MODULE VI

LEARNERS WITH DIFFICULTY

WITH SELF-CARE

Lesson 1 Types, Characteristics, and

Identification of Learners with
Difficulty with Self-care

Lesson 2 Principles and Strategies of

Teaching and Designing IEP for
Learners with Difficulty with
Self-care

Lesson 3 Trends and Issues in Teaching

Learners with Difficulty with
Self-care

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MODULE VI

LEARNERS WITH DIFFICULTY WITH SELF-CARE

 INTRODUCTION

This module discusses the characteristics of learners with difficulty

with self-care in which appropriate IEP can be developed. Further it presents
trends and issues in teaching this type of learners.

OBJECTIVES

After studying the module, you should be able to:

1. identify learners with difficulty with self-care,

2. design an individualized education plan (IEP) applying the principles and
strategies responsive to learners with difficulty self-care, and
3. analyze trends and issues in teaching learners with difficulty with self-
care.

 DIRECTIONS/ MODULE ORGANIZER

There are three (3) lessons in the module. Read each lesson carefully
then answer the  learning activities (LA) to find out how much you have
benefited from it. Work on these exercises carefully and submit your output
to your instructor.
In case you encounter difficulty, discuss this with your instructor during
your online meeting. Good luck and have fun learning!

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Lesson 1
TYPES, CHARACTERISTICS, AND
 IDENTIFICATION LEARNERS
DIFFICULTY WITH SELF-CARE
WITH

This lesson focuses on learners having difficulty with self-care,

specifically, those with intellectual disabilities. Although learners with
difficulty with self-care may also include those with difficulty seeing, hearing,
and communicating as discussed previously, hence will not be included in this
lesson. We shall characterize intellectual disability, its causes and diagnosis.

Intellectual Disability (ID)

 Over the years this was originally referred to as “idiots” (meaning
ignorant or unskilled in Greek), “moron”, “cretin” or “imbecile”
(meaning weak or feeble in Latin), and mentally retarded. These times
they considered to be offensive, inappropriate and stigmatizing.
Now, the term intellectual disability is deemed more appropriate.

 It is a “significantly sub-average general intellectual functioning,

existing concurrently with deficits in adaptive behavior manifested
during the developmental period, which adversely affects a child’s
educational performance. (Individuals with Disabilities Education
Act)
 It refers to deficits in general mental abilities, including reasoning,
problem-solving, planning, abstract thinking, judgment, academic
learning, and learning from experience. (American Psychiatric
Association)

Some Types of Intellectual Disability

Type Illustration
1. Down Syndrome
 Due to trisomy in chromosome
number 21
 Generally results in moderate
level of intellectual disability,
though can be mild to severe
range

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2. Fetal Alcohol Spectrum

Disorder (FASD)
 Due to mother’s excessive
alcohol intake during pregnancy
 Most prevalent type of
intellectual disability
 Aside from cognitive
impairments, the person
experiences sleep
disturbances, motor
dysfunctions, hyperirritability,
aggression and behavior
problems

3. Fragile X Syndrome
 A mutation in the X
chromosome interfering with
FMR-1 protein needed for
normal brain function
 Males are usually affected,
while females ae usually
carriers
 It is the most inherited type of
intellectual disability

4. Phenylketonuria
 Inherited condition where in
the child is born without an
enzyme needed to breakdown
the amino acid phenylalanine

5. Prader-Willi Syndrome
 Due to deletion of a portion of
chromosome 15
 Affected individual is
characterized with intellectual
and learning disabilities,
behavior problems, impulsivity,
aggressiveness, temper
tantrums, OCD, self-injurious
behavior, constant sense of
hunger that usually begins at
about 2 years of age, delayed
motor skills, short stature,
small hands & feet and under
developed genitalia

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6. Williams Syndrome
 Due to deletion in chromosome
17
 Cognitive functioning ranges
from normal to moderate levels
of intellectual disability
 Generally exudes cheerfulness
and happiness, described as
“overfriendly”, often
hyperactive though may get
easily frustrated or have low
tolerance to teasing

Severity or Levels of Intellectual Disability

Intellectual disability is divided into four levels, based on the child’s
IQ and degree of social adjustment.

