedule, the latter can transcribe them into
braille. Extra time will frequently be needed to finish a test or written work in braille. Allowing time
and a half is usually acceptable., Another practice is to allow the buddy or reader to write down the
blind student's test answers.
Have faith and trust in the ability of your blind student to participate actively in class activities. Think
of ways and means to adjust highly visual lessons to tactual or auditory modes. In the absence of
vision, remember that the blind student has four other sense modalities to use in gaining knowledge
and learning the skills in the curriculum.
Read and Respond
Test on Content Knowledge
How much have you learned about students who are blind or have low vision? Answer the following
questions to find out.
1. Describe how the process of vision takes place. Name and tell the functions of the parts of the
visual mechanism that enable man to see.
2. What can go wrong with the process of vision? What are the types and causes of visual
problems?
3. What are the differences between blindness and low vision?
4. How do students with visual disabilities manage to get an education in regular schools side by
side with their seeing classmates? What special adaptations are introduced to make mainstreaming
possible?

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Reflection and Application of Learning
1. Close your eyes tightly for a few hours. Better still, cover them with an eye shade or a piece of
dark cloth so that you cannot see anything at all. Then walk around the house and look for familiar
things that you use every day in the bedroom, the bathroom, the sala and the kitchen.
Next, do the usual activities you engage in, such as cleaning the house, cooking, changing your
clothes, etc.
Write a report on your experiences as a person without sight. How well did you do the usual
activities? What problems did you meet? How did you solve them? How did you feel about the whole
experience?
2. Form triads. Discuss the vignettes about blind persons and how they triumphed over their
disability. Write an article about your discussion and submit it your school's paper for publication.
3. Visit a school where blind students are enrolled. Ask the principal to allow you to talk to some
of them. Ask them questions about the content of this chapter.

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Chapter 10 STUDENTS WITH HEARING IMPAIRMENT

Yolanda T. Capulong
To the Course Professors and Students:
Students with hearing impairment are either deaf or hard of hearing. Students who are deaf do not
have sufficient residual hearing to understand speech without special instruction and training. On the
other hand, students who are hard of hearing have enough residual hearing to understand speech
and learn in a regular class without much difficulty.
Hearing impairment is not simply an inability to hear or to communicate through speech. The most
devastating effect of deafness is the deprivation of language. A hearing person acquires the complex
linguistic system of his or her culture as part of normal growth and development in a spontaneous
effortless and natural manner. Deafness, on the other hand, deprives the person of the normal use of
the hearing mechanism. He or she does not acquire the listening skills that provide the base for the
development of speaking, reading, writing and other communication competencies. The condition
brings about corollary problems in cognitive development, emotional adjustment, difficulties in
socialization and anxiety in daily experiences that only a person with hearing impairment can
describe.
Helen Keller who was deaf and blind, described the problems of deafness as "deeper and more
complex... a much worse misfortune for it means the loss of the most vital stimulus, the sound of the
human voice that brings language, sets thoughts astir, and keeps us in the company of man."
At the end of the chapter, the students are expected to:
1. define the terms hearing impairment, hearing loss, deaf and hard of hearing;
2. name the parts of the hearing mechanism and their functions;
3. describe the normal process of hearing or audition;
4. explain the role of hearing and listening in language development;
5. enumerate and describe the causes and classifications of hearing loss;
6. explain the effects of hearing impairment on intellectual, social and emotional development;
7. enumerate and describe the formal and informal hearing tests;
8. enumerate and describe the assessment procedures in determining the cognitive ability,
communication skills and socio-behavioral traits of students with hearing impairment;

203
9. enumerate and describe the types of educational programs, philosophical approaches and
instructional strategies for students with hearing impairment;
10. cite the importance of support services in the education of students with hearing loss; and
11. appreciate the abilities of persons who are deaf and hard of hearing.
Basic Concepts on Hearing Impairment
1. The two main categories of hearing impairment are deafness and hard of hearing.
2. The causes or etiology of deafness are traced to genetic or hereditary factors, developmental
abnormalities during the prenatal stage, infections, environmental factors and traumatic events.
3. Hearing loss affects language development that in torn leads to delays in cognitive, social and
emotional development.
4. Differences and variations in etiology, the onset or beginning of deafness, the degree and type of
hearing loss as well as family and educational situations result in a widely diverse population of
persons with hearing impairment.
5. Hearing impairment is classified according to the part of the ear where the defect is, the age at
onset, the stage of language development at the time of onset, and the degree of hearing
impairment.
6. Deaf with a capital D refers to those individuals who want to be identified with the deaf culture.
7. The degree of hearing loss and the psychosocial impact of deafness affect cognitive and socio-
emotional development as well as the ability to learn.
8. Assessment procedures include hearing evaluation, test of mental ability, test of communication
skills and psychosocial evaluation.
9. The types of educational placement include full or partial mainstreaming in regular classes, self-
contained classes in the resource room or Special Education Center of a regular school, enrolment in a
special school or a residential school.
10. Special education covers a wide range of educational approaches and strategies that focus on
the development of speech, language and communication skills.
11. Hearing aids and other assistive listening devices facilitate the acquisition of communication
skills.
12. Mainstreaming in a regular class considers acceptance of deaf students by their hearing
classmates, teachers and staff of the school, use of amplification devices, increased use of visual
information, putting down noise levels and preferential seating.

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Vignette About a Girl with Hearing Impairment

The following vignette illustrates that early intervention and special education significantly reduce the
effects of deafness in the life of a young girl.
Elsa is a pretty six-year-old grade one pupil who is deaf. She studies in a regular school where she is
well-accepted by her teachers, classmates and the school staff. She wears a hearing aid that helps her
understand the class discussion. Her teachers often call on her to recite which she does with labored
speech and sometimes not so intelligible speech. A special education teacher teaches her the special
skills that students who are deaf like her need to acquire. Elsa does well in all the subjects and gets
high grades. She studies diligently and she behaves well in class.
Despite her imperfect speech, her classmates like her. They pay attention to what Elsa says. In fact,
they find it exciting to have a classmate who has special needs. Following the guidelines on
mainstream education for students with disabilities that the teacher explained to them earlier,
everybody faces Elsa when they talk to her in natural voices and gestures. A number of them have
started to learn the sign language with Elsa as the teacher. Her hearing aid does not bother them.
They understand why Elsa always gets the front seat. At times Elsa asks her seatmates a lot of
questions to learn the lessons very well and to understand what is going on.
Elsa's medical record shows that she contracted meningitis when she was six months old. Meningitis
is an inflammation of the membranes covering the brain and spinal cord. It can cause blindness,
deafness or mental retardation. Elsa had high fever and convulsion that required two weeks of
hospitalization. Before she got sick, Elsa could produce babbling sounds and responded to the adult's
"conversation" with her. When she recovered from the disease the prelingual speech diminished and
Elsa was not bothered by loud sounds around her at all. She did not react to auditory stimuli coming
from the radio and TV shows, boisterous laughter and noise. The otologist or ear specialist patiently
explained to the mother that meningitis had affected the inner part of the ear that is connected to
the brain where hearing takes place. This condition caused Elsa to lose her hearing. The otologist
informed Elsa's mother about special education and how it can help Elsa get an education like normal
children.
At the age of four, Elsa was enrolled in the early intervention program of the Philippine School for the
Deaf in Pasay City. She was fitted with hearing aids which she eventually got used to wearing every
day. A smart girl, she acquired speech through the oral mode together with the sign language. At
present she attends a regular elementary school where she is mainstreamed in grade one. The
school's special education teacher works closely with the regular teachers so that Elsa can participate
in all of the activities. Before and after classes, the special education teacher teaches Elsa the special
skills and tutors her on the lessons taken up in class.

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Elsa's parents extend their utmost cooperation with the school to achieve the goals and objectives
written in the girl's individualized education plan or IEP. When they think of their daughter's future,
they get the feeling and assurance that Elsa can finish basic education, go on to college and be a
normal and self-sufficient individual.
Definition of Hearing Impairment or Disability, Deaf and Hard of Hearing
Hearing impairment or disability refers to the reduced function or loss of the normal function of the
hearing mechanism. The impairment or disability limits the person's sensitivity to tasks like listening,
understanding speech, and speaking in the same way those persons with normal hearing do.
According to the age of onset, hearing impairment can be congenital when the condition is present at
birth or adventitious when it is acquired after birth or later on. The time when a hearing impairment
occurs in terms of the normal development of spoken language at the age of two or thereabout is
another classification of deafness. When the condition occurs before the child learns to talk, deafness
is prelingual. Deafness is postlingual when it is acquired after the child has learned speech usually at
the age of two.
A person who is deaf cannot use hearing to listen, understand speech and communicate orally
without special adaptations mainly in the visual mode. While a hearing aid amplifies the sounds by
increasing the volume to make the sounds louder, a person who is deaf cannot understand speech
through the ears alone. He or she may be able to perceive some sounds but his or her sense of
hearing is not enough or nonfunctional for the ordinary purposes in life. Speech is accompanied by
visually perceived actions like gestures, signs and facial expression.
A person who is hard of hearing has a significant loss of hearing sensitivity but he or she can hear
sounds, respond to speech and other auditory stimuli with or without the use of a hearing aid. He or
she is more like a hearing person than one who is deaf because both of them use audition or listening
to auditory stimuli in the environment, unlike a deaf person who relies more on visual stimuli.
The concept of hearing impairment is often misunderstood. Hearing impairment itself is mistakenly
attributed to sub-average intellectual capacity, speech defect, inattention and other learning
problems. While deafness adversely affects educational performance because of the difficulty in
processing linguistic information through hearing with or without amplification, it is not the same as
mental retardation, speech and language disorders or learning disabilities.
Hearing impairment brings about a diverse group of individuals with special needs. The etiology of
hearing impairment, the degrees of hearing loss, and other factors affect normal growth and
development in general and speech and language in particular.. There is a concomitant effect on social
adjustment as communication becomes more difficult due to the decrease in hearing sensitivity.

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The Anatomy and Physiology of the Human Ear

Audition is the act or sense of hearing. The ear is one of two lead sense organs that allows a person to
gather auditory stimuli and information from near and far sources in the environment that come in
the form of acoustical energy. Audition transforms acoustical energy into a form called mechanical
energy and finally into neural energy or nerve impulses that can be interpreted by the brain. Neural
energy is called the "language of the brain." Hearing for most people is natural and automatic, but
hearing impairment makes listening, observing, understanding and reacting to others extremely
difficult.
The anatomy and physiology of the hearing mechanism, the parts and functions of the ear, and the
process of audition provide the base for understanding the nature of hearing impairment and its
implications to the teaching-learning process.
The ear has three main parts: the external or outer ear, the middle ear, and the inner ear that extends
to the central auditory nervous system in the brain. The external or outer ear called the auricle or
pinna directs the sounds into the auditory canal or external acoustic meatus. When sounds enter the
external acoustic meatus, they are slightly louder or amplified as they are directed toward the middle
ear. Sounds enter the middle ear through the Eustachian tube and pass through the tympanic
membrane or eardrum. The eardrum moves in and out in response to changes in sound pressure. The
movements of the eardrum change the acoustical energy into mechanical energy which is transferred
to the three smallest bones in the body, the ossicles or ossicular chain, composed of the malleus or
hammer, incus or anvil and stapes or stirrup. The footplate or base of the stapes rests in an opening
called the oval window, the path through which mechanical energy enters the inner ear. The
vibrations of the ossicles transmit the mechanical energy from the middle ear to the inner ear with
little loss. The most
Figure 47. The Anatomy and Physiology of the Human Ear

207
complex and sensitive part of the entire hearing apparatus, the inner ear, is covered by the temporal
bone, the hardest bone in the body. The cochlea is the main receptor organ for hearing and contains
two fluid-filled cavities and the organ of Corti. The cochlea looks like a coiled shell of a snail. The
vibrations stimulate the approximately 20,000 tiny hair cells to transform the mechanical energy into
electrical nerve impulses or neural energy. These impulses are transmitted along the auditory nerve
through the central nervous system pathways to the brain where the auditory experience is processed
and understood. The semicircular canals in the inner ear control the sense of balance.
Classification of Hearing Impairment
The affected part of the ear is one basis for classifying hearing impairment. A conductive hearing loss
occurs in the outer and middle ear thereby blocking the passage of the acoustic energy. The blockage
may be caused by abnormal growths or complications of the outer or middle ear. Impacted cerumen
results from the excessive buildup of earwax in the auditory canal. Diseases of the middle ear can
leave fluid or debris. Malformation, incomplete development, or abnormal growth and improper
movement of the ossicular chains can cause conductive hearing loss. If the inner ear is intact,
conductive hearing impairment can be corrected through surgical or medical treatment. A hearing aid
is usually prescribed.
A sensorineural hearing impairment occurs in the inner ear. The sensitive mechanisms and the
auditory nerve may be damaged. When the cochlea is impaired, the neural energy delivered to the
brain is distorted or not delivered at all. Audition does not take place and speech is not heard.
Sensorineural hearing losses may be congenital or adventitious because of illness or traumatic
incidents. Only a very small percentage of sensorineural deafness can be reversed by medical
intervention.
A mixed hearing impairment results from a combination of both conductive and sensorineural hearing
losses.
Any dysfunction in the central auditory nervous system between the brain stem and the auditory
cortex in the brain results in a central hearing disorder.
Another basis for classifying hearing impairment is its being unilateral or present in one ear only, or
bilateral or present in both ears.
As mentioned earlier, deafness may be congenital or adventitious. The degree of severity of hearing
impairment may be slight, mild, moderate, severe and profound.
Sound is measured in decibels (dB) or units that describe its intensity, that is, its loudness or softness.
Zero dB represents the softest or faintest sound that a person with normal hearing can hear. Zero dB
is also called zero-hearing threshold (HTL) or audiometric zero. Larger dB numbers represent louder
sounds. A whisper five feet away registers about 10 dB, conversational speech 10 to 20 feet away
registers about 30 to 65 dB. A running car registers about 65 dB, while a motorcycle or tricycle
registers louder at about 85 dB. A ten-to-sixteen-wheeler truck registers from about 100 to 125 dB
and causes pain to the ears.

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The following table shows the intensity of sound as heard by persons who have hearing impairments.
The severity or degree of the hearing loss corresponds to losses in decibels that result to learning
difficulties.
Table 3. Severity of Hearing Loss and Resulting Impairments
Degree of Hearing Decibel Loss Resulting Impairments
Loss 0 - 20 dB
Normal
Slight 27-40dB Faint sounds and distant
conversations are difficult to
hear. With a hearing aid, the
student can attend regular
school.
Mild 41-55dB As much as 50 percent of
classroom conversations are
missed. Limited vocabulary
and speech difficulties may
result.
Moderate 56 - 70 dB Loud conversations can be
heard. Defective speech,
language difficulties and
limited vocabulary may result.
Severe 71-90dB Hearing is limited to a radius
of one foot, enough to
discriminate loud sounds.
Defective speech and lan-
guage and severe difficulty in
hearing consonant sounds
may result.
Profound 91 -and above Sounds and tones cannot be
perceived. Vision becomes
the primary sense of
communication. Speech and
language are likely to
deteriorate.

Incidence and Prevalence

In the Philippines, the conservative estimate is that 2% of the population has hearing impairment and
the number may increase if children below school age and persons who lose hearing sensitivity due to
old age are included.
In the United States at least 1 in every 22 newly born infants has some degree of hearing impairment.
At least 3 in 1000 infants have a severe or profound hearing impairment. In its latest report, the U.S.
Department of Education claimed that children with hearing impairment constitute 1.3% of pupils
provided with special education services and 11% of the total age population.

209

Etiology of Hearing Impairment

Hearing impairments are attributed to genetic and heredity factors, infections, environmental and
other traumatic factors. Some hearing impairments have unknown causes.
• Genetic and hereditary types of deafness occur in one out of one thousand live births. Causes are
hereditary and chromosomal abnormalities.
• Infections such as maternal rubella, cytomegalovirus, hepatitis B virus, syphilis, mumps, and otitis
media may occur during pregnancy or after birth.
• Adventitious hearing loss can be attributed to environmental factors such as excessive and constant
exposure to very loud noises. Drugs and medication that can turn toxic when administered to the
mother or to the child at inappropriate times and circumstances. Traumatic factors can cause hearing
impairment at birth. Low birth weight, difficult and prolonged labor can traumatize the hearing
mechanism and cause hearing loss and permanent damage to the ear. Skull fractures due to
accidents, as well as pressure changes may damage the ear. The more specific causes of conductive
hearing loss are otitis media (middle ear infection), excessive earwax (impacted cerumen), and
otosclerosis (a spongy-boney growth around the stirrup which impedes its movement). Sensorineural
hearing loss results from damage to the cochlea or the auditory nerve. Other causes are viral
diseases, Rh incompatibility, hereditary factors, exposure to noise, aging and ototoxic medications.
The common disorders that cause hearing impairment are discussed in the following table.
Table 4. Common Disorders Associated with Hearing Loss
ATRESIA
• Absence of the external ear canal
• Usually unilateral or found in both ears
• Often seen in conjunction with such syndromes as Cruzon's, Treacher Collins, Pierre Robin
• Usually congenital, but can be acquired (fungal infection, squamous cell carcinoma)
• Results in conductive hearing loss
ACOUSTIC NEUROMA
• Benign, slow-growing tumor
• Associated with NF-2, chromosome 22, autosomal dominant
• Found in the internal auditory canal
• Prevalence 1:100,000
• 75% have slowly progressive sensorineural hearing loss
• Other symptoms include poor speech understanding on the affected side, facial numbness,
unsteadiness

210
FISTULA
Hole in or rupture of the oval or round window in the inner ear
• May leak perilymph (clear fluid) into the middle ear
• Caused by head injuries, diving, barotraumas, violent sneezing, etc.
• Results in fluctuating and/or sudden sensorineural hearing loss
• Can be a complication of cholesteatoma
• Dizziness can also be a symptom
AUTOIMMUNE DISEASE
Associated with a variety of immune disorders such as HIV/AIDS
• May be accompanied by chronic otitis media, nasal crusting, cough, iritis, etc.
• Sensorineural hearing loss occurs in 20% of the patients.
OTOTOXICITY
Can be caused by a wide variety of strong antibiotics such as amino glycosides gentamicin, kanamycin
and others as well as chemotherapeutic agents such as cisplatin, or loop diuretics
• Can result from exposure to various chemical agents in the environment
• Characterized by a progressive high-frequency sensorineural hearing loss following such exposure
CYTOMEGALOVIRUS (CMV)
• Most common congenital viral infection causing hearing loss today, occurring in 1:1,000 live
births
• Contracted during pregnancy, during or after birth
• Can result in sensorineural hearing loss as well as CNS, cardiac, optic, and growth abnormalities
• Symptoms may not be apparent at birth, with onset at about 18 months
• Progresses rapidly during the first year
MENINGITIS
Neonatal infection, can be viral or bacterial Most common cause of acquired sensorineural hearing
loss • Hearing loss can range from mild to profound, and may be progressive Symptoms may
include headache, neck stiffness, photophobia, and suppurative otitis media

211
DOWN SYNDROME
• Congenital chromosomal abnormality (trisomy 21)
• 30% of these children have sensorineural hearing loss
• Most have poor Eustachian tube function, resulting in chronic middle ear disease with associated
conductive fluctuant hearing loss
CHOLEASTEATOMA
• May be acquired or congenital
A benign growth of slow-growing skin tissue in the middle ear
• Usually caused by recurring otitis media and negative middle ear pressure
• Associated hearing loss is usually conductive, but may be sensorineural depending on the
location of the growth
• Symptoms may include ear drainage, fullness, dizziness, facial weakness, and recurring middle
ear infections
CRUZON'S SYNDROME
• Congenital abnormality of the external and middle ear
• inherited autosomal dominant disorder
• "Frog face" appearance
• One-third of these children have bilateral conductive hearing loss Pinnas may be low set and
rotated, with atresia
Often have middle ear deformities
WAARDENBURG SYNDROME
• Autosomal hereditary dominant disorder
• 20% have white forelock, 99% have increased distance between the eyes, 45% have irises of
different colors
• Depigmentation of the skin and eyebrows that meet over the bridge of the nose area is a
common feature of this syndrome
• , 50% have mild to severe sensorineural hearing loss, which can be
unilateral or bilateral that is progressive
USHER SYNDROME
• Autosomal recessive disorder
• Occurs in 6-12% of congenitally deaf children, and 3 in 100,000 of the general population
• Involves retinitis pigmentosa and progressive moderate to severe sensorineural hearing loss
Can vary greatly in age of onset, severity, and progression

