Other Health Impairments
Other health impairment exists as an umbrella term encompassing hundreds of types of impairments that may result in a chronic condition limiting the individual's ability to effectively access the educational environment. This category is determined by limitations in the three areas of strength, vitality, and alertness, and these students may be cognitively intact. Three leading classifications under other health impairment include epilepsy, asthma, and diabetes.
However, it is the subcategory of attention-deficit/hyperactivity disorder (AD/HD) that will probably impact your classroom most frequently. According to the DSM-IV, AD/HD is defined as a "persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and severe than is typically observed in individuals at a comparable level of development." (p. 85)
Because of the wide parameters of the other health impairment category, the bulk of this section will be devoted to those students with AD/HD, as they are the highest incidence condition in this category. They are also the students most likely to be impacted negatively by their condition; students with epilepsy, asthma and other conditions in the other health impairment category may have little or no adverse impact on educational performance when their conditions are properly medicated.
The U.S. Department of Education reports 5,971,945 students receiving special education services in the 2003-2004 school year. Of that number, 7.6% or 452,045 students, received special education services based on a classification of other heath impairments.
Because IDEA does not specifically define or count incidence of AD/HD, the exact prevalence of the condition is difficult to determine. However, it is estimated that from 2 to 9% of all children are identified as having the condition.
IDEA lists a number of different chronic health problems as possible reasons for the other health impairment label, including asthma, attention deficit disorder, attention deficit hyperactivity disorder, diabetes, epilepsy, cardiac conditions, hemophilia, leukemia, rheumatic fever, sickle cell anemia, and nephritis. It would be impossible to list all of the possible characteristics under such a large disability category. The primary issue in other health impairments, whatever the condition, the resulting symptoms could adversely impact the student's educational performance. If a child has diabetes, but it is controlled through medication and does not impact learning, special education services are not appropriate for that child.
Students with AD/HD are categorized according to their characteristics into three distinct subtypes: predominantly inattentive AD/HD, predominately hyperactive-impulsive AD/HD and combined type AD/HD.
Students with the predominately inattentive type of AD/HD will exhibit six or more of the following characteristics:
- Does not pay attention to detail and often makes mistakes across a number of activities
- Has difficulty maintaining attention during activities
- Does not complete schoolwork or other assigned activities
- Has difficulty with organization of activities
- Avoids activities that require mental effort or concentration
- Loses materials necessary to complete assignments
- Easily distracted
- Forgetful in many activities
Students with the predominantly hyperactive-impulsive type of AD/HD will exhibit six or more of the following characteristics:
- Fidgets or squirms in seat
- Gets up or leaves seat frequently during class
- Runs about or climbs when inappropriate, and is generally restless
- Difficulty in engaging in play activities quietly
- Talks excessively
- Blurts out answers
- Has difficulty waiting for their turn
- Interrupts others
Students with the combined type of AD/HD will have some features of both the inattentive type and the hyperactive-impulsive type of AD/HD. This is the largest population of students carrying the AD/HD label.
Impact on Learning
Students with AD/HD, no matter what subtype, can have deficits in three areas that may impact their educational performance. These three areas are executive functioning, intellectual functioning, and social/emotional functioning.
Executive functioning is the ability to process information, make decisions, and solve problems. Students with AD/HD display deficits in a number of executive functions, including working memory, internalization of speech, self-regulation, and reconstitution. These students often have an inability to learn from the experiences of the past and can repeatedly make the same mistakes. This problem with memory is often impacted by issues with self-regulation, as these students also have difficulty understanding the effect that their behavior can have on others. In addition, students with AD/HD have trouble internalizing their thoughts and can blurt out inappropriate comments. Reconstitution is the skill of analyzing thoughts and behaviors. It is this deficit in executive functioning that can be the most frustrating to these students: they may know exactly what is expected of them, but are unable to act accordingly.
The average level of intellectual functioning of students with AD/HD is a matter of controversy, but what is certain is that these students frequently have problems with academic achievement. Ten to forty percent of these students are also diagnosed with a learning disability of some type, and 30% have a reading disability. However, these students also can display a high degree of creativity and can display intense levels of focused concentration on a task of interest.
Students with AD/HD often exhibit a number of emotional issues as well, and as many as 25% of these students have some type of anxiety disorder. These emotional issues can lead to conflict with parents, teachers and peers; low self-esteem; difficulty making social connections; and higher rates of alcohol and substance abuse.
Without the appropriate supports, students with AD/HD may experience long-term difficulties in academic, social, and emotional functioning. However, there are a number of strategies that can be taught to these students to enable them to have more control over their own educational outcomes:
- Allow extra time for these students to shift from one activity or environment to the next.
- Teach these students specific techniques for organizing their thoughts and materials. Organize the classroom accordingly, and keep all materials in permanent locations for easy access.
- Allow extra time for finishing assignments or for testing.
- For more complex activities, simplify steps to make them more manageable.
- Seat the student close to the teacher and away from any peers that might be distracting.