1. Mild intellectual disability

Some of the symptoms of mild intellectual disability include:
 taking longer to learn to talk, but communicating well once they know
how
 being fully independent in self-care when they get older
 having problems with reading and writing
 social immaturity
 increased difficulty with the responsibilities of marriage or parenting
 benefiting from specialized education plans
 having an IQ range of 50 to 69

2. Moderate intellectual disability

They may exhibit some of the following symptoms:
 are slow in understanding and using language
 may have some difficulties with communication
 can learn basic reading, writing, and counting skills
 are generally unable to live alone
 can often get around on their own to familiar places
 can take part in various types of social activities
 generally having an IQ range of 35 to 49

3. Severe intellectual disability

Symptoms include:
 noticeable motor impairment
 severe damage to, or abnormal development of, their central nervous
system
 generally having an IQ range of 20 to 34

4. Profound intellectual disability

Symptoms include:
1. inability to understand or comply with requests or instructions
2. possible immobility

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3. incontinence (inability of the body to control the evacuative functions

of urination or defecation)
4. very basic nonverbal communication
5. inability to care for their own needs independently
6. the need of constant help and supervision
7. having an IQ of less than 20

Characteristics of Intellectual Disability

A. Cognitive Functioning
1. Learning rate is slower than their peers.
2. Memory is short term and have difficulty remembering information.
3. They have difficulty keeping attention on learning tasks
4. They have difficulty transferring or generalizing new knowledge and
skills to new settings or situations
5. They have low motivation or interest in participating in problem-
solving tasks and some relies much on others’ assistance and solutions

B. Adaptive Behavior
1. Direct instruction and others’ support such as added prompts and
simplified routines are needed in ensuring that they have quality self-
care and daily living skills.
2. They have poor communication skills, inability to recognize others’
emotional state, and have unusual or inappropriate social behaviors. It
is important that good interpersonal skills are taught to them.

C. Behavioral Excesses and Challenging Behavior

Unlike most of their peers, students with intellectual disability may have
difficulty accepting criticisms, self-control and may show aggression or
self-injury.

D. Positive Attributes
They may display tenacity or determination and curiosity in learning, have
good relationship with others, and positively influence other individuals
around them.

Causes of Intellectual Disability

Sometimes an intellectual disability is caused by genetic, an
environmental factor or other causes as included below.
 trauma before birth, such as an infection or exposure to alcohol, drugs,
or other toxins such as lead or mercury (teratogens)
 trauma during birth, such as oxygen deprivation, complications during
birth or premature delivery
 inherited disorders or chromosome abnormalities
 severe malnutrition or other dietary issues
 severe cases of early childhood illness, such as whooping
cough, measles, or meningitis
 brain injury
 and even unknown cause

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Identification and Assessment of Learners with Intellectual

Disability

The following are tools that can be used to identify and assess learners
with intellectual disability.

1. IQ Test
Intelligence or cognition, often assessed by the range of scores
on an Intelligence Quotient (IQ) test. This type of test will help the
health care provider examine the abilities of a person to learn,
think, solve problems, and make sense of the world. Average IQ test
score is around 100, and 85% of children with an intellectual
disability score in the range of 55 to 70. More severe cases of
intellectual disability generally have lower IQ scores.

2. Newborn screening
This relies on testing blood samples taken from newborns while
they are still in the hospital to help identify certain serious or life-
threatening conditions, including some that lead to intellectual
disabilities. Most tests use a few drops of blood obtained by pricking
the infant’s heel. If a screening test suggests a problem, the
infant’s doctor will follow up with further testing.