212
TREACHER COLLINS SYNDROME
• Autosomal dominant congenital abnormality of the external and middle ear
• Facial anomalies such as depressed cheekbones, malformed pinna, receding chin, large fishlike
mouth, and dental abnormalities
• Poorly developed middle ear space with ossicles frequently absent or deformed
• Can be associated with conductive and/or sensorineural hearing loss
PENDRED'S SYNDROME
• Congenital abnormality of the inner ear
• Recessive endocrine-metabolic disorder occurring in 1 of 100,000 newborns
• Associated with profound sensorineural hearing loss, which may develop during the first 10 years
of life
• Also associated with a thyroid defect, resulting in a goiter during the second or third decade of
life
• 40% have vestibular problems
• Often seen with a Mondini-like cochlear abnormality
LYME DISEASE
Acquired disorder
Caused by tick-borne spirochete
Leading cause of facial paralysis in children
• Symptoms include rash, headache, hearing loss, stiff neck, arthralgia, and fatigue
• Hearing loss usually improves with antibiotic therapy
TURNER' SYNDROME
Aberration of sex chromosomes, X chromosome is absent
• Associated with abnormalities of the external and middle ear, including low set ears, auricle
defect, middle ear abnormalities, and a Mondini-like cochlea
• Can result in conductive and/or sensorineural hearing loss
PIERRE ROBIN SYNDROME
• Autosomal dominant inheritance
• Congenital abnormality of external and middle ear Cleft palate and glossoptosis
• Low set cupped ears, facial nerve abnormalities
• Conductive hearing loss

213

Characteristics of Persons with Hearing Impairment

Individuals with hearing impairment compose a widely diverse group of persons. Since the major
effect of deafness is in language development, concomitant issues occur on intellectual and social
development, speech and language development that are closely connected to educational concerns.
Deafness is described as an invisible handicapping condition because there are only a few physical
and observable manifestations to indicate its presence such as the absence of the outer ear, closed
ear canal and fluid discharge from the ear.
Some of the observable behavioral and learning characteristics of a child with hearing impairment are
as follows:
• Cups hand behind the ear, cocks ear/tilts head at an angle to catch sounds
• Has strained or blank facial expression when" listening or talked to
• Pays attention to vibration and vibrating objects
• Moves closer to speaker, watches face especially the mouth and the lips of the speaker when
talked to
• Less responsive to noise, voice, music and other sources of sounds
• Uses more natural gestures, signs and movements to express self
• Shows marked imitativeness at work and play
• Often fails to respond to oral questions
Often asks for repetition of questions and statements Often unable to follow oral directions and
instructions
• Has difficulty in associating concrete with abstract ideas
• Has poor general learning performance
As mentioned earlier, the primary effect of a hearing impairment is on the development of speech
and the acquisition of language skills. The more severe the hearing loss is, the more difficult it is to
acquire skills in listening, speech and communication, reading and writing. Speech is usually labored,
unintelligible, unpleasant and difficult to understand. Vocabulary is limited with problems in syntax..
Speech sounds telegraphic and has poor rhythm. There are problems in articulation such as omission,
addition, and substitution of letters and sounds or distortion of the words. Poor reading ability results
to difficulties in learning the other school subjects.
Studies show that the educational achievement of students with hearing impairment is three to four
years below the age-appropriate levels of their hearing peers. Appropriate special education
curriculum, instructional strategies and support services help reduce the lags in acquiring the skills in
the basic elementary curriculum.
Those with slight or mild hearing losses have a good amount of residual hearing to learn the skills in
the curriculum. Deaf persons complain that hearing aids amplify sounds but do not necessarily make
them clear and intelligible.

214
Socio-emotional development follows the same stages among children with hearing impairment.
However, lack of communication skills hamper socialization and interaction with hearing persons. The
situation forces persons with hearing impairment to stay in each other's company giving rise to a
"culture of deafness." As the children mature the demand for the use of speech grows and catching
up becomes almost impossible, isolating them further from the mainstream of society. The inclusion
of socialization activities in the curriculum and mainstreaming deaf children in regular classes increase
the opportunities for socio-emotional development. Likewise, hearing students learn to accept those
with hearing impairment as their peers.
Identification and Assessment of Children with Hearing Impairment
Early identification of a hearing impairment increases the chances for the child to receive early
treatment and special education intervention. The assessment program includes audiological
evaluation, test of mental ability, and test of communication ability.
1. Audiological Evaluation
Audiology is the science of testing and evaluating hearing ability to detect and describe hearing
impairments.
Audiological evaluation is done by an audiologist through the use of sophisticated instruments and
techniques. The audiometer is an electronic device that generates sounds at different levels of
intensity and frequency. The purpose of audiological evaluation is to determine frequencies of sounds
that a particular person hears.
Pure tone audiometry utilizes pure tones in air and bone conduction tests which yield quantitative as
well as qualitative description of a child's hearing loss.
Another audiometric test is speech audiometry which uses speech instead of pure tones. Here, the
person's detection of speech at the minimum audible level is measured. The understanding of speech
sound and the ability to discriminate different speech sounds under sufficient loudness are also
determined.
There are alternative audiometric techniques for hearing evaluation such as the sound field
audiometry, evoked response audiometry, impedance audiometry, play audiometry, operant
conditioning audiometry and behavior observation audiometry.

215

Figure 48. Pure Tone Audiogram

In the Philippines where formal audiological services are limited, informal tests of hearing are
employed. The procedures for some of these hearing tests are described below.
Informal Hearing Tests
a. Whisper test
Sit the child comfortably. Ask him or her to stick the tip of the forefinger in one ear.
The tester sits behind the child where the uncovered ear is. After a deep breath, whisper some
familiar words that contain high pitch and low pitch tones right behind the unblocked ear. The child
must be able to repeat the words correctly.
b. Conversational live voice test
Keeping the same position but facing the child, ask him or her to repeat words that contain high and
low pitch consonants. Start with a whisper and increase the intensity up to 20 dB moving away from
the child little by little. If the child hears at a distance of 3 to 6 meters, hearing is normal. If the child
can repeat the words but speech is unclear, he or she might be hard of hearing.
c. Ball pen click test
Use a retractable ball pen and place it one inch away from the ear. While the other ear is blocked by a
finger, press the button of the ball pen down and release it. Do it only once. The child indicates that
he or she hears the click by either raising one hand or acknowledging it with a yes or a nod.
2. Cognitive Assessment
The assessment tools that measure intellectual capacity of children with hearing impairment do not
rely primarily on verbal abilities. In the United States, The Hiskey - Test of Learning Aptitude, the
Wechsler
216
Intelligence Scale for Children (WISC) and the Stanford Achievement Test (SAT) are widely used
because of the nonverbal performance subtests.
3. Assessment of Communication Abilities
Assessment of speech and language abilities includes an analysis of the development of the form,
content and use of language. Articulation, pitch, frequency and quality of voice are examined.
4. Social and Behavioral Assessment
Hearing impairment brings about significant effects on social-emotional and personality development
as a result of the restrictions in interactive experiences and communication activities with their age
group. Linguistic difficulties oftentimes show in low self-concept and social-emotional maladjustment.
Educational Placement
The degree and classification of hearing loss are important factors in deciding the most appropriate
special education program for children with hearing impairment. Table 5 provides the guidelines in
making decisions about the educational placement based on the degree of hearing loss, the possible
effects on the understanding of speech and language, the possible psychosocial impact and the
potential educational needs and programs.
There are other considerations that need attention in the education of students with hearing
impairment. Some of them are educational environments, mode of communication and support
services.

Figure 49. Sign Language Alphabet

217
Table 5. Guidelines on the Educational Placement of Students With Hearing Impairment
(From Anderson, K., & Matkin, N. [1991]. Relationship of degree of loss to psychosocial and
educational needs. Education Audiology Newsletter, 8[2], 11-12, reprinted by permission.) Cited by K.
English (1995)
Degree of Possible Effects Possible ' Potential
Hearing of Hearing Loss Psychosocial Educational
Loss Based on the Impact of Needs and
on Understanding Hearing Loss Programs
of Language &
Speech
modified
pure tone Children have
average better hearing
(500-4000 sensitivity than
Hz) the accepted
 normal range for
adults. A
NORMAL child with
HEARING hearing
sensitivity in
the-10 to+ 15 do
range will
-10 to + 15 detect the
dHL complete speech
signal even at
soft conversa-
tion levels.
However, good
hearing does not
guarantee good
ability to
discriminate
speech in the
presence of
background
noise.
May be unaware May benefit
of subtle con- from mild
gain/low
May have versational cues MPO hearing aid
difficulty hearing which could or personal FM
MINIMAL faint or distant cause child to be system
speech. At viewed as in- dependent on
loss con-
figuration.
Would benefit
from
15 do student appropriate or soundfield
can miss up awkward. May amplification if
class-
(OORDERLI to 10% of miss portions of room is noisy
NE) speech signal fast-paced peer and or
reverberant.
16 to 25 dB when teacher is interactions Favorable
HL at a distance which could seating. May
greater than 3 begin to need attention
feet or if the to vocabulary or
classroom is have an impact speech,
noisy, especially on socialization especially with
in grades k to 3 recurrent
. when verbaf and self-concept. otitis media
instruction May have im- history.
mature behavior. Appropriate
Child may be medical
management
necessary for
conductive
losses. Teacher
re-
predominates. more fatigued quires in-service
than classmates on impact of
due to listening hearing loss on
effort needed. language devel-
opment and
learning.
At 30 d» can arriers beginning Will benefit from
miss 25-40% of to build with a hearing aid
speech signal. negative impact and use of a
The degree of on self-esteem personal FM or
dif-
ficulty as child is soundfield FM
experienced in accused of system in the
school will hearing
depend upon when he or she classroom.
the noise level inwants to," "day- Needs favorable
classroom, dreaming," or seating and
distance from "not paying lighting. Refer to
teacher atten-
MILD and tion." Child special
configuration of begins to lose education for
hearing loss. ability language
26 to 40 do Without for selective evaluation and
HL amplification the hearing, and has educational fol-
child with in-
35-40 do loss creasing low up. Needs
may miss at least difficulty auditory skill
suppressing
50% of class background building. May
discussions, noise which need attention
espe- makes to
cially when the learning vocabulary
voices are faint environment development,
or stress-
speaker is not in ful. Child is more articulation or
line of vision. fatigued than speech reading
Will
miss consonants, classmates due and/or special
especially when to listening effort support in read-
a high frequency needed. ing and self-
 hearing loss is esteem. Teacher
present. in-service
required.
Understands Often with this Refer to special
conversational degree of education for
hearing lan-
speech at a loss, guage evaluation
distance of 3-5 communication and for educa-
feet is signifi-
(face-to-face) cantly affected, tional follow-up.
only if structure and socialization Amplification is
and
' MODERATE vocabulary with peers with essentia!
41 to 55 d controlled. normal hearing (hearing aids
HL Without becomes and FM system).
amplification the increasingly Special
amount of difficult. With education sup-
speech signal full time use of port may be
missed can be hearing aids/ FM needed,
50% to 75% with systems child especially for
40 do loss and may be judged primary children.
80 Jo 100% with Attention to oral
50 do loss. Is language
likely to development,
have delayed or as a less reading and
defective syntax, competent written
learner. language.
limited There is an Speech reading
vocabulary, increasing and speech
imperfect impact on
speech self-esteem. therapy usually
production and needed. Teacher
an atonal
voice quality. in-service
required.

218

MODERATE Without Full time use of Full time use of

TO amplification, hearing aids/FM amplification is
conversa-
SEVERE tion must be systems may essential. Will
very loud to be result in child need resource
un- being
56 TO 70 d derstood. A 55 d judged by both teacher or
HL loss can cause peers and adults special class
as depend-
 child to miss up a less competent ing on
to 100% of learner, resulting magnitude of
speech language
information. Will in poorer self- delay. May
have marked dif- concept, social require special
matu- help
ficulty in school rity and sense of in all language
situations rejection. In-ser- skills, vocabulary
requir- vice to address
ing verbal these attitudes grammar,
communication may be helpful. pragmatics as
in both one-to- well as reading
one and group and writing, in-
situations. service of
Delayed mainstream
language, teachers
syntax, re- required.
duced speech
intelligibility and
atonal voice
quality likely.
SEVERE Without Child may prefer May need full-
amplification other children time special
may
71-90 do HL hear loud voices with hearing aural/oral
about one impairments as program for deaf
foot from ear. friends and children with
When playmates. This emphasis on all
amplified may further auditory
optimally, isolate the child language skills,
children
with hearing from the speechreading,
ability of 90 do mainstream, concept
however,
or better should these peer development
be able to relationships and speech. As
may
identify foster improved loss approaches
environmental self-concept 80-90 do,
sounds and and a sense of may benefit from
detect all the cultural identity. a Total
sounds of Communication
speech. If loss is approach,
of prelingual especially in the
onset, oral early
language and language
speech may learning years.
not develop Individual
spontaneously hearing aid/
 or will be personal FM
severely system
delayed.
If hearing loss is essential.
of recent Participation in
onset speech is regular classes as
likely to much as
deteriorate with beneficial to
quality student. In-
becoming service of
atonal. mainstream
teachers
essential.
PROFOUND Aware of Depending on May need special
vibrations moreauditory/oral program for
91 do HL or than tonal competence, deaf children
more pattern. Many peer use of sign with emphasis
rely on vision language, on all language
rather than parental skills and
attitude,
hearing as etc. child may or academic areas.
primary avenue may not Program
for increasingly needs
communication prefer specialized
and association supervision
learning. with the deaf and
Detection of culture. comprehensive
support
speech sounds services. Early
dependent use of
upon loss amplification
configuration likely to help if
and
use of part of an
amplification. intensive training
Speech
and language program. May be
will not cochlear
develop implant or
spontaneously vibrotactile aid
and
is likely to candidate.
deteriorate Continual
rapidly if hearing appraisal of
loss is of needs in regard
recent onset. to
communication
and learning
mode. Part-time
 in regular classes
as much as
beneficial
student.
UNILATERA May have Child may be May benefit
L difficulty hearing accused of from personal
FM
One normal faint or distant selective hearing or soundfleld FM
hearing speech. due to system In
ear and one Usually has discrepancies in classroom. CROS
ear with difficulty speech hearing aid
at least a localizing sounds understanding in may be of
permanent and quiet versus benefit in quiet
mild voices. noise. Child will settings. Needs
hearing loss Unilateral be more favorable
listener
will have greater fatigued in seating and
difficulty classroom setting lighting. Student
understanding due to greater is at risk for
speech when effort needed to educational
environment is listen. May difficulties.
noisy and/or appear Educational
inattentive
reverberant. or frustrated. monitoring
Difficulty behavior warranted with
detecting or problems support services
understanding Sometimes provided as
evident.
soft speech from soon as
side of bad difficulties
appear.
ear, especially in Teacher in-
a group service is
discussion. beneficial.

219

1. Educational Placement
In the Philippines, students with hearing impairment like other students with disabilities are
mainstreamed in regular classes either on full-time or part-time basis. A special education teacher
assists the regular teacher in seeing to it that the students receive as much instruction as their
hearing classmates. Some special education programs employ an interpreter in the regular class who
translates the verbal activities into signs and gestures to enable the student to follow the lesson. The
special education teacher gives special instruction in the resource room or in the Special Education
Center on oral or total communication, manual communication that includes finger spelling and
different signed systems, auditory-verbal training and cued speech.
2. Support Services
Communication accessibility is provided by sign language and oral interpreters inside and outside of
the classrooms. Computer-aided instruction (CAI) reinforces the knowledge and skills learned in the
different subject areas. The special learning areas like speech, auditory training and language are
taught effectively through computer-aided instruction.
Some TV programs and videos utilize closed captioning services in sign language that make the
programs accessible to individuals with hearing impairment. Telephone services have telecommunica-
tion devices for the deaf where visual display of communication going on is available in print and
electronic display. Cellular phones with text messaging features are very useful to individuals with
hearing impairment.
Suggestions for Teaching Students with Hearing Impairment in a Regular Class
1. Promote the acceptance of the student with hearing impairment in the regular class.
Welcome the student to your class.
• Explain the student's condition to the entire class. Emphasize that he or she can learn together
with the hearing students.
Make modifications in teaching as natural as possible.
• Accept the student as an individual with abilities and limitations.
• Discuss the student's condition with him or her.
2. Be sure that prescribed hearing aids and other amplification devices are used.
Understand and explain to the class that the hearing aid makes sound louder but not necessarily
clearer.

220
Table 6. Educational Approaches Used When Working with Students with Hearing Impairments
Basic Position Objective Method of
Communication
Bilingual- Considers To provide a ASL (American
Bicultural American Sign foundation in the Sign Language)
Language (ASL) to use of ASL with
be the natural its unique
language of the vocabulary and
Deaf culture and syntax rules; ESL
urges recognition instruction
of ASL as the provided for
primary language English vo-
choice with En- cabulary and
glish considered a syntax rules
second language
Total Supports the To provide a Combination of
Communic belief that si- multifaceted sign language
ation multaneous use approach to (accepts the use
of multiple communication of any of the
communication to facilitate sign language
techniques whichever systems),
enhances an method(s) works fingerspelling,
individual's ability best for each and
to communicate, individual speechreading
comprehend and
learn
Auditory- Supports the To facilitate the Spoken (oral)
Oral belief that chil- development of English
dren with hearing spoken (oral) En-
impairments can glish
develop listening/
receptive
language and oral
language
expression (En-
glish) skills;
emphasizes use
of residual
hearing (the level
of hearing an
individual pos-
sesses),
amplification
(hearing aids,
auditory training),
and
speech/language
training
Source: Gargiulo, R., Special Education in Contemporary Society, p. 430
See to it that the special education teacher checks the student's hearing aid or other devices and
that they are working properly.
• Encourage the student to take care of his or her hearing aid and to tell the teacher when it is not
functioning properly.
• Be sure your student has a spare battery at school.
• Tell the special education teacher or the parents if the student's hearing aid is not working
properly.
3. Provide preferential seating.
• Sit the student near the spot where you typically stay when teaching.
• Sit the student where he or she can easily watch your face without straining to look up.
• Sit the student away from sources of noise.
• Sit the student where light is on your face and not in the student's eyes.
• Sit the student so he or she can use the better ear.
• Allow the student to transfer to other seats when necessary.

221
4. Increase visual information.
Remember that your student reads your lips and must see your face in to do so.
• Try to stay in one place while talking to the class so the student does not have to lipread a
"moving target."
• Avoid talking when your back is turned to the class such as when you are writing on the
chalkboard.
• Avoid covering your mouth or face when talking.
When reading in front of the class, be sure that the student can lipread you. '• Avoid standing in
front of windows where the glare will make it difficult to see your face.
• Use visual aids, such as pictures and illustrations whenever possible.
• Demonstrate what you want the student to understand whenever possible.
• Use the chalkboard as much as possible.
5. Minimize classroom noise.
• Seat the student away from noisy parts of the classroom.
• Wait for the class to be quiet before talking to the students.
6. Modify teaching procedures.
• Be sure the student is watching and listening when you are talking. Be sure the student
understands what is said by asking him or her to repeat information or answer questions.
• Rephrase rather than repeat questions and instructions whenever necessary.
• Write keywords, new words, and other needed information on the chalkboard.
• Repeat or rephrase things said by other students during classroom discussion.
Introduce new vocabulary words to the student in advance. Ask the student to repeat if you cannot
understand him or her.
• Assign a student as "buddy" to alert the deaf student to listen and to be sure that he or she
understands the lesson correctly.
7. Have realistic expectations.
Remember that the student cannot understand and grasp everything all of the time, no matter how
hard he/she tries.
• Be patient when the student asks for repetition.
Give the student a break from listening when he or she shows signs of fatigue.

222
• Expect the student to follow classroom routine.
• Expect the student to abide by all the school rules such as attendance, proper behavior,
homework, and dependability as other students are required to do.
• Be alert for fluctuations of hearing. Report any observation to the special education teacher.

Figure 50. Deaf Children Celebrate Deaf Awareness Day

Read and Respond
Test on Content Knowledge
Find out how much you have learned about hearing impairment by answering the following questions
correctly.
1. What is hearing impairment? How does deafness differ from the condition of hard of hearing?
2. What are the parts of the hearing mechanism? How do they function so that normal hearing
may take place?
3. Enumerate the causes or etiology of hearing impairment and discuss each briefly.
4. What are the classifications of deafness?
5. What major areas of development are affected by hearing impairments?
6. Enumerate the informal methods of evaluating hearing loss. Describe each method briefly.

223
7. What are the formal methods of evaluating hearing loss? Describe each method briefly.
8. Why is early identification of a hearing loss important?
9. Enumerate at least five (5) characteristics of a student with hearing
impairment.

10. Name some of the technological devices that deaf persons use to communicate to other people.
Reflection and Application of Learning
1. Do the following activity with a partner. Try to experience how it is to have a hearing impairment.
Watch your favorite TV show with one of you not turning on the volume. On a piece of paper, write
the conversations of the show. Write specific words, phrases and sentences uttered by the characters.
Check what you have written with your partner who watched the show with the volume on.
• How many words, phrases or sentences did you write correctly?
• What were your mistakes? Why did you make those mistakes?
• What inconveniences did you experience? How did you feel when you could not understand what
the actors/actresses were saying?
Repeat the activity, this time exchanging roles as a watcher with the volume off and the other with it
on.
2. Visit a special education class for students with hearing impairment. Talk to one of them by
asking questions about their studies, things and activities they like and similar topics. Share your
experience with your classmates. What characteristics did you observe about the student? Cite the
topics in the chapter that explain why deaf children behave the way they do.
3. What are the advantages of having intact sensory modalities especially vision and audition? What
do you do to preserve your vision and audition? What advice can you offer young adults like you to
preserve their sensory modalities?