- Post a daily and weekly schedule that clearly delineates each activity. These schedules can then be used as prompts to direct the student back on task.
- Keep these schedules as consistent as possible, and keep unstructured time at a minimum.
In a more global sense, teaching these students to create their own goals and objectives can help them learn to manage their lives across any number of environments and activities. This process includes the following steps:
- Clearly define your goal.
- Develop objectives to achieve this goal.
- Define the actions necessary to achieve the desired outcome.
Teaching this process gives control back to the individual, allowing for greater motivation and self-awareness.
There are no specific technological devices that are recommended for students with AD/HD, but there are a number of tools that can be helpful in strengthening and supporting the organizational abilities of these individuals. Low tech devices such as notebooks and dividers can be utilized to record and organize assigned homework and classroom tasks. For older students, personal digital assistants, dictating machines, and a variety of computer programs can perform the same task.
For most students in the other health impairment category, it is the needs of the individual that drive the designation of appropriate assistive technology. For the most part, the majority of these students can access and benefit from the same technological supports that are used with their normally developing peers.
The following two publications from the U.S. Department of Education address important issues related to the instruction of children with ADHD:
- Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home
- Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices
ADD Warehouse has built the world's largest collection of ADHD-related books, videos, training programs, games, professional texts and assessment products. They are a leading resource for the understanding and treatment of all developmental disorders, including ADHD and related problems.300 Northwest 70th Avenue, Suite 102
Plantation, FL 33317
Adults, adolescents, and children with Attention-Deficit/Hyperactivity Disorder (CHADD)
CHADD provides education, advocacy and support to individuals with ADHD. They publish a variety of printed materials to keep members and professionals current on research advances, medications, and treatments affecting individuals with ADHD.8181 Professional Place, Suite 150
Landover, MD 20785
American Diabetes Association
The American Diabetes Association funds research to prevent, cure, and manage diabetes and delivers services at the community level.1707 North Beauregard Street Alexandria, VA 22311
Asthma and Allergy Foundation of America (AAFA)
The Asthma and Allergy foundation of America works to develop and implement public policies to improve the quality of life for people with asthma and allergies.
Center for Disability and DevelopmentDept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225
Council for Exceptional Children
The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704
Epilepsy Foundation-National Office
The Epilepsy Foundation of America® is the national voluntary agency solely dedicated to the welfare of the more than 3 million people with epilepsy in the U.S. and their families. The organization works to ensure that people with seizures are able to participate in all life experiences; to improve how people with epilepsy are perceived, accepted and valued in society; and to promote research for a cure.4351 Garden City Drive, Suite 500
Landover, MD 20785-7223
Epilepsy Foundation of Southeast Texas2630 Fountain View, Suite 210
Houston, TX 77057 8802 Harry Hines Boulevard
Dallas, TX 75235
Epilepsy Foundation, Central and South Texas10615 Perrin Beitel, Suite 602
San Antonio, TX 78217
Learning Disabilities Association of America (LDA)
LDA is the largest non-profit volunteer organization advocating for individuals with learning disabilities and has over 200 state and local affiliates in 42 states and Puerto Rico. The membership, composed of individuals with learning disabilities, family members and concerned professionals, advocates for the almost three million students of school age with learning disabilities and for adults affected with learning disabilities. LDA's mission is to create opportunities for success for all individuals affected by learning disabilities and to reduce the incidence of learning disabilities in future generations.4156 Library Road
Pittsburgh, PA 15234-1349
National Association of Protection and Advocacy Systems, Inc
The National Disability Rights Network (NDRN) is the nonprofit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities. Collectively, the P&A/CAP network is the largest provider of legally based advocacy services to people with disabilities in the United States. Through training and technical assistance, legal support, and legislative advocacy, the National Disability Rights Network works to create a society in which people with disabilities are afforded equality of opportunity and are able to fully participate by exercising choice and self-etermination.900 Second Street, NE, Suite 211
Washington, DC 20002
National Attention Deficit Disorder Association (ADDA)
The mission of ADDA is to provide information, resources and networking to adults with AD/HD and to the professionals who work with them. In doing so, ADDA generates hope, awareness, empowerment and connections worldwide in the field of AD/HD. Bringing together scientific perspectives and the human experience, the information and resources provided to individuals and families affected by AD/HD and professionals in the field focuses on diagnoses, treatments, strategies and techniques for helping adults with AD/HD lead better lives.P.O. Box 543
Pottstown, PA 19464
National Center for Learning Disabilities
The National Center for Learning Disabilities (NCLD) has developed this comprehensive site to help: parents make informed decisions affecting their children who have a learning disability or who may be at risk for learning disabilities; educators gain access to authoritative information about research-based instruction, assessment and support services; child care providers and early childhood teachers understand early literacy skill development, recognize warning signs and respond to young children's needs; and advocates promote educational rights and opportunities for all individuals with learning disabilities.381 Park Avenue South, Suite 1401
New York, NY 10016
American Psychiatric Association (2000). (DSM-IV-TR) Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Press, Inc.
Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.
Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.