3. Prenatal Screening
Health care providers recommend that certain pregnant women,
including those who are older than 35 years of age and those with
a family history of certain conditions, have their fetuses tested
prenatally, while still in the womb, for conditions that cause
intellectual disability. There are two main types of prenatal tests.

a. Amniocentesis
Amniocentesis is a test that is usually performed to determine
whether a fetus has a genetic disorder. In this test, a doctor takes
a small amount of fluid from the womb using a long needle. The
fluid, called amniotic fluid, contains cells that have genetic
material that is the same as the fetus’s genetic material. A
laboratory grows the cells and then examines their genetic material
for any problems. Some intellectual and learning disabilities that
can be detected with amniocentesis are Down syndrome and
certain types of muscular dystrophy. Because amniocentesis can
cause a miscarriage in about 1 out of 200 cases, it is usually only
recommended for pregnancies in which the risk of genetic disorders
or other problems is high.

b. Chorionic Villus Sampling (CVS)

This test extracts cells from inside the womb to determine
whether the fetus has a genetic disorder. Using a long needle, the
doctor takes cells from the chorionic villi, which are tissues in the

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placenta, the organ in the womb that nourishes the fetus. The
genetic material in the chorionic villus cells is identical to that of
the fetal cells.
Like amniocentesis, CVS can be used to test for chromosomal
disorders such as Down syndrome and other genetic problems. CVS
can be done earlier in pregnancy than amniocentesis, but it is also
associated with a higher risk of miscarriage—about 1 in 100 cases.
Healthcare providers usually only recommend CVS in women who
are at high risk for a condition or intellectual disability.

4. Adaptive Behavior and Support Intensity Assessment

Measurements
 These are intended to measure adaptive behaviors necessary for
success in the educational & residential settings and relative
intensity of support needs of people with intellectual disability
not measured by academic skills tests.

5. Development and School Readiness Assessment Measurements

 These measures, screens, or evaluates early developmental
cognitive, motor, language, socio-emotional and cognitive
behavior milestones; concept knowledge and possible academic
developmental delays of young children.

6. Achievement Assessment Measures

 Involves assessment of fundamental academic skills such as
numeracy, spelling, vocabulary, reading comprehension and
identification of children at risk for school failure.

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Lesson 2

PRINCIPLES AND STRATEGIES OF

 TEACHING AND DESIGNING IEP FOR
LEARNERS WITH DIFFICULTY WITH
SELF-CARE
Leaners with intellectual disabilities are typically slower at attending
and accomplishing tasks. They may exhibit low motivation to learn.
Therefore, in dealing with these learners, it is important to break down goals
into smaller steps, to use all possible senses and have hands-on learning, and
to allow increased time for repetition and consolidation of skills. It is also
recommended that there should be at least one teacher for every three
learners with intellectual disability. Parents, teachers, and other
professionals can widen learner’s opportunities to become successful by
working hand-in-hand in providing least restrictive environments that will
nurture their skills, behaviors, and attitudes.

Educational Approaches & Teaching Strategies

A. Active Student Response (ASR)
 This is a strategy that promotes active student engagement in their
own learning. It gives attention to the participation of all learners
at a whole-class or group level as they actively respond to teacher
questions at the same time. It can be used to assess students prior
or after teaching. It involves the following steps:
1. Teacher poses a question.
2. Pupils/Students are given “thinking time” to formulate an
answer.
3. All pupils/students respond at the same time in an active
manner, with each pupil/student required to respond on an
individual basis. Response cards may be used by pupils/students.
4. Teacher reviews pupils’/students’ answers by scanning
individual’s/pupil’s response.
5. Teaching pace is adjusted when required based from
pupil’s/student’s responses.

B. Task Analysis
 It involves breaking down complex or multi-steps into smaller,
easier-to-learn sequenced subtasks. It involves the following steps:
1. Identify the target skill to be taught.
2. Identify the prerequisite skills of the learner and materials needed.
3. Breaking the skill into components.
4. Confirming that task is completely analyzed.
5. Determining how the skill will be taught.

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Task Analysis for Hand Washing Task Analysis for Class Dismissal

6. Implementing intervention and monitoring progress.

C. Direct Instruction
It is an explicit, systematic instruction carefully sequenced to
maximize teacher efficiency and effectiveness. It involves a) modeling
examples and non-examples, student practice with immediate
feedback and reinforcement and c) small group instruction leading

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to observational learning. Students with intellectual disabilities often

have significant language delays/impairments. Since their language
acquisition rate is slower than typically developing students, they often
require explicit instruction of expressive (speaking) and receptive
(understanding) language skills.