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Chapter 11 STUDENTS WITH SPEECH AND LANGUAGE DISORDERS

Yolanda T. Capulong
To the Course Professors and Students:
Do you recall the time when you sent a message to someone standing across the street about fifty
meters away from you? She could not hear you if you shouted because of the noise of the passing
vehicles. So you sent your message without sounds but you did exaggerate the syllables and words,
opened your mouth wider, used gestures, signs and body language. When your friend nodded her
head, you knew that she received your message.
Teachers and students communicate their thoughts and ideas with one another when discussing the
lessons, eliciting answers to questions, expressing one's thinking and feeling about the topics or
sharing personal experiences. Students know that their responses are correct when the teacher nods,
smiles, thumbs up or puts on a satisfied facial expression. We spend long hours chatting with our
friends on the phone, sending text messages, e-mail or letters written the traditional way. There are
times when we prefer to sit quietly in a place, inside the church, perhaps, or in the privacy of our
bedroom just so we can think or meditate. The process of communication takes place every minute of
our waking hours.
Every day at home, at school, at work and in other places where we interact with people the
communication process functions as a means of informing, explaining, and expressing our ideas.
Spoken and written words are the basic means of communication. Often they are used together with
paralinguistic behaviors and nonlinguistic cues (Heward, 2003). Examples of paralinguistic behaviors
are nonlanguage sounds such as ah, oh, haha (laughter), changes in pitch, intonation, speed of speech
and pauses that change the meaning of the message. Nonlinguistic cues include body postures, facial
expressions, gestures, eye contact, head and body movement and physical proximity.
At the end of the chapter, the students should be able to:
1. define the terms communication, speech and language and explain how they relate to each
other;
2. enumerate and define the processes involved in speech production;
3. enumerate and define the elements of language;
4. enumerate and describe the milestones in language development;
5. enumerate and describe voice disorders, articulation disorders and fluency disorders;

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6. enumerate, define and give examples of the components of language;
7. enumerate and define types of language disorders;
8. identify and describe the criteria for a communication disorder;
9. name and describe the causes of communication disorders;
10. describe the assessment procedures in determining the presence of speech and language
disorders;
11. enumerate and describe the special education programs for students with speech and language
disorders;
12. describe the classroom management techniques to maximize learning of children with speech
and language disorders in a regular classroom; and
13. develop positive attitudes towards people who are deaf and hard of hearing.
Basic Concepts on Communication, Speech and Language
The concepts of communication, speech, and language are interrelated. Speech and language are the
key components of communication. Basically, communication takes place when both the sender and
the receiver of the message use common speech patterns and language. Difficulties in speech
production and lack of language skills interfere with effective communication. Nevertheless, these
concepts have their respective definitions, descriptions and uses.
Communication
Communication is the exchange of information, ideas, needs and desires between two or more
persons. It is an interactive process where there is (1) the intention to send a message, (2) a sender
who encodes and expresses the message, (3) a receiver who decodes and responds to the message,
and (4) a shared means of communication. In general, speech and language make communication
possible.
Speech
Speech is the actual behavior of producing a language code by making appropriate vocal sound
patterns (Hubbell, 1985, cited in Heward, 2003). It is the neuromuscular act of producing sounds that
are used in language. While the eye is the specific organ for vision and the ear for audition, there is
not one specific organ for speech. Instead the parts of the speech organs are "borrowed" from the
respiratory system and the digestive system. Figure 51 illustrates the anatomy of the speech
mechanism.

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Figure 51. The Normal Speech Organs
Speech is the most effective and efficient method of expressing language. It is also the most complex
and difficult human activity. The other ways of expressing language are gestures, manual signing,
pictures and written symbols. There are four separate but related processes in the production of
speech sounds, namely, respiration, phonation, resonation and articulation. Respiration or breathing
provides the air or power supply for speech sounds to be audible. Phonation is the production of
sounds as the vocal bands or folds of the larynx are drawn together by the contraction of specific
muscles causing the air to oscillate or vibrate. Resonation refers to the sound quality of the oscillating
air that is shaped as it passes through the throat or pharyngeal, oral or mouth, and nasal cavities.
Articulation is the formation of specific, recognizable speech sounds by the tongue, lips, teeth and
mouth. A black-box representation of the speech mechanism in shown in the following figure. Figure
52 illustrates a section of the head showing the three major resonators of the vocal folds. Figure 53
shows the three major resonators or cavities of the vocal tract.

Figure 52. A Block-box Representation of the Speech Mechanism

Figure 53. A Section of the Head Showing the Three Major Cavities (Resonators) of the Vocal Tract

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Language
Every country has its own language system that people use to communicate with each other through
the meaning given to sounds, words, gestures and other components of the language. Language is a
"code whereby ideas about the world are expressed through a conventional system of arbitrary
signals for communication" (Lahey, 1988, cited in Heward, 2003). Language has five dimensions,
namely, phonology, morphology, syntax, semantics and pragmatics.
Phonology refers to the linguistic rules governing a language's sound system. The rules describe how
sounds are sequenced and combined. The English language uses approximately 45 different sound
elements called phonemes. Phonemes are represented by letters or other symbols between slashes.
For example, the phoneme /nl represents the "ng" sound in sing.
Morphology refers to the way the basic units of meaning are combined into words. A morpheme is
the smallest element of a language that carries meaning. For example, the word basket and ball have
one morpheme each. The word basketball has two morphemes.
Syntax is the system of rules governing the meaningful arrangements of words into sentences. The
rules of syntax are specific to a particular language, that is, English has its own syntactical rules, so do
Spanish, German, Thai, Chinese, Japanese, Filipino and all other languages. The rules specify relations
among the subject, verb and object.
Bloom's and Lahey's language model integrates phonology, morphology and syntax into the form of
the language, the surface structure that connects sound and meaning.
Semantics is a system of rules that relate phonology and syntax to meaning. Semantics describes how
people use language to convey meaning. The language model refers to semantics as the content of
the language that allows its expression and understanding.
Pragmatics is a set of rules governing how language is used. There are three kinds of pragmatic skills:
(1) using language to achieve various communicative functions and goals, (2) using information from
the conversational context, for example, modifying one's message according to listener reaction, and
(3) knowing how to use conversational skills effectively, for example, starting and ending a
conversation, turn taking. The language model refers to pragmatics as the use of language.
Milestones in Language Development
The milestones in normal language development from birth to five years (Perangelo, 1998) are shown.
It is helpful to know how infants, toddlers and children acquire language as they mature. A six-month-
old baby coos with facial expressions and gross body movements in response to an adult's
stimulation.

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Cooing is a speech sound because the characteristics resemble certain sounds that adults produced.
In the given example speech is present but language is not used. Parents and significant others
around the baby might understand him or her but most others will not be able to interpret the sounds
being said. Speech of very young children hardly conforms with adult language.
Birth to 6 months
• First form of communication is crying.
• Babies make sounds of comfort, such as coos and gurgles.
• Babbling soon follows as a form of communication.
• Vowel sounds are produced.
• No meaning is attached to the words heard from others. 6 to 12 months
• The baby's voice begins to rise and fall while making sounds.
• Child begins to understand certain words.
• Child may respond appropriately to the word "no."
• Child may perform an action when asked.
• Child may repeat words said by others. 12 to 18 months
• Child has learned to say several words with appropriate meaning.
• Child is able to tell what he or she wants by pointing.
• Child responds to simple commands. 18 to 24 months
• There is a great spurt in the acquisition and use of speech at this stage.
• Child begins to combine words.
• Child begins to form words into short sentences. 2 to 3 years
• At this age, the child talks.
• Child asks questions.
• Child has vocabulary of about 900 words.
• Child participates in conversation.
• Child can identify colors.
• Child can use plurals.
• Child can tell simple stories.
• Child begins to use consonants sounds.

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3 to 4 years
• Child begins to speak rapidly.
• Child begins to ask questions to obtain information.
• Sentences are longer and more varied.
• Child can complete simple analogies.
4 to 5 years
• Child has an average vocabulary of over 1,500 words.
• Child's sentences average 5 words in length.
• Child is able to modify speech.
• Child is able to define words.
• Child can use conjunctions.
• Child can recite poems and sing songs from memory.
The principle on the uniqueness of a person includes the way a child acquires speech and learns a
language. There are individual differences in the way children develop speech and gain efficient use of
a language.
Can speech exist without language? Yes, in the case of infants who communicate their feelings of
discomfort and hunger through crying and satisfaction, through smiling, cooing, gurgling and
babbling. Cooing produces a speech sound that resembles some sounds that adults make.
Some children may develop speech faster or slower than the timetable or acquire language in an
unusual sequence. Others may deviate from the normal sequence of language development to such
an extent that may result to serious difficulties in school and interpersonal relations. A lag of more
than three months should not be a cause for worry, but a longer period of delay may signal the pres-
ence of communicative disorders and necessitate professional services. Communicative disorders
exert a great impact in the life of children who are likely to have problems in almost all aspects of
education and personal adjustment.
The question on whether speech can exist without language was raised earlier. The answer cited the
prelingual speech among babies in the form of crying, smiling, cooing, gurgling and babbling. This
time the question is reversed: Can language exist without speech? Again, the answer is yes.
People who are deaf communicate through sign language. The American Sign Language or ASL is a
language because it meets the criteria for a language. ASL communicates thoughts, ideas and
messages through the manual method. ASL has a shared code, a unique grammatical structure, and
arbitrary symbols composed of signed letters of the alphabet, words, phrases, gestures, facial expres-
sions and body movements. Finally, ASL is generative, that is, it allows an infinite number of sentences
to be constructed to express one's ideas. Finally, ASL is creative. Original stories, poetry, and other
forms of written work can be expressed in sign language.

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Oftentimes, children with autism or mental retardation echo or repeat the messages that adults relay
to them. Here, speech is present and the children's responses may be understandable to the sender
but not to other people. This example illustrates that while speech and language are basic in the
process of communication, the latter does take place without the use of speech or language. Special
education teachers are sensitive to the way children with language difficulties communicate their
thoughts. In turn, they employ effective modes of responding to their messages so that
communication will continue in the teaching-learning process.
Speech and Language Disorders
Speech and language disorders cause problems in communication. In the United States, it is estimated
that 5% of the school population has communication disorders. In the Philippines, the incidence of
children and youth with communication disorders may be higher.

Figure 54. Types of Speech and Language Disorders

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Emerick and Haynes (1986, cited in Heward, 2003) distinguish a communication difference from a
communication disorder. The following criteria must be present to indicate the presence of a
communication disorder:
• The transmission and/or perception of messages is faulty.
• The person is placed at an economic disadvantage.
• The person is placed at a learning disadvantage.
• The person is placed at a social disadvantage.
• There is a negative impact on the person's emotional growth.
• The problem causes physical damage or endangers the health of the person.
In this chapter, speech and language disorders and communication disorders are used
interchangeably. There are three categories of these disorders as shown in Figure 54. These are the
disorders in speech, language and those that result from hearing disorders. The disorders in speech
are voice or phonation and resonance disorders; the language disorders come in the form of delayed
language, aphasia and related disorders; while the communicative disorders that result from damages
to the hearing mechanism are caused by conductive hearing loss, sensorineural hearing loss, auditory
nerve and central auditory nervous system hearing loss and functional hearing loss.
The common speech and language disorders are characterized by difficulty in understanding language
and limited ability in choosing appropriate words and combining into correct sentences. Speech and
language disorders affect cognitive development and learning, emotional development, social
interaction and job opportunities.
Speech Disorders
The most popular definition of speech impairment or disorder is the one by Van Riper (1984, cited in
Heward, 2003) which states that "speech is abnormal when it deviates so far from the speech of other
people that it calls attention to itself, interferes with communication, or causes the speaker or his
listeners to feel distressed." In the same reference, Perkins (1977) defines speech impairment as
"unintelligible, abuses the speech mechanism, or culturally or personally unsatisfactory."
In determining whether or not a speech disorder exists, the person's age, education and cultural
background are taken into consideration. The speech of a three-year-old child is naturally
unintelligible, but the speech patterns of a thirty-year-old person that deviates quite markedly from
adult speech would indicate the presence of a speech problem. People who speak English as a second
language may mispronounce certain speech sounds but this cannot be considered as a speech
disorder. Neither should the influence of one's native language or dialect on the pronunciation of
words in another language be interpreted as speech disorder.

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Any deviation in the condition of the breathing and voice producing mechanisms including the
integrity of the mouth and oral cavity can cause speech disorders. There are speech related problems
that cause ineffective communication like problems in voice, articulation, and fluency.
Voice disorders are deviations in phonation such as in pitch (too high or too low), frequency (too loud
or too soft) and quality (pleasant or irritating to the ears). Speech can be hoarse or may lack
appropriate inflection. Vocal resonance is affected by impedance in the flow of air. Hypernasality
results when there is too much air flow and the voice seems to come from the nose, or, in the case of
hyponasality the air flow is too little and the voice seems to be impeded by severe cold.
Articulation disorders are errors in the formation of speech sounds. Toddlers who are learning to talk
and young school children who have to deal with new communication experiences often exhibit
wrong articulation or utterance of speech sounds. Before long they outgrow the inability to say and
read words and sentences correctly.
Haycock (1933) who compiled a classic manual on teaching speech describes how the speech organs
go through a variety of shapes and patterns and how the breath and voice are molded to form words
in the correct formation of speech sounds. Any deviation from the process of correct articulation
results to errors in pronouncing sounds and words. Specialists agree that articulation disorders are
not simple at all and they are not necessarily easy to diagnose effectively.
There are four basic errors of articulation: omission (see for seen), substitution (wip for lip), distortion
(tali for salt) and addition of extra sounds (buhrown for brown). Individuals with hearing loss and
cerebral palsy exhibit articulation disorders.
Articulation disorders vary in degree of severity. They may be mild, moderate, or severe. In mild or
moderate cases, the child may mispronounce certain sounds or use immature speech, but the speech
can be understood. The problem usually disappears as the child matures, but if it persists for a long
period of time, referral to a speech specialist should be made. A severe articulation disorder is present
when many speech sounds are pronounced incorrectly that speech becomes unintelligible most of
the time. In this case, the speech specialist complements the work of the special education teacher.
Fluency disorders interrupt the natural, smooth flow of speech with inappropriate pauses, hesitations,
or repetitions. Unlike normal speech that makes use of rhythm and timing, so that words and phrases
flow easily, fluency disorders are characterized by unnatural variations in speed, stress and pauses.
Cluttering and stuttering are examples of fluency disorders. In cluttering, speech is very fast with extra
sounds and mispronounced sounds that make speech garbled and unintelligible. Stuttering is marked
by "rapid-fire repetitions of consonant or vowel sounds especially at the beginning or words and
complete verbal blocks" (Jonas, 1976, cited in Heward 2003). The cause of stuttering is

233
unknown. It is a disorder of childhood that appears between the ages of 3 and 5 after the child has
acquired fluency in speech. The condition is more common among males than females and occurs
more frequently among twins. It is situational and appears to be related to the setting or
circumstances of speech.

Language Disorders
The American Speech-Language-Association (ASLA) defines language disorders as the abnormal
acquisition, comprehension or expression of spoken or written language. The disorder may involve
one, some or all of the phonologic, morphologic, semantic, syntactic or pragmatic components of the
linguistic system. Individuals with language disorders frequently have problems in sentence
processing and retrieving information from short and long term memory.
Children with language disorders manifest delays or lags in language development. They lack age-
appropriate language comprehension or receptive and expressive abilities in the basic facets of
communication, namely, listening, speaking, reading and writing. However, a child who has a language
delay may not necessarily have a language disorder. A language delay implies that a child is slow to
develop linguistic skills but may acquire them in the same sequence as normal children (Reed, 1994,
cited in Heward, 2003). Generally, all features of language are delayed at about the same rate. On the
other hand, a language disorder is present when there is a disruption in the usual rate and sequence
of the milestones in language development.
The following factors can contribute to language disorders in children (Chaney and Frodoma, 1982,
cited in Heward, 2003):
1. cognitive limitations or mental retardation
2. environmental deprivation
3. hearing impairments
4. emotional deprivation or behavioral disorders
5. structural abnormalities of the speech mechanism
Language may be delayed, disordered or absent as a result of the above factors. Adults reward
children for efficient communication skills as shown in the ability to recite, orate, sing or recall
information. Others may punish children for talking too much or participating in conversation among
adults. Lack of motivation at home to engage in communicative activities may discourage a child from
developing his or her own skills in using vocabulary learned and in expressing ideas. As a result,
problems connected with the form, content and use of language may occur.
• Form problems cover phonology, morphology and syntax problems that range from difficulty of
decoding spoken language, abnormal use of prefixes to abnormal structure of words and wrong use of
tenses.

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• Content problems include semantic disorders manifested in poor vocabulary development,
inappropriate use of words, and poor comprehension of the meaning of words.
• Use or pragmatic problems cover the inability to comprehend or use language in context or
conversation on various situations.
Some examples of language disorders are discussed below.
1. Central auditory processing disorder is a problem in processing sounds attributed to hearing loss
or intellectual capacity.
2. Aphasia is a language disorder that results from damage to parts of the brain responsible for
language.
3. Apraxia, also known as verbal apraxia or dyspraxia is a condition where the child has trouble
saying what he or she wants to say correctly and consistently.
Children with autism do not respond to stimulation, communicate little or none at all and display
deviant behavior that seem to be out of touch with the environment.
4. Dysarthria is the speech condition where the weakening of the muscles of the mouth, face and
respiratory system affects the production of oral language.
Children who have cerebral palsy or other neuromuscular disorders suffer from dysarthria as well as
those who had a stroke or brain injury.
Speech and Language Disorders that Result from Hearing Impairment
The most devastating effect of deafness and other forms of hearing impairment is on language
development. Thus, persons who are deaf or hard of hearing manifest speech and language disorders
as a result of conductive, sensorineural, auditory nerve, central auditory nervous system and
functional hearing losses.
Deafness restricts the perception of the sound elements of a language and other sounds in the
environment with or without a hearing aid. Depending upon the types of hearing loss - conductive,
sensorineural, or mixed, auditory nerve or auditory nervous system - in the outer, middle or inner
areas of the hearing mechanism, the greatest impact of deafness lies in the acquisition of speech and
language skills. While deaf persons can develop their communication skills manually through sign
language and arbitrary gestures and movements, or orally through speech reading and auditory
training, these adaptations cannot approximate normal speech and language development.

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Etiology of Speech and Language Disorders

The causes of speech and language disorders are complex. The cause can be functional like
environmental stress and can also be organic in the case of cleft palate. The causes can be congenital
when the disorder is present at birth or they can be adventitious or acquired after birth, in infancy
and early childhood and in the later years. Etiological factors are traced to brain damage, or the
causes can be secondary to mental retardation, hearing loss, ADHD, learning disabilities, autism,
schizophrenia, cerebral palsy, cleft palate, vocal cord injury, disorders of the palate and Gilles de la
Tourette syndrome.
Injury, accidents, diseases and trauma can result in childhood aphasia or loss of language functions.
Damage to the left hemisphere of the brain causes language disturbances or aphasia more than
damage to the right hemisphere. Meningitis, a common child's illness may bring about complications
that can result in hearing loss and other problems related to communication.
Incidence and Prevalence
Language and speech disorder is a high incidence disorder. In considering incidence and prevalence
figures, we have to take note of the fact that there is a strong relationship between communication
disorders and learning disabilities, and the primary disability should be identified.
In the US, approximately 20% of children receiving special education services are with speech and
language disorders, excluding cases that are secondary to these conditions.
The estimate for speech and language disorders is agreed to be at least 5% of school aged children. Of
this figure 3% has voice disorders and stuttering, 1%. The incidence of school children who manifest
articulation is 2% to 3% but this percentage decreases steadily with age.
Learning and Behavior Characteristics
Children with speech and language disorders have problems in receptive and expressive language.
They have difficulties in understanding what is meant by spoken communication as shown in the
inability to follow directions, improper use of words, difficulty in expressing ideas in oral, signed or
written forms, inappropriate grammatical patterns, and minimal vocabulary. Children with receptive
language deficits have difficulty in communicating their ideas as shown in the inability to express or
verbalize their thoughts, respond to questions, retain and retrieve or recall information and difficulties
in activities that require abstraction. The areas of deficit in expressive language include difficulties in
grammar, syntax, fluency, and vocabulary. There are instances when a child has better receptive than

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expressive skills.
Delays in language development show when the child is behind his or her peers in the acquisition of
speech and language skills.
Speech and language disorders are secondary to disabilities such as ADHD, learning disabilities,
autism, schizophrenia, cerebral palsy, cleft palate and other disorders of the palate, vocal cord injury,
and Gilles de la Tourette syndrome.
Speech and language disorders negatively affect cognitive functioning, social interaction, and
behavior. Children with the disorders manifest significantly low academic performance as result of
concomitant difficulties in organizing ideas, following directions, recognizing phonemes, producing
sounds and finding the right word for things. As a consequence, these children are reluctant to
participate in school activities. They are perceived to be inattentive.
Difficulty in carrying on a conversation affects social interaction, The children are reluctant to interact
with their peers because of perceived exclusion or rejection. They develop feeling of frustration that
causes them to withdraw from social groups.
Assessment Procedures
Like the assessment procedures for all types of disabilities, the following steps are prescribed by the
Special Education Division, Bureau of Elementary Education of the Department of Education:
1. Pre-referral Intervention
Teachers in regular classes, parents, classmates and other people who communicate with the child
regularly report the student who is suspected to have speech and language disorders to the school
principal. A "Teacher Nomination Form" is accomplished, scored and interpreted. A child who
manifests at least half of the characteristics of speech and language disorders is recommended for
screening.
The special education teacher conducts the screening process by using a "Checklist of Characteristics
of Children with Speech and Language Disorders," by observing the child's communication skills in
formal or classroom setting, and informally at home, in the playground, canteen and similar places.
The pupil and the parents or caregivers are interviewed to validate the results of the nomination form
and checklist. The findings are compared to the normal characteristics of speech and language
development indicated in the "Milestones on Language Development" to determine delays
tentatively.
2. Multifactored Evaluation
Ideally, formal evaluation must be done by a speech pathologist. While there are a few professionals
in this field in the Philippines, their
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services are often inaccessible to students in public schools. Thus, the special education teacher,
especially those who trained in teaching children who are deaf, are called to administer several
assessment tools to determine the presence of speech and language disorders.
By comparing the child's receptive and expressive language levels to his or her mental age,
differentiation between a language problem and a developmental delay can be made. An effective
language assessment is done carefully, thoroughly and carefully.
As soon as possible, formal evaluation by a speech pathologist is arranged. While waiting for this
opportunity to come, special education services are given to the student as remedial and preventive
measures.
Some of the widely used speech and language tests in the United States are the Peabody Picture
Vocabulary Test, Auditory Comprehension of Language, Boehm Test of Basic Concepts,
Comprehensive Receptive and Expressive Vocabulary Test and Kaufmann's Test on Early Academic and
Language Skills.
Educational Programs
In line with the practice of inclusive education, the child with speech and language disorders is kept in
the regular classroom as much as possible. Inclusion encourages immediate intervention as the
teacher corrects the child's mispronunciation. Inclusion minimizes the isolation of the children from
speech environments and social development. Classroom management provides for preferential
seating arrangement, minimum distractions and opportunities for interaction. The child works with
the special education teacher or speech pathologist for speech habilitation.
The American Speech-Language-Hearing Association offers some suggestions for the regular teacher
(Gargiulo, 2003) in an inclusive class and for the special education teacher as well.
1. Introduce changes in the home and school setting especially if the child has central auditory
processing problems.
• To help the child focus and maintain attention, give him or her a seat that is away from auditory and
visual distractions. A seat close to the teacher and the blackboard and away from the window or door
may be helpful.
2. Reduce external visual and auditory distractions. A large display of posters or cluttered bulletin
boards can be distracting. Provide the child with a study carrel. Ear plugs may be useful to block
distracting noises. Check with an audiologist to find out if the ear plugs are appropriate and which
kind to use.

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3. To improve the listening environment, the following rules are helpful. • When speaking to the
class:
* gain the child's attention before giving directions.
* speak slowly and clearly, but do not over exaggerate speech.
* use simple, brief directions.
* give directions in a logical, time-ordered sequence. Use words that make the sequence clear, such
as first, next, finally.
* use visual aids and write instructions to supplement spoken information.
* emphasize key words when speaking or writing, especially when presenting new information.
Preliminary instructions with emphasis on the main ideas to be presented may be effective.
* use gestures that clarify information.
* vary loudness to increase attention.
* check comprehension by asking the child questions or asking for a brief summary after key ideas
have been presented.
* paraphrase instructions and information to shorter and simpler sentences rather than just
repeating them.
* encourage the child to ask questions for further clarification.
* make instructional transitions clear.
* review previously learned material.
* recognize periods of fatigue and give breaks as necessary.
* avoid showing frustrations when the child misunderstands a message.
* avoid asking the child to listen and write at the same time. For children with severe central
auditory processing problems, ask a buddy to take notes, or ask the teacher to provide notes. Tape
recording classes is another effective strategy.

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Read and Respond
Test on Content Knowledge
Find out how much you have learned about speech and language disorders by answering the
following questions:
1. What are the two categories of communication disorders?
2. Define speech and language disorders.
3. Enumerate the categories of speech disorders and give an example of each.
4. How is language different from speech?
5. Differentiate expressive from receptive language.
6. What are the five rules that must be learned for a successful language acquisition?
7. Cite one developmental milestone in language and speech at a particular stage of a child's
development.
8. Describe one kind of communication disorders.
9. Discuss an ideal educational placement for a child with communication disorder.
10. Justify the importance of the family's participation in the educational program of a child with a
communication disorder.
Reflection and Application of Learning
1. Think of people you know who have speech and language disorders. Try to explain their
communication problems by referring to the parts in the chapter.
2. Recall the times when you abused your voice. What were the results? What lessons did you learn
from such experiences?
3. Interview your grandparents and other old people regarding certain beliefs on how to cure sore
throat, hoarse voice and similar ailments. Compare them to the effects of medicines that are
advertised on TV. Make a stand on the wisdom of the old cure versus what the present
advertisements claim.

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Chapter 12 STUDENTS WITH PHYSICAL DISABILITIES, HEALTH IMPAIRMENTS AND

SEVERE DISABILITIES
Yolanda S. Quijano
To the Course Professors and Students:
There are students in regular schools who walk with a limp as a result of poliomyelitis when they were
young. Some students are crippled due to amputation of the legs or arms as a result of diseases,
fractures or accidents. There are other diseases that affect the normal development and functions of
the skeleton and muscles. Students with crippling conditions walk with crutches, braces or move
around in a wheelchair. Thus, students with physical disabilities are very visible in the school and the
community as they ambulate with the use of assistive devices.
On the other hand, there are students who have health impairments and acute health problems
caused by asthma, heart diseases, rheumatic fever and other diseases. Certain cases of health
impairments affect the child's strength and vitality and may require hospitalization and long absences
from school.
In the neighborhood there are children who have cerebral palsy, a severe impairment that disables
them from maintaining normal posture and balance to perform normal movements and skills. In the
case of children with epilepsy, they experience seizures caused by abnormal and excessive electrical
discharges within the brain.
Crippling conditions, cerebral palsy and epilepsy are only a few of the many physical disabilities,
health impairments and severe disabilities that children and youth suffer from. These disabilities
restrict their movements and activities and their intellectual functioning as well. The children may
have normal mental ability but their conditions limit their participation in class activities. Thus, special
education services are extended to them like the other categories of exceptionalities discussed earlier.
At the end of the chapter, the students should be able to:
1. define, compare, and contrast the terms physical disabilities, health impairments and severe
disabilities;
2. describe the skeletal and the muscle systems of the human body;
3. define and differentiate orthopedic from neurological impairments;
4. enumerate and describe the types and classification of physical disabilities;

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5. identify and discuss the chronic illnesses and health related conditions;
6. enumerate and describe the severe and multiple disabilities; and
7. enumerate and describe the educational programs and support services for students with
physical disabilities, health impairments and severe disabilities.
Vignettes of Persons Who Triumphed Over their Disabilities
Idols, heroes, leaders, stars ... whatever they are called, they are people we look up to and emulate,
people we pattern our lives after. Almost always, Filipinos have the tendency to put someone in a
pedestal, to serve as a guiding force in their day-to-day lives. We tend to put them above us to serve
as an example and an inspiration so that we can follow their footsteps or perhaps copy what they
have done in order to achieve something in their lives.

Apolinario Mabini, the sublime paralytic, hero

By Araceli G. de Leon
Concern Magazine, National Council for the Welfare of Disabled Persons
1st Semester, 2001
To a large segment of the Filipino people, Mabini was one of the best heroes who shaped Philippine
history as the "Sublime Paralytic." He is one of the heroes who have been respected through the
generations. Mabini's role in the revolution was that of a leader who was known for his authority, one
who gained prestige because of his intellectual capacity, his principles, and his ability to influence
persons and situations and to analyze circumstances. In short, he was the epitome of a hero.
Mabini can perhaps be credited for the way persons with disabilities are now slowly coming out of
their shells. Slowly they are showing us that they too have a role play in our society. Why? Maybe
because they feel that if someone like Apolinario Mabini can lead a revolution and become a hero in
spite of his disability, then they too can be a hero during their own time. Indeed, Apolinario Mabini
has become the idol of many persons with disabilities. He has become a shining example for them to
follow and to emulate.
Mabini is indeed worthy of recognition. No one can dispute the significance of his frontline role in our
Philippine history. His actions have shown that his disability was not a hindrance. He did not let it
deter him from doing what he wanted to do and that is to fight for the rights of the Filipino people.
There are, however, some issues that cloud Mabini's story that need to be clarified. For example,
people wonder about his real illness and the cause of his death. Some say Mabini contracted his
paralysis when he was 32 years old and not

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when he was born. Some also believe he did not die of his paralysis but that he caught cholera which
became the cause of his death.
Historically speaking, Mabini as a boy was very bright. He preferred to read and study rather than play
with his friends. In spite of their hardships, he worked hard in order to continue studying. Even when
he contracted paralysis after a long illness in 1886, he did not let it deter him from taking up law at
the University of Santo Tomas in 1888. He also continued working for social and political reforms in
the country. Filipino revolucionarios would carry Mabini in a hammock to enable him to confer with
General Aguinaldo, who then was constantly on the move in the jungles to confuse the Americans.
In fact his enemies feared him. They continually tried to arrest him. When the revolution broke out,
he was arrested and taken to San Juan de Dios Hospital where he was interrogated. Later on, Mabini
was freed by virtue of a general amnesty issued by the Spaniards to win over the Filipino rebels.
Through his pen, Mabini displayed the range of his vision for his country. With his incisive mind, he
brought the perspective necessary to give direction to the Philippine Revolution of 1898. It was for
this that he became known as "the brains of the revolution." He was the man who, frail as he was,
braved long journeys in a hammock to answer his country's call in Cavite, where he later emerged as
the first secretary of state under the first Republic President, General Emilio Aguinaldo. He was the
man whose selfless work and dedication earned him the other title of "sublime paralytic."
His steadfast nationalism brought him to the hills of Kuyapo, Nueva Ecija, where he continued to fight
against the Spaniards, and later, the Americans. He was also exiled for two years in Guam, a fate he
received with stoicism. Although Filipino political prisoners were fairly treated in Guam, Mabini
suffered hardships mainly because of his illness. He even got sick while finishing his book La
Revolucion Filipino, a personal account of the leading events and personalities involved in the 1898
revolution.
In his letter to his brother, Mabini expressed his longing to go home even only to fulfill his wish to die
in his native land. Even before his exile, he felt his "cruel sickness" shortening his life, but the
collaboration of his compatriots with the Americans brought him more suffering and bitterness. He
was in his country again on February 26, 1903. He died a victim of a cholera epidemic that swept
Manila for two months and seventeen days after he came home.
And the rest is history. His shining example has caught the interest of many Filipino people especially
those with disabilities. His example shines as a beacon for many of us, a light in the midst of our
despair. He is our candle in the dark.

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Arturo Acosta Borjal, the good Samaritan
A Legacy Par Excellence of a Man with a Heart
By Florita J. Bisco
Concern, National Council for the Welfare of Disabled Persons
2nd Semester, 2002
From childhood until the last few days of his life, Atty. Arturo A. Borjal who died on June 6, 2002 was
admired by many of our countrymen, the poor especially. Wearing two leg braces and a pair of
crutches, he was known in his school as a brainy guy. He graduated at the top of his class in
elementary school with academic honors at the Ateneo de Manila University. He pursued his tertiary
education in the same school where he finished his Bachelor of Arts and Bachelor of Laws likewise
with honors. He made a name in his alma mater, where he was the editor-in-chief of the school
publication. Showing his prowess as a great student debater, he became president of the Ateneo's
debating team and the Supreme Student Council. He was the recipient of various awards, among
them are: Newspaper Man of the Year given by the Rotary Club of Manila; Best Opinion Columnist by
the Catholic Mass Media Awards in 1986; Special Apolinario Mabini Presidential Award given by the
Philippine Foundation for the Rehabilitation of the Disabled Inc. in 1991; Outstanding Citizen of
Manila given by the City Government in 1981; and Distinguished Leadership Award given by the
Ateneo de Manila University in 1961. He is the only Filipino journalist to be elected president of the
Manila Overseas Club and the National Press Club at the same time.
Atty. Borjal along with the Philippine Star founding chairman, the late Betty Go-Belmonte, publisher
Max Soliven and Tony Roces, founded the renowned national newspaper The Philippine Star in July
1986. He became deeply involved in activities concerning the sector of persons with disabilities. He
was a Commissioner of the National Commission Concerning Disabled Persons in 1981; director of
Tahanang Walang Hagdan in 1987; speaker/delegate to the 16th World Congress of Rehabilitation
International in Tokyo, Japan in 1988 and a resource person in a Seminar Workshop on Community
Based Rehabilitation Services in Thailand in 1989.
From 1988 to 1990, he was Executive Director of the National Council for the Welfare of Disabled
Persons. He served as Disabled Sectoral Representative at the House of Representatives during its
Eighth Congress in 1990 when Cory Aquino was president. He was one of the principal authors of R.A.
7277 otherwise known as the "Magna Carta for Disabled Persons." This law grants the rights and
privileges for Filipinos with disabilities and is considered a milestone legislation for persons with
disabilities. He was also elected president of the City College of Manila. He served under President
Joseph Estrada as consultant for the disadvantaged.
After he left the government service, he became a full-time daily columnist in several national
newspapers. For almost a decade, he hosted television and

244
radio programs that had nationwide reach. As a journalist, he became deeply involved in activities
involving the sector of persons with disabilities. He used the power of his pen to encourage building
owners to put up ramps and other accessibility facilities. He continuously inspired persons with
disabilities to strive for self-reliance and called attention to disability-related issues like prevention of
the causes of disabilities, rehabilitation and equalization of opportunities.
As a crusading sector leader, he was elected as officer and trustee of principal organizations involved
in disability concerns. He initiated and organized nongovernment organizations such as the Abilympic
Philippines Incorporated and Impact Philippines. Abilympics is now a regular part of TESDA's
Philippine National Skills Competition which is held every two years.
He used his newspaper column "The Jaywalker" to open the eyes of the nation and the Filipino people
on the potentials of persons with disabilities as productive and self-reliant citizens. He continued to
push the political, civic, academic and business sectors to provide equal opportunities for qualified
persons with disabilities.
Arty. Borjal wrote the book Walking Through the Pathways of Life, a collection of essays culled from
among 8,000 newspaper columns he had written in 20 years. As an achiever extraordinaire, he
encouraged and inspired the more fortunate sectors of society to become good Samaritans. On his
own, he put up the Good Samaritan Foundation, a non-stock, nonprofit organization that extends as-
sistance to the less fortunate in life.
Truly, Atty. Borjal lived a full life by being a "man for others."
Stephen W. Hawking, the great scientist of the 20th century
Profiles and Perspectives, Heward, 1996.
The Great People of the 20th Century, Time Publication, 1996
Stephen W. Hawking is a Lucasian Professor of Mathematics and Theoretical Physics at the University
of Cambridge in England. He is considered by many to be the foremost theoretical physicist in the
world today. His goal is to develop a "grand unifying theory" of the entire universe. Such a theory
would encompass all known laws of science and describe how the universe began. While a student in
college, he was diagnosed with amyotrophic lateral sclerosis (ALS), a degenerative disease of the
nervous system sometimes called Lou Gehrig's disease.
ALS is a motor neuron disease of middle or late life that involves progressive degeneration of nerve
cells that control voluntary motor functions. Initial symptoms usually entail difficulty in walking,
clumsiness of the hands, slurred speech, and an inability to swallow normally. The muscles of the
arms and legs waste away; eventually, walking is impossible and control of the hands is lost, although
sensation remains normal. There is no known cause or cure for ALS. He uses a wheelchair for mobility
and a computer-assisted synthetic speech generator to communicate.

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Hawking is featured in the 1996 Time Publication as one-of The Great People of the 20th Century
among the famous scientists whose works had revolutionized the world in only a span of one hundred
years - Albert Einstein, Marie Curie, Alexander Fleming, Watson and Crick, Jonas Salk and Linus-
Pauling. The book writes that Hawking does not dwell on his handicap. His succinct, synthe-sized-
voice comments are often laced with humor, but he can also be stubborn, abrasive and quick to anger.
Without his wife Jane, Hawking used to emphasize, his career might never have soared. She married
him shortly after he was diagnosed with ALS, fully aware of the dreadful progressive nature of the
disease, giving him hope and the will to carry on with his studies. They had three children early in the
marriage. As Hawking became increasingly incapacitated, she devoted herself to catering to his every
need. Friends were shocked when Hawking abruptly ended their 25-year marriage; he wed one of his
former nurses in 1995.
With his 1988 best seller, A Brief History of Time, Hawking became perhaps the best-known scientist
in the world. Why the rush to buy a dense volume of mind-bending physics? Ever wry, Hawking insists,
"No one can resist the idea of a crippled genius."
Christopher Reeve is a superhero in the eyes of the world's disabled
By Jean Marc Mojon
Philippine Daily Inquirer (AFP) 2002
TEL AVIV - Patients at Tel Hashomer rehabilitation center in Israel had no time for Superman, only for
Christopher Reeve, arguably the world's most famous disabled man and, now, an ambassador for
scientific research.
The pictures some of the patients in this hospital near Tel Aviv have pinned up above their beds are
not of the caped wonder, but of the 50-year-old, balding and wheelchair-bound paraplegic who
stunned the medical world this year by recovering some sensation in his body.
"I was once told I would never move below my shoulders," Reeve told 50 patients and their families
during a visit. The actor was paralyzed from the neck down in 1995 after a horse riding accident.
"But I began to get motor and sensory recovery five years after the injury," he told them. "The point is
that there is no such thing as conventional wisdom anymore, and no patient can be told by any doctor
what the future will be."
The actor's trip was prompted by his correspondence with Elad Wassa, a 25-year-old Israeli Ethiopian
who was crippled by a Palestinian suicide attack in the coastal town of Netanya in May 2002.
"You are my hero," the young man told Reeve after an emotional meeting at the Weizmann institute
which employs some of the world's leading neurology experts.
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But at the Tel Hashomer hospital, the first to arrive to catch a glimpse of her idol was a 23-year-old
Israeli who reads everything she can on the evolution of Reeve's health and even set up a website
with links to related articles.
"At the age of 15, I was affected by a rare syndrome which touched my nervous system and left me a
quadriplegic. Haifa year later, Christopher Reeve was wounded and I identified with his situation," she
said.
"I tried to contact him ever since because we became soul mates. I felt our lives were developing in
parallel."
Few paraplegics who suffer similar injuries could sustain the level of activity which has been Reeve's,
but the former actor, who chairs a scientific research institute in the United States, shared
experiences and tips to give hope to other disabled people.
"Christopher Reeve really is Superman, not because of what he did on the silver screen, but because
of what he is doing now," said Dan Berk, a representative from the consulate in Los Angeles.
Starring role for Christopher Reeve in ABC documentary
by Frazier Moore
Philippine Daily Inquirer (AP), 2002
NEW YORK - Christopher Reeve wants to show that "conventional wisdom is now falling by the
wayside" in a new documentary that chronicles remarkable progress in his fight to regain movement
and even walk again.
Airing last Wednesday on ABC network, "Christopher Reeve: Courageous Steps" shows the
"Superman" star moving his right wrist, left fingers and both legs - developments few in the scientific
community predicted after he was paralyzed in a riding accident in 1995.
The film was directed by Reeve's 22-year-old son Matthew, who "enabled the documentary to give
what I call a fly-on-the-wall, warts-and-all look at my life, which I would not have been willing to
reveal to some other documentary-maker."
"In the past, people have seen me when I'm all put together in the wheelchair, dressed and
groomed," Reeve said during a telephone conference Monday. "This is what really goes on daily."
The film narrated by Reeve shows his intensive exercise regimen, as well as his home life with his
family, including actress-wife Dana Reeve near New York City. It covers a yearlong period from May
27,2001 the sixth anniversary of the accident, and includes his' attendance at Matthew's graduation
from Brown University on May 27, 2002.
"There's tremendous potential for harnessing the body's desire to heal itself," he said. But his
regained motion and sensation (he can feel a pinprick on

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the majority of his body) falls short of his widely quoted pledge to walk by his 50th birthday, which is
on September 25.
"That vow," said Reeve, "was meant to motivate researchers to move more quickly, and I think that it
did have that effect."
"However, more recent controversy over embryonic stem cell research -which could help people with
Alzheimer's disease, Parkinson's disease or spinal cord injuries - has delayed important work," Reeve
said. "I feel that we've lost almost four years of significant progress," he said.
A sportsman on wheels
by Barbie Ganaden Concern Magazine, 1996
"Total recognition from the government will be the most attractive incentive for a disabled athlete,"
says Francis Silva.
Francis "Paco" Silva is an archer and a basketball player aside from being a painter. He excels in
throwing events such as javelin throw, shotput and discus throw. He was once a swimmer in his
elementary and high school days.
He had joined the Far East and South Pacific International Competition (FESPIC) Games in Kobe, Japan
in 1989 where his team in archery got special awards. He also participated in the Philippine Olympics,
also known as Philympics, a national sports program for persons with disabilities in 1980. He was the
coordinator of the Wheelaton held in UP, Diliman in December 1995, which received a recognition
award from the Sports Columnists Organization of the Philippines (SCOOP). He is the sports
coordinator of the Philippine Orthopedic Center and a member of Squarewheels.
Francis Silva once again exhibited his sports ability in the 2nd Philippine National Games co-sponsored
by the Philippine Sports Commission and the National Council for the Welfare of Disabled Persons
held at the Ninoy Aquino Stadium. He represented the North Sector NCR, the area of Quezon City, in
the ortho category. The other three categories were composed of the visually and hearing impaired
and the mentally retarded. Francis was asking even before the game: "Why do they have to still
demonstrate their sports ability? We want a competition because we have already showed our
potentials."
Francis Silva is a 38-year-old bachelor. If one will look at him, he seems like only sitting on a
wheelchair because you can never see his physical handicap. He has a big body build. He possesses a
very strong determination and a magnetic personality. He is tall, macho and has a voice quality of a
newscaster, announcer, or a disc jockey. He also has the qualities of a real and good athlete.
"I lift weights daily," answered Francis when asked how he maintains his physical fitness.