D. Community-Based Instruction (CBI)

This is a strategy that promotes the teaching and use of
academic and functional skills in the learner’s natural environment.
The setting, as well as the tasks, should be relevant and age-
appropriate to the learners. Areas of study include, a) domestic – self-
care and grooming, wellness, nutrition, cooking, laundry,
housekeeping, b) vocational – career exploration, employability skills,
instructions, rules, schedules, c) community – transportation, libraries,
shopping, post office, restaurants, and d) recreation and leisure –
crafts, games, parks, sports, etc. Role-playing at the next level of
realization. Classroom teachers often use role-playing scenarios to
build skills, on task behavior, and cooperative work practices in many
of the previously mentioned areas (domestic, vocational, community,
recreation and leisure). CBI offers the same instructional methodology
but within the applied setting, rather than the classroom. CBI should
not replace the roleplaying activities created in classroom settings, but
enhance these learning activities by providing opportunities to further
practice these skill sets with non-disabled members of the community.
CBI is recommended to be done twice a week, so learners will be taught
to function as independently as possible.

E. Systematic Feedback
Giving of information to learners about their performance which can
be done by:
1. Praise and other forms of confirmation or positive reinforcement
for correct responses and in introducing a new concept or skill, and
2. Error correction for incorrect responses.
A good feedback is specific, immediate, positive, frequent, and
differential.

F. Play-based Learning
This is a hands-on approach where play activities are used to teach
cognitive skills to learners with intellectual disabilities. In this way,
learners feel like they are just on game, while they are actually
learning.

G. Technology Applications
Some learners are highly motivated by using technology-based tools.
There are computer games and tasks that are instantly rewarding and
motivating that provide instant feedback about their responses. This
could be used so learners can practice skill on their own. Other
technology applications are audiobooks where learners can listen about

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stories and PowerPoint or slide presentations in which learners could

see pictures combined with short sentences.

Lesson 3

TRENDS AND ISSUES IN TEACHING

 LEARNERS WITH DIFFICULTY WITH
SELF-CARE

What should be taught and who should teach learners

with intellectual disabilities?
Inclusion has been seen as the central issue in special education but is
gradually giving way to concern for what students learn. Although
generalizations are difficult with such a diverse population as those with
intellectual disabilities, it appears that direct, systematic instruction is
typically most effective. Special education is different from general
education along several specific dimensions and should be provided by special
educators. More concern should be shown for what children learn than where
they learn it. Inclusion is often confused with other civil rights issues. The
terminology ‘segregated’ should be replaced by the terminology ‘dedicated’.
That is, racial segregation and special education are built on completely
different assumptions, and placement of children for their special education
is not the same as racial segregation. Special education for children with
intellectual disabilities should occur in the general education classroom
whenever possible, but the first concern of special education should be
improving children’s learning, not the place or with whom they learn. We
are afraid of the viewpoint that puts placement (where students should be
taught) ahead of the educational needs of the students (what needs to be
taught).

Direct, systematic instruction in reading, arithmetic, and daily living

skills are the most effective approaches to teaching students with
intellectual disabilities. What students are taught should be put ahead of
where they are taught. Our fundamental concern is that students with
intellectual disabilities be respected and be taught all they can learn.

Conditions of Successful Inclusion of Learners with

Intellectual Disability

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The vast majority of children with intellectual disabilities

have comparatively mild intellectual disabilities, often similar to learning
disabilities. According to Høybråten Sigstad (2017) in her study “Successful
Inclusion of Adolescent Students with Mild Intellectual Disabilities”, the
conditions of successful inclusion included four sub-themes: 1) inclusion as a
core value, 2) organization that promotes inclusion, 3) good facilitation, and
4) awareness of student-specific conditions.

1. Inclusion as a Core Value

The rooting of inclusion as a basic idea within the whole school
community seemed to be a crucial prerequisite for inclusion to work.
Inclusion as a core value initially applied the school’s management and its
basic philosophy for education, but such positive values also seemed to
influence special education teachers’ attitudes. The importance of an
overarching vision of inclusion within school management was
highlighted as a force for inclusion. In one case, the school principal
emphasized that students with special needs enriched the entire school.
Such attitudes thus helped increase the opportunities for inclusion.
Inclusion as a core value in the school community also appeared to affect
teachers’ attitudes and their daily work in teaching. The most important
thing is to get in touch with the other students. They cannot be sitting by
themselves within small groups all the time; it becomes a poor quality of
life.”