248
Francis Silva started to use a wheelchair when he was in second year high school at the Far Eastern
University. He was hit by a stray bullet in the spinal column. He was immediately brought to the Jose
Reyes Memorial Hospital and was confined for almost three months. He was rehabilitated for two
years at the National Orthopedic Center. After he was discharged from the center he had learned that
there were athletes like him who came from the center and who had been participating and
competing in the national and international games. He kept in touch with them and thus started his
competition in archery in the FESPICS in Kobe, Japan.
"Lack of training equipment is one of the problems of an athlete with disability," said Francis. "I
remember the time I competed in archery in Japan. I really could see the difference of the bow and
arrow I brought there compared to those of Japan and the other competing countries. Japan had its
built-in telescope in the wheelchair. The telescope was used to see the alignment of its target. I also
recall a Japanese who asked me who made my bow because he said it was very unique. If we really
consider our equipment to be high tech, regardless of the high cost we may bring home the bacon,
the cash awards and medals."
Logistics is another problem of the disabled athlete. One has to use his own money and equipment to
practice and to travel. As in the wheelaton, the participants used their own wheelchairs in the
practices and the competition itself. They financed the wheelchair's repair and maintenance.
"Money really counts the least for me. What we really need is the recognition of the government so
that the athletes and those who are interested to join the teams will be motivated. Even the losers
should be given consolation prizes in the form of tokens or plaques," Francis explained.
Francis Silva gives the following message to athletes with disabilities: "Discover the sports you excel
in, develop your ability and show everyone your will and determination. Prove to all that we can be
successful athletes despite our disability."
Figure 55. Apolinario Mabini, The Sublime Paralytic, A National Hero

249
Figure 56. Prominent Persons with Physical Disabilities

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Human Body's Skeletal and Muscle Systems The Skeleton and Muscles (Reader's Digest, 2004)
Physical disabilities attack the body's skeletal and muscle systems, the nervous system, the bones,
joints and limbs. A brief review of the normal skeletal and muscle systems provides the background
for a better understanding of physical disabilities.
The Skeleton
The adult skeleton provides the body's internal scaffolding; it is made up of 206 bones and accounts
for one-fifth of the body's total weight. There are four classes of bones:
Long bones or limbs
• Short bones in the wrists and ankles
• Flat bones in the skull
• Irregular bones in the face and vertebrae
The bones of the hands and feet constitute half the total number of bones in the body. The 206 bones are found in the
different parts of the body.
Skull 22 Pectoral girdle 4
Ears 6 Hip bones 2
Vertebrae 24 Arms (2 x 30) 60
Sternum 3 Legs (2 x 29) 58
Throat 1
An adult's spine consists of 26 bones called vertebrae. It is divided into four sections:
Cervical vertebrae - the top seven bones of the spine in the neck
• Thoracic vertebrae - the 12 vertebrae attached to the ribs
• Lumbar vertebrae - the five vertebrae below the ribs
• Sacrum and coccyx - the sacrum is made of five vertebrae and the coccyx of four. In adults the
vertebrae are fused together.
The skeleton supports the body, protects the internal organs and allows a wide variety of movement.
Most bones are connected together by ligaments to form flexible joints.
The skull is formed from 22 different bones. The bones that form the braincase (cranium) are separate
at birth but gradually fuse together through childhood.
The collarbone or clavicle supports the upper arm and allows it to move in a range of direction.
• The shoulder blade
• The humerus

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• The ribs protect internal organs and the chest cavity.
• The breastbone or sternum is a bony plate that connects the ribs.
• The radius
• The ulna
• There are eight wrist bones or carpals in each wrist.
The metacarpal bones are the five long bones of the hand that lead
to the fingers and thumb.
The hip or ilium is the outer part of the pelvic girdle.
The kneecap or patella is the small bone that sits inside the cord-like
tendon joining the thigh and muscles.
• . The thigh bone or femur is the longest and strongest bone in the
body.
• The shinbone or tibia is the major load-bearing bone of the lower leg.
• The fibula is the smaller of the two lower leg bones.
Cartilage is a type of connective tissue that forms shock absorbing discs between vertebrae, gives
elasticity and strength to the knee joint, and surrounds the end of every long bone where it meets
other bones to form a joint. It also joins the ribs to the breastbone.
Muscles
Muscles control movement throughout the body, including automatic actions such as heartbeat,
movement of the gut and blinking. Muscles make up over half of the body's total weight.
There are three kinds of muscles. Striped muscle, so-called because of its striated appearance under
the microscope, makes up the majority. It contracts in response to messages from the brain. Smooth
muscle is not under conscious control. It controls the digestive, urinary, reproductive and circulatory
systems, and such unconscious responses as adjusting the iris in the eye. Cardiac muscle is found only
in the heart, and is unique in being able to contract rhythmically and continuously.
Muscles produce movement by contracting and are arranged in opposing pairs or groups. To raise the
forearm, the biceps at the front of the upper arm contract and shorten while the triceps at the back
relax and lengthen. To lower the forearm, the actions of these muscles are reversed. The biceps are
stronger than the triceps because raising the arm works against the pull of gravity.
• Trapezius is a large, diamond-shaped muscle in the upper back. It holds the head straight and
contracts to pull it backwards.
• Shoulder deltoid raises the arms outwards from the body.
• Triceps contract to straighten the arm.
• Pectoral muscle

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Figure 57. The Skeletal and Muscle Systems

253
Biceps
External obliques contract to twist the torso.
Lattissimus dorsi is the large back muscle that holds the body upright.
Trunk deltoids contract to bend the body forward.
Thigh muscle or quadriceps is the large muscle that pulls the lower
leg forward when walking and holds the leg straight when standing.
Gluteus maximus is the largest muscle in the body located in the
buttocks.
Hamstring muscles contract to bend the leg at the knee.
Calf muscle contracts to pull the heel upwards and lift the back of
the foot off the ground.
Achilles tendon is a tough cord that links the bottom of the calf
muscle to the heel and pulls the heel upwards when the calf muscle
contracts.
Types of Physical Disabilities
Physical disabilities refer to impairments that are temporary or permanent that:
• affect the bones and muscle systems and make mobility and manual dexterity difficult and/or
impossible;
• cause deformities and/or absence of body organs and systems necessary for mobility; and affect
the nervous system making mobility awkward and uncoordinated.
Orthopedic and Neurological Impairments
The two distinct and separate types of physical disabilities arc orthopedic impairments and
neurological impairments.
An orthopedic impairment affects the bones, joints, limbs and associated muscles of the skeletal
system. Examples of orthopedic impairments are:
1. Poliomyelitis also known as infantile paralysis
2. Osteomyelitis or tuberculosis of the bones and spine
3. Bone fracture or breakage in the continuity of the bone results from falls and accidents.
4. Muscular dystrophy is a group of long-term diseases that progressively weakens, deteriorates and
wastes away the muscles of the body. The disease is usually fatal. The infant appears normal at birth
and the muscles begin to weaken at age 2 to 6 years old. The calf muscles appear unusually large
because the degenerated muscle has been replaced by fatty tissue. The child walks with an unusual
gait, a protruding stomach and hollow
back. He or she experiences difficulty in running or climbing stairs, getting to his or her feet after lying
down or sitting on the floor and may fall easily.

254
By age 10 to 14, the child loses the ability to walk. The small muscles of the hands and fingers are
usually the last to weaken and deteriorate.
5. Osteogenesis imperfecta is a rare inherited condition marked by extremely brittle bones. The
skeletal system does not grow normally, and the bones are easily fractured. As the child matures, the
bones may become less brittle, and require less attention.
The child with osteogenesis imperfecta is fragile and may be able to walk for short distances with the
aid of braces, crutches and other protective equipment.
6. Limb deficiency refers to the absence or partial loss of an arm or leg. The Greek word "plegia"
which means "to strike" is used in combination with the affected limb, that is, arm or leg, to describe
the condition.
• Quadriplegia. All four (quadri) limbs, both arms and legs, are affected. Movement of the trunk
and face may also be impaired.
• Paraplegia. Motor impairment of the legs only.
• Hemiplegia. Only one (hemi) side of the body is affected, for example, the left arm and the left
leg may be impaired.
• Diplegia. Major involvement of the legs, with less severe involvement of the arms.
• Monoplegia. Only one (mono) limb is affected.
• Triplegia. Three limbs are affected.
• Double hemiplegia. Major involvement of the arms, with less severe involvement of the legs.
• Orthopedic and neurological impairments have close relationship. For example, a child who is
unable to move his legs due to damage in the central nervous system may also develop disorders in
the bones and muscles.
An infant may be born with a congenital limb deficiency. Acquired limb deficiency results from the
amputation of the arms or legs due to diseases or accidents that require surgery. A prosthesis or
artificial limb is often used to replace the limbs to facilitate balance and to create a more normal
appearance. Braces, crutches and wheelchairs are used wherever applicable.

255
7. Crippling conditions that are congenital or present at birth include:
• clubfoot - The child is born with one or both feet deformed usually with the feet and toes turned
inward, outward or upward often accompanied by webbed toes.
• clubhand - The same as clubfoot but this time the hands and fingers are deformed.
• polydactylism - The child is born with extra toes or fingers.
• syndactylism - The fingers or toes or both are webbed like those of fowls, ducks and hens.
A neurological impairment involves the nervous system and affects the ability to move, use, feel, or
control certain parts of the body. Some of the types of neurological impairment are described in the
pages that follow.

Figure 58. JASON DE LOS REYES is a paraplegic who does wonders through his
creative inclination in visual arts. He exists as a living proof against the conventional
conception of the disabled as unproductive and dependent.
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Cerebral Palsy
Cerebral palsy is characterized by disturbances of voluntary motor functions that may include
paralysis, extreme weakness, lack of coordination, involuntary convulsions and other motor disorders.
It is a long term condition resulting from a lesion to the brain or an abnormality of brain growth. It can
be treated but not cured. It is not fatal; the impairment does not get worse as the child ages. It is not
contagious, and in most cases not inherited. The causes are varied and not clearly known. It has often
been attributed to the occurrence of injuries, accidents, or illnesses that are prenatal (before birth),
perinatal (at or near the time of birth) or postnatal (soon after birth).
The children with cerebral palsy have little or no control over the arms, legs, or speech depending on
the type or degree of impairment. They may have impaired vision or hearing. Perceptual and sensory
difficulties, learning difficulties and intellectual impairments may accompany cerebral palsy. Specific
types are as follows:
1. Hypertonia commonly called spasticity. This is characterized by tense, contracted muscles and
the movements may be jerky, exaggerated and poorly coordinated. Deformities of the spine, hip
dislocation and contractures of the hand, elbow, foot and knee are common. These result in the
inability to grasp objects with the fingers and if able to walk, it may be with a scissors gait, standing on
toes with knees bent and pointed inward.
2. Hypotonia or weak floppy muscles particularly in the neck and trunk. The child with hypotonia
has low level of motor activity, slow to make balancing responses and may not walk until 30 months
of age.
3. Athetosis. It is a condition characterized by slow, worm-like involuntary, uncontrollable and
purposeless movements. A child with this condition may not be able to control the muscles of the
tongue, throat and may drool so there is difficulty, in expressive oral language. He/She seems to
stumble and lurch awkwardly when walking, at times the muscles may be tense and rigid or loose and
flaccid and has serious problem in mobility and in doing the activities of daily living.
4. Ataxia. It is a disturbance of balance and equilibrium resulting in a gait like that of a drunken
person when walking and may fall easily if not supported.
5. Rigidity. It is characterized by the marked resistance of the muscles to passive motion and display
extreme stiffness in the affected limbs.
6. Tremor is marked by rhythmic, uncontrollable movements or trembling of the body or limbs.
7. Mixed type. This is characterized by the presence of traits mentioned in the preceding categories.

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Spina Bifida
Spina bifida is a congenital defect in the vertebrae that encloses the spinal cord. As a result, a portion
of the spinal cord and the nerves that normally control muscles and feeling in the lower part of the
body fail to develop normally. The condition ranges from mild to severe. The mildest form is not
visible and does not usually cause any loss of function for the child. However, in the most serious
condition, the spinal lining, spinal cord and nerve roots all protrude and are usually tucked back into
the spinal column shortly after birth. This carries a high risk of paralysis and infection. About 80 to
90% percent of children born with spina bifida develop hydrocephalus, the accumulation of
cerebrospinal fluid in tissues surrounding the brain. This could lead to head enlargement and severe
brain damage.
Spinal Cord Injuries
Spinal cord injuries are results of accidents. Injury to the spinal column is generally described by
letters and numbers indicating the site of the damage. For example C5-6 means the damage has
occurred at the level of the fifth and sixth cervical vertebrae, a flexible area of the neck susceptible to
injury from whiplash and driving. In general, paralysis and loss of sensation occur below the level of
injury. The higher the injury on the spine and the more the injury (lesion) cut through the entire cord,
the greater the paralysis.
Traumatic Brain Injury
Traumatic brain injury is commonly caused by injuries to the head as results from automobile,
motorcycle and bicycle accidents, falls, assaults, gunshot wounds and child abuse. Severe head
trauma often causes coma or an abnormal deep stupor from which it may be impossible to arouse the
affected individual by external stimuli for an extended period. Temporary or lasting symptoms may
include cognitive and language deficits, memory loss, seizures and perceptual disorders. Children may
also have difficulty in paying attention and may display inappropriate or exaggerated behavior ranging
from extreme aggressiveness to apathy.
Health Impairments
Health impairments of children are due to chronic or acute health problems that adversely affect their
educational performance. These problems are present over long periods and tend to get better or
disappear. Children with these health problems are not usually confined in hospitals except during
attacks or flare ups of their diseases. In many instances, health impairments could result to poor
school performance and social acceptance and their effects to the child is great; hence, it is important
for teachers to be aware of these problems.
Among the chronic illnesses and other health related conditions are the following:

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Asthma is a chronic lung disease characterized by episodic bouts of wheezing, coughing, and difficulty
in breathing due to the inflammation of the airways in the lungs. It is usually triggered by allergens
(certain foods, pets, pollen), irritants (smog, cigarette smoke), exercise, or emotional stress. The
severity of asthma varies greatly. The child may experience only a period of mild coughing or extreme
difficulty in breathing that requires emergency treatment. Symptoms generally begin in early
childhood but sometimes do not develop until late childhood or adolescence. Its symptoms might also
appear following a viral infection of the respiratory system.
Diabetes is a disorder of metabolism that affects the way the body absorbs and breaks down sugars
and starches in food. Children with diabetes have insufficient insulin, a hormone normally produced
by the pancreas necessary for proper metabolism and digestion of food. Early symptoms include
thirst, headaches, weight loss (despite a good appetite), frequent urination, and cuts that are slow to
heal. The child lacks energy and important parts of the body particularly the eyes and the kidneys can
be affected by untreated diabetes.
Epilepsy is a convulsive disorder commonly known as seizure, a disturbance of movement, sensation,
behavior, and/or consciousness caused by abnormal electrical activity in the brain. The specific causes
of epilepsy are not clearly known. It is believed that people become seizure-prone when a particular
area on the brain becomes electrically unstable. Many children experience a warning sensation,
known as an aura, a short sensation before seizure. The aura takes different forms in different people:
distinctive feelings, sights, sounds, tastes, and even smells. The aura can be a useful valve enabling the
child to leave the class or group before the seizure occurs. There are several types of seizures, three of
which are common:
• Generalized tonic-clonic seizure formerly called grand mal is the most conspicuous and serious
type. The affected child has little or no warning that a seizure is about to occur; the muscles become
stiff, the child loses consciousness, and falls to the floor. Then the entire body shakes violently as the
muscles alternately contract and relax. Saliva may be forced out of the mouth; legs and arms may
jerk; and the bladder and bowels may be emptied. After about 2 to 5 minutes, the contractions
diminish, the child either goes to sleep or regains consciousness in a confused or drowsy state. This
type of seizure may occur as often as several times a day or as seldom as once a year and more likely
to occur during the day than at night.
• Absence seizure previously known as petit mal is far less severe than the generalized tonic-clonic
seizure but may occur more frequently, as often as 100 times per day in some children. Usually there
is a brief loss of consciousness, lasting for a few seconds to half a minute. The child may stare blankly,
flutter or blink his/her eyes, grow pale, or drop whatever he/ she is holding. Teachers mistake him/her
as daydreaming or not listening.

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The child may not be aware of the seizure and no special first aid is necessary.
• Partial seizure which could be complex or simple. A complex partial seizure also called psychomotor
seizure may appear as a brief period of inappropriate or purposeless activity. The child may smack
his/her lips, walk around aimlessly, or shout. She may appear conscious but is not actually aware of
the behavior. It could last from 2 to 5 minutes, after which the child has amnesia about the entire
episode. The simple partial seizure is characterized by sudden jerking motions with no loss of
consciousness. It may occur weekly, monthly, or only once or twice a year.
When a child experiences a seizure especially the generalized tonic-clonic seizure, the teacher should
follow these procedures: i) Keep calm. Reassure the student that the student will be fine in a minute;
ii) Ease the child to the floor and clear the area around him/her of anything harmful; iii) Put
something flat and soft under the head so it will not bang on the floor when the body jerks; iv) You
cannot stop the seizure. Let it run its course. Do not try to revive the child and do not interfere with
the movements; v) Turn the body gently to the side to keep the airways clear and allow saliva to drain
away. Do not try to force his mouth open. Do not try to hold on to the tongue. Do not put anything in
the mouth; vi) When the jerking movements stop, let the child rest until he/she regains
consciousness; and vii) Breathing may be shallow during the seizure, and may even stop briefly. In the
unlikely event that the breathing does not begin again, check the child's airway for obstruction and
give artificial respiration. (Source: From Epilepsy School Alert, The Epilepsy Foundation of America,
1987, Washington. D.C.)
Hemophilia
Hemophilia is a rare hereditary disorder in which the blood does not clot as quickly as it should. The
most serious consequences are usually internal, rather than external bleeding contrary to popular
opinion. Internal bleeding can cause swelling, pain, and permanent damage to joints, tissues, and
internal organs may necessitate hospitalization for blood transfusion.
Burns
Burns result from household accidents but sometimes caused by child abuse. Children with serious
burns usually experience pain, scarring, limitations of motion, lengthy hospitalization and repeated
surgery. Serious burns can cause complications in other organs, long-term physical limitations, and
psychological difficulties. The disfigurement caused by severe burns can affect a child's behavior and
self-image.
Other health problems include a heart condition, leukemia or severe anemia, rheumatic fever,
nephritis, and lead poisoning.

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Severe and Multiple Disabilities

This category includes children who exhibit two or more disabilities, with the exception of the deaf-
blind. Usually, the combinations are mental retardation, learning disabilities, autism, Down syndrome,
speech disorders, physical disabilities, visual and hearing impairments, emotional and behavioral
disorders and others. However, while they need intensive support for life, there are those who have
average or above average intellectual abilities, giftedness and talent.
These children have a wide range of characteristics brought about by the combination and severity of
the disabilities and age of onset. Some traits are shared like limited speech or communication,
difficulty in basic physical mobility, problems in generalizing skills from one situation to another,
restrictions in relating or attending to others, tendency to forget skills through disuse, and need for
intensive and pervasive support in major life activities.
Characteristics
The disabilities significantly affect the development of cognitive, social, emotional and adaptive skills.
Learning does not take place the way it does with most children. The condition limits interaction with
other children, adults, and restricts normal activities. They have difficulties with adaptive behavior
and in coping with the natural and social demands of the environment.
They may display age-inappropriate and socially unacceptable behaviors brought about by the
inability to recognize situations when and where certain acts may be improper and permissible.
Examples are certain forms of antisocial behavior such as undressing in public, self-stimulatory
behavior like touching parts of the body, self-injurious behavior like head banging, poking the eyes
and self-mutilation.
They may appear to be completely out of touch with reality and may not show normal human
emotions. It may take some work and effort to capture the child's attention or to evoke any
observable response.
Many of these children need intensive and pervasive support under constant supervision since they
are often unable to care for their basic needs, such as dressing, eating, toileting, and maintaining
personal hygiene.
Prevalence and Incidence Trends
The 1997 UNICEF report on Situation Analysis of Children and Women in the Philippines cited in
Chapter 2 indicates that 25.9% are without one or both arms or hands while 16.4% are without one or
both legs or feet in the projected 80 million population. No other local data on prevalence or
incidence estimates are available for those with health impairments and severe or multiple
disabilities.

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The Special Education Enrolment Data of school year 2004-2005 show that 10% of the students with
disabilities have orthopedic impairments while 2% are those with health problems. No enrolment
data are available for children with severe disabilities. It is possible that these children may have been
categorized according to their primary disabilities.
The low participation rate of children with physical and health impairments could be due to the fact
that these children are enrolled in regular classrooms without the benefit of special education
services. Hence, they are counted among the regular students. Others are out-of-school, unlocated
and unidentified due to the severity of the disabilities.
The growing public awareness on disabilities has partly reduced the incidence of numerous childhood
diseases and disabilities. Some of the initiatives are the law on newborn screening that detects and
treats congenital disabilities, prenatal care made available in government health centers,
immunization programs, along with early intervention, physical therapy, medication and the
application of assistive technology.
Educational Programs
Educational programs and services to children with physical disabilities, health impairments and
severe disabilities take into consideration both the administrative and instructional models of special
education.
Administration of Special Education
Four administrative models are appropriate for this group of children:
1. Inclusion in the regular class
This setting advocates for inclusive education mainly through mainstreaming and full-time placement
in regular classes. In this model, the special education teacher helps the regular teacher in dealing
with the special needs of the children. Ideally, there should be access to the services of an
interdisciplinary team composed of physical therapists, occupational therapists, speech therapists,
physicians, nurses and other specialists, psychologists and guidance counselors.
The amount of support that may be required by these children varies greatly according to the
condition, needs and level of functioning. Children with physical disabilities, health impairments and
severe disabilities who can develop their full potentials in this setting are those who:
• have mild to moderate disabilities that are correctible with assistive devices, need for support is
intermittent or periodic;
• have borderline or average mental ability, i.e., slow learner or with mild mental retardation, with
mild learning disabilities;

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• require only minor modifications in facilities such as ramps, altered seating arrangement and
simple assistive equipment like braces, crutches and wheelchairs; and
• require no drastic curriculum revisions with respect to content, type of educational experiences,
length of time spent in schooling, or ultimate goals.
Parents of those children with chronic illnesses who are often absent from school should be assisted
to tutor their children at home if they cannot hire special tutors. This way, the children will be able to
cope with the lessons discussed in class.
An effective inclusive education program develops self-direction and independence as the students
with disabilities attend to their schoolwork. Peer relationships and social development are enhanced
by the cooperative class activities that allow the nondisabled students to recognize the abilities of
their classmates with handicapping conditions. Research data show that, with adequate support
services and class modifications made available, attending the same school and participating in the
same activities with their nondisabled classmates greatly contribute to the social development of
these children.
2. Special class
The special class is composed of children with disabilities who do not meet the criteria for inclusion in
the regular class. While the special education teacher handles the class, partial mainstreaming in
regular classes may be worked out. There may be more than one grade level in a special class. The
class may be located in the Special Education Center or special education resource room in the regular
schools or in special schools.
3. Hospital-bound instruction
The special education program of the hospital admits children with physical disabilities or chronic
illnesses who cannot study in regular schools. The National Orthopedic Hospital (NOH) located in
Quezon City has a School for Crippled Children that offers educational services from the elementary to
the secondary level. The Philippine General Hospital in Manila has a ward known as "Silahis ng
Kalusugan" that caters to children who are suffering from chronic illnesses and diseases.
4. Homebound or home-based instruction
Children who have severe or multiple disabilities, mobility problems, or chronic illnesses are regularly
visited by itinerant special education teachers in their home who provide instruction based on their
needs and capabilities. In case a SPED teacher is not available, the parents can provide direct
instruction or hire a teacher to provide regular
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instruction. The knowledge and skills learned at home or in the hospital can be accredited through
the Philippine Educational Placement Test (PEPT) of the Department of Education.
Instructional Models
Modifications and adaptations in the curriculum and strategies in teaching and evaluation of learning
are introduced to suit the needs and conditions of children with physical disabilities, health
impairments and severe disabilities.
1. Individualized Instruction Model
The Individualized Education Plan or IEP identifies the annual goals, short-term objectives and weekly
or daily instructional plans for specific children. Self-management skills are taught for self-regulation
and competence in the adaptive skills. A structured curriculum is used and the academic subjects are
learned through diagnostic and prescriptive teaching, task analysis, close monitoring of progress, and
reinforcement through immediate feedback mechanisms.
2. Resource Room Model
Children who are mainstreamed in regular classes go to the resource room for special instruction,
tutorial and mentoring activities. The resource room is the repository for instructional materials and
references that the children use in doing their homework and projects to comply with the
requirements in the regular class. The resource room is used for meetings with regular teachers,
administrators, parents and others. Nondisabled classmates go to the resource room to do work with
the children with disabilities or simply to socialize with each other.
3. Curriculum Modification Model
Changes are introduced in the regular curriculum to accommodate the special education needs of the
children in a functional curriculum. The functional curriculum includes training on gross and fine
motor skills, maximum use of vision, hearing, touch, and other working sensory modalities, receptive
and expressive communication skills, functional academics, and social skills. Active rather than passive
learning is employed.
4. Instructional Variations Model
A variety of suitable and effective instructional approaches are employed. Choices of instructional
strategies are based on successful previous preferences of the students, motivation level, individual
learning style, and learning rate.

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Educational Support Services

Students with physical disabilities, health impairments and severe disabilities need the services of an
interdisciplinary team composed of the special and regular teachers and school administrators,
parents, physical and occupational therapists, medical personnel, specialists, psychologists and
guidance counselors. The team addresses the medical, educational, therapeutic, vocational, and social
needs of the children. The job descriptions of the interdisciplinary team members are presented
below.
The physical therapist (PT) is primarily concerned with the planning and implementation of the
program to development and maintain correct bodily posture and mobility. The program objective is
to assist the child in the use of muscles and locomotor functions to reduce pain, discomfort or long-
term physical damage. Ultimately, efficiency and independence in the use of motor skills and the
development of muscular functions is achieved. Massage and prescriptive exercises are used together
with activities on proper sitting position, special positioning for toileting and feeding, use of special
equipment, and play programs, and swimming that children with or without disabilities can enjoy
together.
The occupational therapist (OT) focuses on the child's participation in activities that are useful in self-
care, communication, recreation, employment and other daily living skills. Specific training is given to
motor behaviors like drinking from a modified cup, buttoning clothes, tying shoes, pouring liquids and
other adaptive skills. These activities enhance the child's physical development, independence,
vocational potential, and self-concept.
The speech therapist (ST) deals with the remediation of all forms of speech, voice, hearing and
language problems caused by physical, mental or psychological disorders.
Physicians, nurses and specialists appraise the current health status and the disability itself, provide
treatment and recommend therapy services when needed. The prosthetist designs and fits artificial
limbs; the orthotist designs and fits braces and other assistive devices; the biomedical engineer
develops or adapts assistive technology; and the social worker assists students and families in their
adjustment to the disabilities. The psychologist conducts psychodiagnostic and educational
assessment for use as basis in school program planning and intervention. The guidance counselor
offers individual counseling, guidance service and family therapy to those who need these services.
Environmental Modifications
Within the regular school buildings, modifications have to be made in the learning environment to
enable the students with physical disabilities and health impairments and those with severe
disabilities participate more fully in the school and classroom activities.

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Environmental modifications may involve work space modifications, changes in the location of
materials and equipment, object modifications or adapting the equipment or materials for given
tasks, changing the manner in which the task is done, and use of manipulation aids.
The most visible type of environmental modification is seen in buildings, offices, restaurants, hotels
and other service-oriented places that have been made accessible to persons with disabilities. Batas
Pambansa Blg. 344, otherwise known as the Accessibility Law enacted in 1983 and Republic Act 7277
or the Magna Carta for Disabled Persons direct schools and institutions to provide barrier-free
architecture which includes but not limited to sidewalks, ramps, handrails, parking spaces, toilet and
restroom facilities for persons with disabilities. The law provides that classes that have students with
physical disabilities should be held in the ground floor as much as possible.
Within the classroom, the problems of students with physical disabilities may be solved by simple
procedures that require little or no cost at all like the following:
1. Modifying school furniture by:
• changing desk and table tops to appropriate heights for students who are very short or who use
wheelchairs;
• adjusting seats to turn to either side so that the child with braces can sit more easily;
• providing foot rest;
• adding hinged extension to the desk with a cut-off for the child who has poor sitting balance;
• eliminating protruding parts over which the child might trip.
2. Providing need-based assistance like:
• taping paper to the desk;
• devising some means of keeping pencils, crayons and other materials from rolling on the floor;
• providing backracks or mechanical page turners;
• providing wooden pointer to indicate responses on the board;
• installing paper cup dispenser near water fountains for wheelchair users; and
• placing rubber mats over the slippery sections of the floor.
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Assistive Technology
The United-States Congress defines assistive technology as any item, piece of equipment or product
system, whether acquired commercially off the shelf, modified, or customized, that is used to
increase, maintain, or improve the functional capabilities of individuals with disabilities. Students use
assistive technology so that they can access the same educational opportunities as their peers.
For students with disabilities, use either high-technology assistive equipment or low-technology
adaptive devices or both. These are used to increase mobility, perform daily life skills, improve
environmental manipulation and control, facilitate better communication, access computers, and
enhance learning.
Several companies and universities are currently producing technology products that meet the needs
of students with disabilities. The categorization of these products is as follows:
1. Mobility aids are assistive technology devices that help people perform movements in a variety
of environments. These include manual and electric wheelchairs, canes, scooters, walkers, vans
modified for travel, electronic direction-finding/mobility aids and other adaptations and devices.
2. Seating and positioning aids are used to position the disabled person in the best posture to
participate in a particular activity. The activity might involve moving from place to place, sitting during
conversation, eating, sleeping, and others. Specific body features are considered in order to adapt the
devices for maximum efficiency and comfort. Examples of these aids are adapted seating, standing
table, seat belt, braces, transfer aids, cushions and wedges to maintain posture, and devices for trunk
alignment that assist the students in maintaining body alignment and control so they can perform a
range of daily tasks.
3. Aids for daily living are devices used to increase independence. They assist an individual in
performing functional living skills or self-help activities such as cooking, eating, bathing, toileting,
dressing, and home maintenance. Examples of these are spoons and forks with custom-designed
handles or straps, mug with lids and handles, utensil hand clip, color coded measuring cups and
spoon set, long handled hairbrushes, dressing stick, tube squeezer, zoom mirror, zipper pull, nail
clipper with magnifying lens, and others.
4. Communication aids include devices such as speech synthesizers, text-to-spee'ch software, and
telecommunication for the deaf. These augmentative and alternative communication or "aug com"
devices assist students who may have speech difficulties, are nonverbal, or have difficulty in
communicating with other people.

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5. Sensory aids are assistive technology devices for students who have primary disabilities as hearing
impairment and visual impairment. These devices may include hearing aids, FM systems, auditory
trainers, eyeglasses, low vision aids or magnifying glasses, Braille and speak, Perkins brailler, braille
printers, pocket slates, large print cards, reading devices, tactile and visual globe, telecommunication
for the deaf, feel and hear activity box, magnetic blocks, story time rhymes musical storybook and
many more.
6. Instructional aids refer to the devices and adaptations to materials that help facilitate an
individual's learning. These include instructional technology that is used in the education of a person
such as overhead transparencies and projectors, audiotape players, multimedia software and tools,
Internet technology for watching real-time activities, and computer software and hardware including
computers with adaptive switches or adapted keyboards. There are specific instructional aids in
reading, writing, and mathematics.
Users of assistive technology are cautioned to be informed when selecting these devices. There is a
wealth of information that teachers and parents can access, thus allowing them to make informed
choices about the products they want to purchase and the services they want to select. They can start
by reading general information on the subject from books and available publications. They can con-
tact national and local agencies, institutions and disability organizations like the National Council for
the Welfare of Disabled Persons (NCWDP), the Department of Social Welfare and Development
(DSWD), the Department of Education (DepED), National Orthopedic School for Crippled Children,
Philippine National School for the Blind, Philippine School for the Deaf, Tahanang Walang Hagdan,
Resources for the Blind (RBI), among others which can give them the information they need. Local
hospitals, community rehabilitation or vocational centers may be active in designing and fitting
assistive devices to complement the child's capabilities. Another local resource is a computer users'
group which can provide valuable information about the use of software and hardware among the
students with physical or severe disabilities.
Read and Respond
Test on Content Knowledge
Find out how much content knowledge you have learned in this chapter by answering the following
questions correctly.
1. Describe the skeletal and muscle systems of the human body. What is the importance of keeping
the bones and muscles healthy?
2. What are the differences between orthopedic and neurological impairments?

268
3. Enumerate the common types of physical disabilities, health impairments and severe disabilities.
Describe each of them.
Reflection and Application of Learning
1. Conduct an interview with young people you know who have physical disabilities and health
impairments. Ask them about the types and causes of their disabilities. Ask them how they adjust to
their disabilities. You may also ask them about their future plans.
2. Interview their teachers and classmates, parents and family members. Ask them about their
observations about the ways the physically disabled persons adjust to the demands of their
environments. Ask them what assistance they extend to the persons with physical disabilities or
health impairments.
3. Find children with severe disabilities in the community or visit an institution for this type of
children. Gather information on the causes of the disability, their characteristics and how the parents
or teachers/ caregivers train them to become independent and self-reliant.

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Chapter 13 ADVOCACY ON THE EDUCATION OF CHILDREN WITH SPECIAL NEEDS

Julieta A. Gregorio
To the Course Professors and Students:
The following collection of materials was selected from various sources that may not be accessible to
the future teachers. These materials are useful as references in discussing the importance of special
education with parents, school administrators, regular teachers, and people in the community. The
articles aim to supplement the content knowledge covered in the previous chapters on children and
youth who are exceptionally gifted and talented and those who have disabilities such as mental
retardation, learning disabilities, emotional and behavioral disorders, sensory disabilities, speech and
language disorders, physical disabilities, health impairments and severe disabilities. The specific
disabilities discussed in this chapter are autism, cerebral palsy, sub-acute sclerosing panencephalitis,
epilepsy and Down Syndrome.
The vignettes about the pains and joys of rearing children with disabilities poignantly related by the
parents themselves and the articles about young people's adjustment to their disabilities serve as
testimonies to what hope, perseverance and trust in God can do in overcoming the negative attitudes
towards disabilities.
At the end of the chapter, the students are expected to:
1. espouse the cause of children with special needs in the areas of
a. their abilities and strengths despite their condition
b. the values of special education and the different types of placement
c. family's, parents', and friends' support particularly in the early years
d. goal setting for the future to become an efficiently functioning adult;
2. gain inspiration from the vignettes on the sorrows and joys, successes and failures of persons
with disabilities; and
3. strengthen one's resolve to help children and youth with disabilities.
Working with the Families and Parents of Children and Youth with Special Needs
Parents, both biological and extended, as well caregivers naturally depend on the teacher for answers
to their questions and anxieties about their children with disabilities. The following articles are useful
references for teachers in explaining the circumstances about a child with a disability in the family.

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A Family Is the Most Important Support a Child Can Have
Reference: Archived Information. April 1997 http//www.ed.gov.pubs/parents/chapter 1 .html
Although this material is addressed to American families and parents in consonance with the
implementation of the Individuals with Disabilities Education Act, the concepts and suggestions are
applicable to Filipino families and parents as well.
Being a Parent Is a Very Important Job
A parent is anyone responsible for the care and well-being of a child. Included are single parents,
parents by birth or adoption, guardians, grandparents, foster parents, surrogate parents and
caregivers.
You help your child learn and develop every day. You are your child's first teacher. You are there to
give help and support when it is needed. When you have a child with special needs, it is sometimes
hard to know if you are doing the right thing. Your love and concern for your child is a good beginning.
As the parent of the child with special needs, you may be making decisions for your child that other
parents don't face. You may meet with many different people who will provide the services needed by
your child. You will need to know what kinds of services are available so you can make decisions that
you think are best for your child and your family.
All Families and All Children Have Strengths
A family is a group of people close to you and your child. This may include parents, husband or wife,
grandparents, in-laws, aunts and uncles, brothers or sisters.
People with different strong points can help each other. Discovering your child's strengths and
interests is important. Knowing them will help as you plan for your child's education and
development.
Make a list of your child's strengths and successes. Keep a file of photos, videos, notes, artwork, and
school work to show what your child likes to do. Let others know what your child can do.
Make a list of your child's need and what can be done to meet these needs. You play an important
role in getting the services that can be provided for you and your child. There are places to for help
and support.
Help and Support Are Important in the Early Years
Trust Your Feelings
Trust your feelings about your child. If you have a concern, get advice and help as soon as you can.
The sooner your child's special needs are met, the

271
better off your child and family will be. Remember, each child is different and may learn and develop
at a different pace. However, if you notice that your child's development is very different from other
children of the same age, you may want to talk with someone about your concern.
Where Should You Start?
Your doctor or public health agency can be a good place to begin. Most doctors and nurses have a lot
of experience with children. They may send your child to special doctors for tests. Or they may ask
you to wait a month or more to see how your child develops. Social service agencies or your local
school system might also be able to help. No one knows your child as well as you do. Before you meet
with a doctor or teacher, make a list of the things you notice about your child that concern you. If you
do not want to write things down, ask a friend to write them down for you, or use a tape recorder.
The notes and lists you keep over time will help you talk about your concerns. Also, your notes will tell
you and the doctor or teacher any of the changes you have noticed. Your notes will help you
remember little things you might forget to say during the meeting.

They may test your child and ask you questions:

• How does your child move? For example, does your child turn over?
• How does your child see? For example, does your child follow moving things with his or her eyes?
• How does your child hear? For example, does your child react to loud noises?
• Does your child make sounds or words? For example, how many words does your child use?
• How does your child act around others? For example, does your child play well with other
children?
Information and findings about your child's needs will be made based on what you say, test findings,
your child's health record, and what doctors or others see when they watch your child play or do
special tasks. Because your child is a unique person, it is important that the people testing your child
get to know and understand him or her as a whole person. The results will be a good picture of your
child, which is often called evaluation.
Evaluation is information collected by testing and watching a child, and by talking to a parent. This
information is usually collected by doctors, teachers, and others who work with your child, and who
help you have a clearer picture of your child's abilities and needs.
Find the Support You Need
As you work with your child, you may find it helpful to meet with other parents of children with
special needs. Sometimes you may feel alone, angry, and

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stressed in your search to find help or care that your child needs. This is natural, but you shouldn't
ignore your feelings. To help your child, you must also help yourself by getting the support you need.
Ask your child's teacher or doctor for information about a support groups like a parent's association
for families and parents of children with special needs. Find a group that makes you feel comfortable.
Surround yourself with people you can trust.
It is important that you find help for your child as soon as you feel there is a problem. Finding help for
your young child may prevent further developmental delays and may also improve the quality of your
family life.
Developmental delays are delays in the development of skills and abilities which usually would have
developed by a certain age.
Don't give up when you know you are right. You and your family's support are important to your
child's development, education, and well-being.
If your child is already going to school, visit the school, talk to your child's teachers, and watch your
child in class. It is important to share information with your child's teacher and school. The following
information may be helpful for the teacher to know:
• What can your child do without help?
• What can your child do with some help?
• What seems to help your child learn? When is it easiest for your child to learn?
• What makes your child happy?
• What makes your child angry?
• What do you do to help your child when he or she gets angry?
• What works for you and your child?
• What would you like your child to learn?
It Is Important to Have Dreams for Your Child
Every parent has dreams for his/her child. When you find out that your child has special needs, your
child will need extra help and support to make these dreams come true. Remember, your child has
many strengths. With your help and support, and the appropriate education, your dreams for your
child can come true.
Understanding your child's special needs can help you set goals and guide your dreams. Knowing why
some goals may be hard to reach can be helpful to you. Look for different ways to help your child
learn and develop. Information about how your child learns can also help family, friends and teachers
care for and teach your child. Helping others get to know your child will make it easier for everyone to
work together to build on your child's strengths and meet her or his needs.