2. Organization that Promotes Inclusion

Inclusion presupposed a physical presence; thus, locations were
essential. Having special education groups partly isolated from the other
classrooms is described as limiting opportunities for successful inclusion.
On the other hand, teachers stressed that the students needed to be
organized in small groups as a condition for successful inclusion in a
mainstream school context.

3. Good Facilitation
In various ways, inclusion was dependent on good facilitation in
general. It was all about an awareness of finding adequate common
avenues of inclusion, compliance in teaching topics in regular classes and
in special education groups, and facilitation with a focus on social
interaction. However, adequate facilitation presupposed close teacher
collaboration and teacher engagement. Special education teachers
selected certain lessons in the regular classes that they deemed best
suited for inclusion. Frequently, in those lessons, academic qualifications
were not so significant: “The lessons that are best suited for inclusion
are instruction involving joint activities that do not require high
academic competence but primarily have a focus on social
interaction.” As much as possible, the special education teachers
attempted to prepare their students on the relevant education subjects
before they entered the regular classes in according to one of the special
education teachers: “We try to teach the same material within the
special education group before they enter their regular classes so that
they may be better equipped to participate.”

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4. Awareness of Student-Specific Conditions

Inclusion depended not only on teachers’ facilitation but on an
awareness of students’ individual needs. The teachers had a particular
focus on the students' individual needs: “Inclusion in regular classes
depends on the students themselves. There are always the needs of the
students, which govern the need for support.” One of the teachers
emphasized that the opportunity for successful inclusion could be a matter
of students’ ability to be independent: “If the subjects are too
theoretical, it is completely wrong. However, inclusion within practical
subjects works if the students have a certain degree of independence.”

Constraints of Achieving Successful Inclusion

In the same study, the constraints of achieving successful inclusion
included three sub-themes: 1) organizational constraints, 2) inadequate
facilitation, and 3) lack of self-confidence.

1. Organizational Constraints
In addition to the challenges that appeared to be caused by human
limitations, there were organizational constraints of achieving successful
inclusion. In several cases, the special education teachers underlined
the physical location of the room that housed special education groups
was a limitation for social interaction with the other students: “We are
slightly isolated on campus; thus, there is no close contact. There are not
many meeting points with the others.” Some special education teachers
also lacked additional resources.

2. Inadequate Facilitation
Constraints in achieving inclusion frequently also appeared to be
related to inadequate facilitation and insufficient teacher engagement.
First, this revolved around insufficient academic arrangements. The
special education teachers experienced an increasingly challenging
dilemma regarding the growing academic gap and the need for individual
facilitation: “It’s hard to benefit academically in a regular class. At the
lower secondary level, the academic gap starts to be quite large. They
need individual adaptation, and it is difficult to achieve adequate
support within the classroom.” Some of the special education teachers
emphasized that inclusion in regular classes was suited only for the
cleverest students.

3. Lack of Self-Confidence
Challenges in inclusion were due not only to a lack of facilitation but
to specific limitations of the students. These constraints were related to
psychosocial factors and academic difficulties. Students with intellectual
disabilities are struggling with bad self-confidence. Thus, it is highly
difficult to motivate the students to participate in their regular classes. A
lack of academic confidence was a cause for participating in regular
classes, and inadequate academic benefit was also a real experience

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for several students. They find it difficult to participate in mainstream

teaching lessons. The teachers are talking too fast, writing too much
on the blackboard, and using difficult words. They are anxious about
being asked questions they are not able to answer. They are spending
more time having stress about it than listening to what is being said.
The teachers described that their students with intellectual disabilities
experienced being outside the community. A lack of involvement and
interest among the regular students prevented the school from
fostering successful inclusion: “They do not want be with their regular
class. They have no relation to the others, and when they might
participate only four times a week, they are regarded as weird, and
they get a sense of being outsiders.”

Foundations of Special and Inclusive Education Module VI