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Your dreams for your child might change over time. This is natural. You and your child will also change.
Try to be flexible. Remember that part of making your dreams come true means you may have to
work hard to get the right services to meet your child's special needs.
You know your child best. Set goals your child can reach. When a goal is reached, set a new goal and
keep trying. Think about what your child can do and build on each success. Remember, even the
smallest achievement is something for which your child and your family can be proud. Work to meet
your child's special needs. Think about what would help your child do more. Don't let anything stop
you along the way.
You will find that others will support you and share your dreams. You can help make your dreams for
your child come true. Don't give up! Remember, your child will also have dreams of his or her own
that you can share.
Include Your Child in Activities with All Children
All children learn by playing. It is important that children with special needs take part in activities with
all children, including those who do not have special needs. All children can learn from one another.
Your child has as much to give to others as he or she will receive from others. Good friendships can
develop as children learn to work and play together.
If your child has a brother or sister, encourage them to play together. They will learn from one
another, building confidence and skills needed for playing and being with others outside of the family.
You can help your child learn by including your child in many different activities. You and others who
care for your child may need to think of new ways to make or buy toys, furniture, or other tools to
help your child learn.
Think about what your child does well. Try to find an activity where that skill or talent is used. Look for
activities or play groups your child will enjoy and that can develop skills and talents. Ask about
activities at school and in the community. There are programs or activities your child may enjoy:
swimming, art, church activities.
All children need time to play. By playing, children begin to explore and ask questions. Playing gives
children the chance to dream, make choices, try new things, have fun, and learn. Children with special
needs should have the same chance to play and meet other children.
Reach Out To Others
Being a parent or caregiver is not always easy. Raising a child with special needs places many demands
on parent and the family. Finding the right help for your child may be hard at first. You and your family
need support and understanding. Help is available from many places:

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• family members - husband or wife, parents, in-laws, sisters and brothers, grandparents, aunts
and uncles, legal guardians, or caregivers;
• school administrators, teachers, school staff;
• friends, neighbors, or members of churches;
• government offices - Departments of Education, Social Welfare and Development, Health,
Barangay;
• school or health center doctors, nurses, and other health professionals; organizations of parents
of children with special needs.
Consult the National Council for the Welfare of Disabled Persons for government and nongovernment
organizations, parent organizations and other support groups:
Address: SRA Main Building, North Avenue, Diliman, Quezon City Tel. (632)925-1165; 920-1503; 927-
5916 Fax No. (632)929-8879 E-mail Address: [email protected]
Look for elementary schools nearest your home that have special education programs. Visit the
school's Special Education Center and talk to the teacher and the children themselves. Ask the school
principal for referral in case there is no Special Education Program in the said school.
Join a parent organization and actively support its advocacy. Brothers and sisters of children with
special needs also need support- Brothers and sisters may get together and form support groups or
join one. These support groups are a good way for children to talk and share information about
special needs.
It is important for you and your child to do things with different children. Everyone will benefit and
learn from you and your child. By getting to know you and your child, others will be better able to
help you by sharing their ideas, support, and other assistance.
Remember it is not the size of the support group that is important, but rather how well it works for
you. One good friend or supportive relative may be the most helpful to you. Only you can decide what
is best for you and your child.
Your love and dream for your child are your greatest strengths. Use these strengths to reach out to
others who know what it's like and can give you support.
Below is a summary of the ideas and suggestions given in the previous sections. These are helpful
hints that may help parents in their search to meet the child's special needs.
1. Get help and advice right away if you have a concern about your child's development and
learning. It may prevent some developmental delays.
2. Start by talking to your child's caregiver, doctor or teacher.
3. Make notes and lists of questions for meetings.
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4. Bring a friend or relative with you to give support when meeting with doctors and teachers.
5. Keep good records of shots, tests, letters from doctors and teachers, and notes from meetings,
and put them in a file.
6. Learn all you can about your child's special needs.
7. Learn as much as you can about support groups and services that can help you and your child.
8. Imagine goals and dreams for your child and talk about them with others who know your child.
9. Your child has special abilities and talents. Use your child's abilities to create a plan to make the
dreams come true.
10. You know your child best; set goals your child can reach.
11. Keep notes of your child's progress. .
12. Get the support you need by joining a support group, or by talking to other parents, friends, or
family members you can trust.
13. Brothers and sisters of children with special needs need support and attention, too.
14. Include your child with special needs in activities with all children, both with and without special
needs.
15. Gather as much information as you can about programs your community offers children of your
child's age.
16. Be sure to look at your whole child: your child's strengths as well as the areas for which your
child needs supports and services.
17. Do not give up when the going gets tough! Pray for God's grace in your effort to help your child
with special needs.
Inspiring Vignettes About Families and Parents of Children and Youth with Special Needs
Let us draw inspiration and strength from the accounts of parents and families on how they coped
with difficulties and seeming hopelessness in dealing with the presence of a child with disabilities in
the family.
Joshwa: My Special Son
By Leira Bhagwani Pagaspas
Smart Parenting Magazine, March/April, 2003
Raising an autistic child is a lesson in itself filled with wonder. It is serendipitous that my son's birthday
is so close to Christmas Day -he is the best Christmas gift I have ever received.

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Having Joshwa taught my husband, Philbert and I a lot of things: how to survive on four hours' sleep,
how to work through a tantrum, how to make a little boy eat his vegetables. However, I only found
out about the real meaning of motherhood after a surprising revelation a few months ago. When
Joshwa was ten months old, he had measles. I panicked and took him to the pediatrician. While there,
I also raised another concern. I asked the doctor if something was wrong with my son.
I've noticed that Joshwa wouldn't look at me when I called out his name. He didn't seem to be
learning any of the tricks that I taught him. The doctor dismissed my fears. She said it was normal. She
said that I didn't have to worry. My husband agreed. He said I. was just being paranoid. So I tried to
reject such negative thoughts and just filled my heart with gratitude for my beautiful family.
After five months, I went back to the same doctor and asked the same question. This time, she gave
me a different answer. First, I was to take Joshwa to an ENT (ear, nose, and throat) specialist to have
his hearing checked. Next, I was to consult a developmental pediatrician, who eventually told me the
grim news -my Joshwa might be autistic.
I was in a daze. I thought I was ready for anything but nothing could really prepare a parent for such a
diagnosis. My first thought was - how could I help my Joshwa?
I knew nothing about autism, but I had a lot of frightening preconceptions. I blamed myself. I had
failed my Joshwa. I had dyscalculia (a math learning disability) and now I may have passed something
on to my son. I cried myself to sleep that night.
Learning from it
When the tears dried, I resolved to find out everything I could about autism. I began a learning
process that will continue, I imagine, for the rest of my life.
I read books. I went online. I talked to people. I signed up with an Internet support group. It was
comforting to know parents who felt that children were gifts, whether they had autism or not. My
friends and family have also been very supportive. My parents even offered to shoulder some of the
expenses.
It was easy enough to piece the facts together. While its exact cause is unknown, autism is a
neurological disability most likely caused by immature development of the cerebellum and limbic
system. But of course, there was nothing in the books that tackled the other side of the story - the ups
and downs of raising an autistic child. That's what we've been learning from Joshwa himself, and it's
been a lesson filled with wonder.
Every day with Joshwa
Joshwa's life is more complicated. He has therapy five times a week. He sees the doctor regularly.
There have been good days and there have been bad.

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And there have been frustrating moments when we've struggled to learn more about each other.
Joshwa is actually more like other kids. He will learn to walk, talk, read, sing, and dance but he will
have to work harder than most kids to reach these milestones. All he needs is more time. Beyond
that, he will have skills, talents, and quirks all his own. He already does.
The future for people with autism is brighter than it has ever been, which makes me hopeful for my
son. Most of them graduate from high school. Many live independently, marry and have jobs. Early
intervention, medical advances, progressive schools, new types of therapy - all these help to make
people with autism enjoy happy and productive lives.
I dream about the future and Joshwa. Will he love eighties music in the same way that his father
does? Will he work as a chef and run a restaurant like his great grandmother? The possibilities are
endless.
Admittedly, our family is still on an emotional roller coaster. Sometimes there is pure joy for the many
gifts and wonders that Joshwa has brought us. Sometimes there is guilt. Are we doing enough for our
little boy? Would he be better if we could afford this program, those vitamins, or that new therapy?
Other times, we just get so scared. We are frightened about the many challenges that Joshwa will face
in the future.
Yet, as we head into year two of Joshwa's life, Philbert and I have realized how lucky we are. In many
ways, our lives have been transformed for the better. We have found loving support from people who
used to be strangers. We have learned to take things slow and to meet challenges one day at a time.
We take pleasure in every battle won, no matter how small. Most of all, we have realized that LIFE IS A
GIFT, AND EACH ONE A TREASURE.
What is autism?
By Ruth M. Floresca Parenting Magazine, March/April 2003
Allison Lareza is a bright ten-year-old boy who loves to sing, draw and play computer games. He was
named Outstanding Student in his special education preschool's graduation last year. He is autistic.
Allison was diagnosed when he was three years old. He has since received physical and occupational
therapy. And though Allison is now academically capable for mainstream education, his mom Alice
says he is still not emotionally ready. Now and then Allison throws a tantrum but his future prospects
are quite promising.
A complex thing
Joel Lazaro, M.D., a developmental pediatrician holding clinics in the Southern Tagalog area, says
autism is a complex developmental disorder that

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affects the brain's normal development of social and communication skills. It involves a wide range of
behavior.
An autistic child may be withdrawn or exhibit inappropriate and intrusive social behavior. The child
may not respond when his name is called, have poor eye contact, be indifferent to affection or
sometimes have inappropriate affection. He may also lack social and emotional empathy.
He may fail to develop meaningful language skills. Some autistic children display immature language
such as echoing what was said, being unable to maintain proper conversation and being unable to use
gestures to communicate.
An autistic child may also be resistant to change and be attached and fascinated with objects. He is
not into imaginative play and instead plays with toys by merely lining them up or spinning them. Hand
flopping, rocking, running in circles and repeating words, phrases or songs may be exhibited.
One out of every 500
Autism affects about one out of every 500 Filipino children. Boys are five times more likely to have
autism than girls and there a three to eight percent risk of recurrence in a family with one affected
child. Family income, education and lifestyle do not influence the risk of autism. There is no known
prevention for this disorder.
In the past, autism was thought to be a mental illness caused by bad parenting. This destructive idea
has been disproved. There is evidence that genetics is an important but not an exclusive cause of
autism although no specific gene for autism has been identified yet. Some conditions such as seizure
disorders and mental retardation can also be related to autism.
Is It Autism?
Signs parents should watch out for
As early as one to two years, signs such as the absence of speech and eye contact may already be
present in a child. These may be observed by an astute physician or parent. Autism may also be
suspected whenever a child fails to meet any of the following language milestones: babbling and
gesturing, e.g., pointing, waving bye-bye by 12 months; single words by 16 months; two-word
spontaneous phrases by 24 months (not just echoing); or the loss of any language or social skills at
any age. A specialist experienced in the diagnosis and treatment of autism should be consulted.
Sometimes people are reluctant to make the diagnosis of autism because of concerns about
"labeling" the child. However, the first step in helping the child is the correct identification and
assessment of his abilities, strengths and weaknesses. Failure to make the right diagnosis can lead to
failure in getting the treatment and services the child needs.
It is important to start intensive treatments early with emphasis placed on

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the development of functional communication and social skills as this greatly improves the outcome
for most young children with autism. Treatment is most successful when geared toward the
individual's particular needs. Intervention programs are also more effective when parents are actively
involved and taught appropriate strategies for dealing with their children.
Autism tends to improve in some cases significantly, as children start to acquire language and learn to
communicate their needs and influence other people. With appropriate intervention, many of the
symptoms of autism can be improved, though most people will have some symptoms throughout
their lives. Overall prognosis for individuals with autism is variable and is probably dependent on the
degree of their disabilities and the kind of intervention that they receive.
Special kids need special parents
Manila Standard, July 22, 2000
The term "special child," although originally coined as a euphemism, is often misunderstood or seen
as derogatory. Some now think a special child is always one who has below normal intelligence and is
unable to care for himself.
This is not true, because hyperactive or highly intelligent children are also categorized as special
children.
Nowadays, enlightened parents usually acknowledge raising a special child in the family. The child
stays with his or her parents and siblings and often takes part in community life. Parents obtain all the
medical assistance their child needs from neurologists, child psychologists and/or psychiatrists,
teacher of special education, hearing, speech and vision specialists and physical therapists.
Family members collaborate with the special schools to come up with a comprehensive treatment
and education plan for their child.
But what's really entailed in "parenting" a special child? What extra-demands - rewards - lie in store
for the "special" parent?
Ana Libunao, mother of 10-year-old Romeo Conrado, shares with us her story. Her son, Romeo or
Roco to friends, was diagnosed in 1990 with cerebral palsy spastics diplegia. Here are Ana's thoughts:
"I don't remember having problems with my pregnancy. My doctor made sure I ate the right food, I
had regular check-ups and was an active mom. During the pregnancy stage, I noticed my baby kicked
hard and moved in incessant intervals. I would be jolted by the intensity of his kicks. Friends said
these were normal for babies while still in the womb.
"When I gave birth at the Manila Doctor's Hospital, he came out reed thin. He was a pre-term baby at
seven months old, so doctors had to rush him to a phototherapy session to nourish his system The
nurses who witnessed the delivery observed Roco very differently. My son kicked because he gasped
for air. His umbilical cord was found all tied around his neck like a snooze, resulting in insufficient
maintenance of air.

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"We were not informed of any repercussions or complications about the umbilical cord, but at eight
months old we noticed Roco could not carry his head well. He moved it continuously in a clockwise or
counterclockwise manner. His pediatrician assured that everything was okay, but they advised us to
see a neurologist, a rehab doctor and a therapist to better assess Roco's condition.
"It was the neurologist who diagnosed that Roco has cerebral palsy (CP) spastics diplegia. He said a
part of Roco's brain suffered from central and peripheral atrophy, resulting in damaged motor skills.
The rehab doctor and the therapist opined that Roco has to undergo therapy sessions to improve his
motor skills.
"For parents who wish for a normal child for their firstborn, who would not be devastated by this
piece of news? I cried when I learned about the diagnosis. Jun was crushed. He could not believe it.
He went down on his knees, sobbed like a child and questioned God why it had to happen to him, to
us. Why us? One could not imagine the magnitude of negative feelings. We could not accept the fact
that our firstborn is far from being normal. It took some time before we were able to move on.
"In time we found ourselves acquiring CP information from friends and from the Elks Cerebral Palsy
Center. At Elks we had the chance to interact, share experiences with parents of CP patients. But Roco
had to cut short the sessions. Thus, we asked the doctors to find us cheaper therapy centers, but they
have no idea where to lead us.
"When Roco stopped seeing his doctors, we administered him traditional and alternative medicine
concoctions such as lagundi for his daily dose of health drink. We asked the Department of Social
Welfare and Development to find us a donor for a motorized wheelchair so Roco could move around.
"Unfortunately, for three years now, nothing has come out of that request. I also wrote friends and
relatives telling them about the developments in Roco, but they too remained passive about the
whole thing. It is at this depressing stage that sometimes you wish those who are afflicted with CP
should at least come from affluent families so they could sustain the needs of their child.
"As far as our expenses were concerned, we relied on the freelance income my husband earned. We
have not saved a single centavo for Roco more over, prepare something that shall see him stable in
the future. I wish it were true that a person with disability is part of the mainstream society and is a
priority in our social service programs. For us, it is not quite true.
"I do not know what will happen to my son when we are gone. I have only the slightest idea how local
social work agencies could help him. Perhaps our neighbors will look after Roco or our relatives will
take care of him, as God takes charge of everything. If you will ask me what my wish for Roco is, my
reply is, I want him to go ahead of us. Better yet, we should go together because no one can take care
of him."

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Cerebral Palsy
NIH Publication No. 96-3572, 1994
Cerebral Palsy is a range of neuromuscular disorders caused by injury to an infant's brain sustained
during late pregnancy, birth, or any time during the first two years of life. CP causes a wide range of
difficulties, from a clumsy walk to an inability to speak, swallow, caused by faulty messages sent from
the brain to the muscles. In the mid-1800s, William Little, an English physician, first described CP in
connection with birth injuries.
Each year in the US about 10,000 babies develop CP. Other countries have reported higher rates.
Improved obstetric techniques over the past few decades have reduced the likelihood of brain injury
during birth. But increased survival of premature infants - those born after only 25 to 37 weeks of
pregnancy and weighing less than 5.5 pounds some of whom develop CP, has kept the incidence in
the US fairly stable.
Types
From birth, a year or more may pass before the signs of CP are recognized and diagnosed. The three
most common forms are spastic, athetoid, and ataxic. A combination of these forms is called the
mixed type.
Spasticity occurs in about 60% of all individuals with CP. Symptoms typically include reduced
movement due to stiff or permanently contracted muscles. Spasticity is associated with damage to
nerve fibers in the brain that carry messages for voluntary motor control.
Twenty percent of CP cases are of the athetoid type characterized by uncontrolled movements. This
form of CP is caused by injury to brain nerve fibers that are responsible for inhibition of muscle
movement.
The ataxic type of CP is unusual, occurring in only 1 percent of cases. It results when the cerebellum,
an area at the base of the brain is injured. Since the cerebellum maintains balance and precision of
body movements, affected individuals have difficulty with coordination while walking and moving the
upper limbs.
Although the term CP refers primarily to problems with muscle tone and movement, other disorders
may be present. Mental retardation is common but does not necessarily result in all cases. Other
associated problems include epilepsy, visual disturbances, hearing impairment, language difficulty,
and slow growth.
Causes
Advances in diagnostic technology have led to a much better understanding of the causes of CP. Over
half of the cases are now thought to be due to prenatal causes such as infection from the mother to
the fetus, maternal stroke that prevents proper blood supply to the fetus, exposure to environmental
toxins, or problems in brain development. The remaining cases are due to adverse events
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such as traumatic birth delivery, premature birth and its complications, meningitis or the infection of
the brain or its protective coverings, or head injury due to child abuse. Very rarely, heredity plays a
role. In some cases it is difficult to pinpoint a single event that may have caused CP.
Treatment
Injury to the brain in individuals with CP is permanent and full recovery is not possible. Damaged
brain tissue does not regenerate, but to some extent, normal nerve cells and nerve pathways can take
over some functions from injured areas, with some limitations. The degree of severity varies so
greatly from case to case that it is difficult to make a general prognosis.
Successful treatment of CP requires input from a variety of professionals. Physicians address health
issues such as poor eyesight or restrictions in joint motion. Physical and occupational therapists help
the child develop skills necessary to the activities of daily living. Speech pathologists deal with
swallowing and speech dysfunction. Psychologists and educators work with emotional and learning
difficulties. Nutritionists ensure normal growth. These professionals and numerous others work
together as a team with the child or adult to help the individual achieve as much independence and
competence as possible. In addition, family involvement in treatment, especially with children, is an
essential component. With therapy, training, and community support, most individuals with CP can
lead meaningful and productive lives.
Many causes of CP are preventable, especially those that occur at or after birth. Good prenatal care
has been shown to minimize the likelihood of premature birth. New vaccines against influenza have
reduced the incidence of meningitis. Family support programs have reduced the number of case of
severe child abuse. Such preventive measures are cost-effective in that they reduce the expense of
supporting individuals with CP.
Young Jayson wages battle against hydrocephalus
By Jofelle P. Tesorio
Philippine Daily Inquirer, 1998
Paul Jayson Villon was barely 2 months old when the doctors detected that he had congenital
hydrocephalus.
Now, he is already 3 years old and his situation has worsened. His head continues to grow bigger
because of the large amount of water inside his head.
Jayson's case is different from those of other children suffering from hydrocephalus. He has multiple
congenital anomalies.
When he was over a year old, Jayson underwent an operation to correct an intestinal "malrotation" -
a medical situation in which the intestines are intertwined with other internal organs. The surgical
process called exploratory laparotomy meant opening up the abdomen. It had been very difficult for
the fragile Jayson to have such an operation at a very tender age.

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He survived, although it was only the start of his many battles.
Since his anal opening was very small, his intestine had to be placed outside his abdomen so he could
still digest and discharge waste.
"We were so nervous because his genitalia swelled, but the doctor said it was the normal effect of the
operation," Jayson's mother Julie said.
He became malnourished because his body could only take in so much milk and infant food. If he ate
too much, he would throw up.
Manila trip
Julie said they already went to the National Children's Hospital in Manila three years ago after her son
underwent two operations in Puerto Princesa City. They were advised to go there because the local
hospitals lacked facilities for operations on children with hydrocephalus.
Jayson was too small and weak for another major operation when he was brought to Manila. "We had
to go back to Puerto Princesa because we had no money to sustain our stay at the National Children's
Hospital even if it was free," Julie said.
They went to a lot of friends and other government officials for help just to meet Jayson's everyday
needs at the hospital. They have no relatives or friends in Manila.
"The parents of other patients were so kind that they sometimes offered to wash our clothes, buy
some things or run some errands for us," she recalled.
Jayson needs another operation to remove the water from his head, but Julie is not sure if this will be
best for her only son. Even the doctors in Palawan cannot assure her if the operation will be
successful because his intestines must first be put into place.
Costly surgery
The operation will cost a lot of money. The family's income is not even enough to meet its daily needs.
Julie's husband, Placido, 38, earns a measly P150.00 a day from his welding job. But the job is not
stable as there are not many customers requiring his services every day.
Placido had already sold the lot he inherited from his parents in order to finance Jayson's earlier
operations.
Julie used to work as utility woman at the provincial government, but she had to stop after giving
birth to Jayson to personally attend to her son's needs.
When Jayson was younger, Julie used to bring him regularly to the cathedral to hear Mass. But when
her son's head grew bigger, going to church became difficult. She was afraid Jayson might break his
neck because his head was too heavy. Besides, onlookers got so curious.

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The Villons have vowed to save Jayson in every possible way they can. For them there is still hope.
Placido cannot bear looking at his son. He cries at the sight of Jayson and cannot even muster enough
courage to carry him. When Jayson occasionally whimpers, the couple feels happy. They are ecstatic
when the boy shows a very rare smile. They get their strength from prayers and hope that one of
these days, a successful operation will enable Jayson to live like any other normal child.
Extreme Pressure Health Today, 1998
Hydrocephalus is one of the most common birth defects afflicting more than 10,000 babies each year.
The major cause of hydrocephalus is the obstruction of the cerebral aqueduct which is the natural
draining point for fluid in the brain. The condition may be brought about by prematurity at birth,
spina bifida, brain hemorrhage, brain infection such as meningitis, head injury, brain tumors, and
brain cysts. Genetic causes are extremely rare.
Facts and figures:
1. Studies by the World Health Organization show that one birth in every 2,000 results in
hydrocephalus.
2. More than 50 percent of cases are congenital.
3. As many as 75 percent of children with hydrocephalus will have some form of motor disability.
4. Over the past 25 hears, death rates associated with hydrocephalus have decreased from 54 to 5
percent; intellectual disability has decreased from 62 to 30 percent.
5. Studies show that the risk of shunt failure in an infant's first year is 30 percent.
6. Shunts are revised about two to times in the first 10 years of use per patient.
7. Ninety-five percent of infections occur within three to five days of surgery.
8. Shunt malfunctions occur in about two to 40 percent of cases.
9. Ocular gaze and movement disorders are found in approximately 25 to 33 percent of case.
10. Hydrocephalus occurs in 70 to 90 percent of children with the most severe form of spina bifida.
11. Ninety to 95 percent of babies with spina bifida and related defects are born to parents with no
family history of these disorders.

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Common problems associated with hydrocephalus
Visual: Visual impairments that influence the upward gaze and ocular movement affect 25 to 33
percent of children. Depth perception is also a common visual impairment.
Motor skills: As many as 75 percent of cases have some form of motor disability. An individual with a
shunt can participate in most physical activities. However, he or she is advised to stay away from
rough contact sports, particularly those that require the use of a helmet. Some other physical
complications that are sometimes associated with hydrocephalus are the sensitivity to pressure,
sound and bright lights and side effects such as seizures, constipation and hormonal imbalance.
Learning disabilities: These are the most common complications. Individuals are able to learn.
However, modifications in teaching strategies are required. Two-thirds of children with hydrocephalus
do have at least borderline intelligence. A problem related to learning disabilities is the inability or
deficiency in memory retention. However, with special care and attention, they can achieve their
fullest potential. As a result of the physical implications of the disease, it is not uncommon for
psychological effects to set in.
Other issues. Financial strain caused by numerous medical treatments or surgical procedures may
deplete a family's financial reserve. The child's ability to be independent and self-supporting in adult
life is of serious concern.
What Happened to My Son
By Bea David Good Housekeeping October 2002
Coping with her child's terminal illness, one mother tells her story of strength.
Everything was going well. I had Von, my kind and loving husband, adorable four-year-old twin sons,
Paolo and Jheron, and another baby on the way. I even had very supportive in-laws. Life was great and
I couldn't complain.
I married young but early on I knew that a family was what I always wanted. My kids have always
been my joy. No matter how busy I was, I would drop everything for them. My twins were identical
but had very different personalities. Paolo was the shy and quiet one while Jheron was the show-off.
He was very loud and talkative.
Between the two, it was Jheron who was more a mama's boy because he was the one who spent
more time with me. I was just 19 when they were born and it was quite difficult for me to take care of
twins. Thankfully, to help ease my load, my in-laws were more than happy to help take care of Paolo
during his first year. We were not rich but I was blessed.
Then the trouble came. I'd like to say that it has since gone away but, no, it never left us. It seems that
the disease is determined to haunt us for the rest of

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our lives. Everything happened so fast. One day my child was full of life and then the next thing I knew
he couldn't move anymore; he couldn't even recognize who I was.
Losing control
Before their scheduled vaccination, my twins contracted measles at seven months. They soon
recovered and we all went back to our normal lives. Years sped by and my twins grew up into active,
playful schoolboys. At four, my boys were inseparable. They often jogged around the village or played
basketball with my husband.
Then, all of a sudden, there was a change in Jheron's behavior. My very active boy seemed to lose
control of his motor skills. He kept tripping and falling when he walked or ran, his saliva would drip
from the sides of his mouth, and his eyes were always droopy. We took him to the local doctor in
Pampanga, but he just gave Jheron vitamins. I remember that everything happened so fast. In just a
matter of weeks my son started losing control of his movements. It was also during this time that I
gave birth to my third child, Bea.
A week after, Jheron started having difficulty standing up. That's when we decided to bring him to
Manila. He was confined at the Philippine General Hospital where an uncle is a resident
neurosurgeon. It was there that he was diagnosed with Sub-acute Sclerosing Panencephalitis, a
generative neurological condition caused by measles. SSPE is a terminal illness characterized by
delayed onset where the first symptoms may not be seen for five to 15 years. Jheron's symptoms
began in less than five.
All a bad dream
That night I couldn't sleep. The doctor gave it us straight. He said that Jheron would get worse every
day. One by one, his senses would deteriorate.
But in the hospital, Jheron was still very much like his usual active self. In the afternoons he would talk
on the phone, always asking for his twin, he would watch TV, and he would go to the comfort room by
himself. Before his first week in the hospital ended, I told Jheron that I needed to go back to
Pampanga to get someone to help me take care of him. I can't forget how he didn't want me to go.
"Don't leave," he said. I explained to him why I had to go, and reassured him that I wouldn't be long. I
left not knowing that that would be the last time I would hear my son speak. That night I went back
and my son could not say a thing. This is what hurt me the most.
Within the week he started having difficulty swallowing. He stopped eating normally. He lost control
of his urinary faculty, so we had to use diapers. He no longer responded to stimuli. You could pass in
front of him and he wouldn't even blink. Nothing. I refused to believe that everything was real. I kept
thinking that all that was happening was part of a bad dream, a nightmare that I desperately wanted
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We stayed in the hospital for two months. I envied those who would check out healthy. It broke my
heart to know that my son would leave the hospital not the same person who entered it.
Pulling ourselves together
Sleep still eluded me. I felt myself getting weaker every day. I was losing weight fast. I kept thinking of
my son, and the baby daughter whom I left with the maids. I couldn't stop crying. But I realized that I
couldn't do that forever. I made a decision to pull myself together. What kept me going was the
thought that I had to be strong for my kids. If I didn't take care of myself, then who else was there? It
was prayers that really tided me over. I realized that I have God and that I am not alone. I was given
this problem because He knows I can handle it.
The most difficult part came when we finally left the hospital. Our lives took a drastic turn. We felt
bereaved. It was like losing a son. Every time we'd look at him, he wasn't the same anymore-not
gregarious, not full of energy. It was as if he were there but half of him was gone. It was a very painful
change.
My husband took it the hardest. Von suffered from depression. He refused to talk to people. He
wouldn't watch TV and he wouldn't go to work. He wouldn't even leave our room. Von was so
affected that he didn't want to be reminded of the old Jheron. He didn't want to see our old home
because it reminded him of where our little boy used to play. He didn't want to see his old clothes, old
uniform, old shoes, old books, old bags, and especially not old photos of our son able to stand up. My
husband simply wanted to see Jheron as he was. Maybe it was easier for him to accept the situation if
he pretended that our son had always been like that; that way nothing was ever really lost. Whatever
the reason, I just wanted it to be as painless for everyone as possible. Ad so I immediately disposed of
my son's old things. His old photos I gave to my in-laws. But in my wallet I always kept his precious
school ID.
My other son Paolo was not used to the idea of not having his twin around. He refused to go to school
because Jheron was not going with him. His young mind didn't understand what was going on. But it
was surprising that since Jheron has gotten sick, my shy Paolo has become bubbly and outgoing. I
never really understood why. In the same way that no one can explain why SSPE evolves from
measles. Or why a particular individual like Jheron should respond to the disease as he did while
another, his twin, even didn't.
Still we are grateful that at least one of our sons was spared. To be on the safe side, Paolo's blood is
tested and studied every year.
Coping and adapting
When we went back to Pampanga, we initially stayed with my in-laws. My kind biyenan insisted on
helping me out during this adjustment phase. Plus, in case complications arose, hospital care was
more accessible and modern in San Fernando where they lived. After 10 months, we moved to a place
of our own in the same town.

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To give my full attention to my kids, especially Jheron, I became a stay-at-home mom. The adjustment
period over, we slowly got used to the situation. When something like this happens to a family,
everyone's life is bound to be affected; priorities change and activities become limited. A few months
later, Paolo was finally convinced to go back to school. Of course it also took the school some
convincing to take him back. In time, the entire family settled into a routine.
Life with SSPE
I had to hire three maids to get my household running. One is there just to look after Jheron and to
assist me in taking care of my special boy. I make sure that I personally attend to all his needs,
including his daily baths and toilet rituals.
In the mornings I supervise Jheron's exercises. These I learned in the one year that he underwent
professional physical therapy. Since Jheron is unable to walk, however, his legs have atrophied. But
apart from this he is, a very healthy boy. He has a very strong immune system and hardly gets sick. In
fact there have been times when everyone in the house has had the flu except him. He has smooth
skin and is still soft all over, unlike others in the same condition. His diet is always nutritious and
balanced. Since he doesn't have any regular physical activity, I don't give him anything that is high in
cholesterol, salt, or sugar.
His meals come in liquid form, as he is unable to chew anymore. Swallowing is also difficult. So
mornings and evenings, his food, vitamins, medication, milk and fruits are injected through a tube
that is inserted through his stomach and is attached directly to his intestines. The hose is replaced at
least once a month. Lunch is when I feed him orally. His food is processed through a blender and is fed
to him as one would to a baby. Everything is measured and adjusted as he grows.
To help out with the finances, I established a small business right inside my home. IK sell all kinds of
fresh produce and wet goods. My customers are the other residents of our village. By word of mouth I
became known and my small venture is thriving. But I do this only on weekends, from six to nine a.m.
The rest of the time I devote solely to my family.
Von and I don't have a social life anymore, but it doesn't bother us. We don't go out with friends.
Whatever free time my husband has, he'd rather spend with our kids. Whenever we do go out on
family gatherings and outings, we always take Jheron with us. We never leave him with the maids. If
I'm not home, my husband is there. On the weekends Paolo and Bea stay with my in-laws. It is their
lolo and lola who fill whatever role that we can't. They usually take them to the malls and other
pasyalan.
My other children
Even if he doesn't say anything, I sense Paolo's insecurity over the attention we give Jheron. Both my
husband and I make it a point to explain to him that Jheron is not the same anymore. He can't do the
things that normal kids can. He's like a baby, so he is treated like one. And we always reassure Paolo
that if it happened to him, we'd do the same thing. He seems to understand.

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Despite this very challenging situation, I still feel very blessed. I think that the timing of Bea's birth
was actually a blessing in disguise. God knew that I probably wouldn't have allowed myself to get
pregnant again for fear of not being able to care for another child. During our darkest hours, the new
baby gave me something to look forward to. It wasn't all sadness. I am so grateful that this little girl is
growing up to be so affectionate and protective of her brother. She always talks to him even if he can't
listen and talk back. She kisses him and even wipes his saliva for him. I am moved when I hear her
nighttime prayers for her brother.
A blessed life
The way I see it, we all have our burdens in life, our own crosses to carry. I guess this is mine. But I
don't even see it as a burden anymore. I simply see it as the life I was given. I have an abundance of
blessings so who am I to grumble? Since Jheron's illness, we have never been wanting for anything.
Despite all our expenses, we still have enough to put in our savings - this of course is with the help of
my in-laws.
I've learned never to worry about the future. The doctor did not really tell me how long my son will be
around. He did tell us that the chances of Jheron recovering are quite slim. But anything is possible
with God, and I choose to think of the positive. I believe my son will get better. And even if he doesn't,
I am still happy because in my heart Jheron is already an angel.
Joji - a woman of substance and a wonderful friend
By Lila Simon Concern, National Council for the Welfare of the Disabled Persons (NCWDP), 1st
Semester, 1996
Born on August 24, 1958, Jocelyn Arias Geli is the eldest in a brood of 11. She was only five months
old when she was rushed to the hospital because of high fever. The high fever brought on polio and
left her with a permanent disability. Lack of information on immunization at that time was the main
culprit.
Joji grew up in an environment where a disability was not a big issue. She was treated just like any
ordinary girl. Her disability didn't bother her at all. Of course she became conscious of her plight when
she reached adolescence, but this did not last long.
She never missed opportunities to go to picnics, parties and other social activities with her brothers,
cousins and friends. She said that she does not blame her parents for her disability. She attributes her
happy disposition to the way she was brought up. She never got any special attention from the family,
yet she felt that she was special in many ways.
She took public transportation to get to school from Quezon City to Manila. Her college education was
interrupted by two operations. In 1998 she started to work at the National Council for the Welfare of
Disabled Persons. It was in this office where she got her baptism of fire about people with disabilities
that she

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encountered for the first time. It fascinated her no end watch persons who are deaf communicate in
sign language, and persons who are blind move about the building expertly using their orientation
and mobility technique.
Joji is a talented lady. She has the proverbial patience of Job. She learns things on her own, patiently
discovering knowledge from the Internet to the point of skipping her meals. In last year's
International Abilympics which is dubbed as the world's Olympics of Abilities, she was a participant in
the English Desktop Publications and Waste Re-use Category. She is also involved in civic activities as
treasurer of the Dreams for Children, Inc., a non-profit organization for out-of-school youth and
children with physical and mental disabilities. She was also the Philippine Coordinator of the "Kids 4
Kids" held in Australia in 1995. She continues to do her share, no matter how small, she says, for the
disabled sector.
Joji is first and foremost a woman, who happens to have a physical disability that does not affect her
professional, social and personal life at all. With faith in God, prayers, a loving family and friends who
accept her limitations, Joji is truly a woman of substance, an inspiration to other polio victims and
those with physical disabilities.
Disability: an intimate encounter with God
By Angelita P. Gillego
Concern, National Council for the Welfare of Disabled Persons
1st Semester, 1996
A beam of light shone upon His face as He stared at me. That night, His image was strangely different,
so real, so very much alive. He asked me, "Why is it that I am not included in your plans? How come I
am not even one of your concerns?"
I experienced this seven years ago as I was praying before the holy image of our Lord Jesus Christ. I
was just licensed as a professional then and was before Him, searching for so many answers to my too
many questions. A profound realization was stimulated by that moment and made me involve myself
in meaningful community and church services. I felt very fulfilled then though I did not expect that He
wanted a most intimate relationship.
On May 9, 1991, I was infected by a virus which caused my present disability. It was a blow to me for it
happened at the peak of my youth. Nevertheless, it was the start of a wonderful metamorphosis of
my life.
The gift of grace
In the early phase of an illness, any afflicted person passes through the denial, indignation and
bargaining stages. These are the crucial times when personal turmoil results from the unacceptance
of the disability. One gets the chance to bargain anything material - a task, a promise or even an
aspect of his life, for good health. However, when he comes to accept his disability, which usually
takes time, the power of God's grace becomes apparent in his life.

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Grace permeates and elevates human nature and acts in accordance with man's nature. Thus, the
more we know about interpersonal love relationships, what love does to people, the more we know
about divine grace.
This very well explains why the acceptance of the disability varies in every person with disability. The
human nature propels the weakness of man while divine grace radiates the brilliance of the power of
God which alone suffices.
Very often, solitude, for a handicapped, is a time when confusion and inner turmoil creep in. They
slowly infiltrate and saturate his mind until the most painful emotion is felt. One is left with the
inherent response to overcome or be defeated.
In such times, prayer becomes a trusting companion, a sincere friend. It consoles the mind and the
spirit. The mere ejaculation of the Lord's Prayer, Hail Mary or any other form of prayer makes a
difference. There is more essence when a person with disability learns in the process of frequent
praying, to open up his inner self to God to share with Him his most cherished longings an desires.
Most especially, to offer his pains and hardships for His glory.
Thus, every moment of a handicapped person's life becomes an encounter with God. Every pain and
suffering become an earnest offering. His disability and his whole life become a prayer. Keeping the
commitment to prayer by finding a prayer time further develops his personal relationship with God. A
close communion with God happens in prayer.
Empowerment through virtues
Humility and simplicity are the virtues which are most pleasing to God. The Blessed Mother's
possession of these virtues makes her the most amiable creature in God's eyes. A person through his
disability is greatly challenged by the virtue of humility. An obvious disability prevents him to become
proud.
Humility includes the acknowledgment of our brokenness and nothingness before God. This should
not mislead us into seeing ourselves as worthless, but to keep us from becoming proud and to make
us understand the weaknesses of other. True acceptance of one's restrictions and loving himself in
spite of these show that God abides in his hear. Self-hatred because of the disability is expressed
through severe depression and bitterness. The process of the acceptance of one's disability brings
forth a humble heart while leading to a recognition of his self-worth.
Disability can be instrumental for a person to be detached from the world's vanities. Though in some
cases there may be exceptions, for most of this special group of people, their being handicapped
prevents them from being attached to all forms of worldliness. Everybody faces the risk of being
tempted to have different kinds of attachments, and for people with no restrictions, they can freely
embrace such. People with disabilities have the wonderful opportunity to become simple.
When disability sets in a person, his life takes on an abrupt detour. Utilizing the special gift of grace, it
becomes a beautiful transformation to a spiritually enriched life. Still, the potency of grace makes it
possible for God to work in a person. He uses the handicap's openness to God in the accomplishment
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The very touching experience of the handicaps helping their fellow handicaps is a wonderful
manifestation of God working in these special people's lives. As he uses them in the accomplishment
of His works, their relationship becomes closer and closer. As they respond further to the call of
mission despite the many obstacles, intimacy is created and eventually nurtured. In time, a fruit of
glory shall spring forth the glory in heavenly bliss.
Now, I am in the state of cherishing my intimacy with God. The intimacy brought about by my
disability. My whole being is transformed as I transcend myself to the Almighty Power of God. As He
sweetly embraces me in the warmth of His tremendous love, I whisper, "Your most Holy will be done,
my Lord."
Read and Respond
Test on Content Knowledge
1. Do you believe that awareness and knowledge of special education is of paramount importance
to parents, school administrators, teachers and people in the community? Defend your answer.
2. Elaborate the meaning of "Special Kids Need Special Parents."
3. List down some hints for parents to meet the child's special needs.
Reflection and Application of Learning
1. Find a special child in your school or community where you belong and interview him/her in
terms of his/her abilities and strengths despite his/her condition.
2. Complete the sentences in the following vignettes
a. Joshua: My Special Son
I feel _______________________________________
_________________________________________because
I realize_________________________________________
b. Young Jayson Wages Battles Against Hydrocephalus
I feel___________________________________________
_________________________________________because
I realize_________________________________________

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c. What happened to my son?
I feel____________________________________________
__________________________________________because
I realize__________________________________________
d. Joji: A Woman of Substance and a Wonderful Friend
I feel____________________________________________
________________________________________ because
I realize__________________________________________