CHILDREN WITH SPECIAL NEEDSCHILDREN WITH SPECIAL NEEDS ALL THAT YOU WANTED TO KNOW Usha Ram Lf FRANK BROS. & CO.Contributors to this manual are: Mrs Seema Banerjee, Head of Social Work Department Dr Vandana Mishra, Counsellor Mrs Jharna Bhattacharya, Headmistrees, Kulachi Manovikas Kendra Mrs Madumeeta Chatterjee, Psychology Teacher Edited by Dr S.K. Mishra, Assistant Director, Rehabilitation Council of India Published by Frank Bros. & Co. (Publishers) Ltd. B-41, Sector-4, Noida-201 301, Gautam Budh Nagar Phones : 0120-4689999 (100 Lines) Regd. Office: 2/10, Ansari Road, Daryaganj, New Delhi-110 002 ©All rights reserved. No part of this publication may be reproduced in any form without the prior written permission of the publishers. First Edition 2004 Reprinted 2005, 2011 ISBN: 81-7170-732-7 Printed at Shree Maitrey Printech Pvt. Ltd., A-84, Sector-2, NOIDA (U.P.)— ConTENTS 1. Special Education 2. Children with Mental Retardation 7 3. Associated Conditions 27 4. History of Special Education in Western Countries 44 5. History of Special Education in India 48 6. Training and Teaching of Children with Mental Retardation 51 7. Educational Assessment 57 8. Programme Planning 71 9, Curriculum Outline 74 10, Teaching and Learning Strategies 103 11. Persons With Mental Retardation in Family and Community 112 12. Legislation: Major Milestones 132 13. Learning Disability 148 14. Identification and Characteristics of Learning Disability 152 15. Hyperactivity: SocioEmotional Problems of Learning Disability 162 16. Educational Provision 167 17. Integration 173 18. Strategies and Approaches 177 19. Inclusive Education 181 20. Case Studies 197image not availableimage not availableimage not availableimage not available4 obtained by undergoing standardised general intelligence tests developed for the purpose and adapted to the conditions of the region/country. ‘Adaptive Behaviour’ is defined as the degree with which the individual meets the various levels of personal independence and _ social responsibility expected of his age and cultural group. The expectations of adaptive behaviour vary with the chronological age. The deficits in adaptive behaviour may be reflected in the following areas: During infancy and early childhood in: a. Sensory and motor skill development, b. Communication skills (including speech and language), c. Self-help skills. d. Socialisation. During childhood and adolescence in: a. Application of basic academic skills in daily life activities. b. Application of appropriate reasoning and judgement in control of the environment. c. Social skills. During late adolescence and adult life in: a. Vocational and_ social responsibilities and performances. ‘Developmental period’ is defined as the period of time between conception and the eighteenth birthday. 2. LEARNING DISABILITY: The learning process is affected in children with learning disability. The child has problems in the 3R’s, i.e. reading, writing and arithmetic. He cannot sit at one place and lacks attention. The IQ is normal.image not availableimage not availableimage not available8 normal environment of his fellows in such a’ way to maintain existence independently of supervision, control or external support. Not only is it important to define mental retardation accurately, but it is also equally important to conceptualise it as a condition that is alterable. This means that through training and treatment, some individuals acquire adaptive behaviour skills to such a degree that they function in a normal fashion. . DEFINITIONS Smith (1971): Mental retardation is a condition which is characterized by sub-normal mental functioning and manifested as an inability to acquire, process, maintain or properly use experience for the solution of problems. World Health Organization (WHO) of the United Nations Organization (UNO) in International Classification of Diseases and Related Problems (ICD-10), published in 1992 states: Mental retardation is a condition of arrested or incomplete development of the mind which is especially characterized by impairment of skills manifested during the developmental period which contributes to the overall intelligence, that is, cognitive, language, motor and social abilities. . According to the new definition: Mental retardation refers to substantial limitation in present -functioning. It is characterized by significantly sub-average intellectual functioning, existing concurrently and with’: related. limitations in two or more of the following applicable adaptive areas: communication, self-care, home living, social’ skill, community use, self direction, health and safety, functional academics, leisure and work. Mental retardation manifests before the age of 18. .image not availableimage not availableimage not available12 GENERAL CHARACTERISTICS OF MR 1. Delayed development in all developmental milestones. 2. Very poor language development, restricted to expression of wants/needs. 38. Short attention span—tends to get distracted very fast— poor concentration. 4. Poor motor integration—clumsy and uncoordinated motor skills and, therefore, has problems in developing adaptive skills. 5. Limited social skills—unable/delay gratification. 6. Poor short-term memory—difficulty ‘in retaining information for a sufficient length of time, related to poor information perceiving. 7. Difficulties experienced in thinking, generalisations or imagination affect their conceptual learning, concept formation. 8. General scholastic difficulties due to poor rate of learning, poor grasp of the matter taught, slow reactions to environmental demand and poor problem solving ‘skills. 9. Some types of mental retardation exhibit physical features such as small head, very large head, fissured tongue, tiny slating eyes. . Certain behavioural signs give an indication of the presence of Mental Retardation: 1. Slow in understanding things. 2. Longer time to respond to what others say and to ‘what happens around him.image not availableimage not availableimage not available16 contraceptives, maternal alcoholism, etc.) and exposure to industrial chemicals also leads to retardation in newborns. Lead poisoning is yet another major cause of MR. 2. TRAUMA AND PHYSICAL AGENT: Any injury or an insult to the brain can irreversibly limit growth and organisation as no further increase in the cell number (neurons) occurs after birth and, therefore, cannot be made up at any later stage. Also, neurons do not possess the power of regeneration; therefore, once a neuron is destroyed it is lost forever. The foetus’ brain can be damaged from any injury or trauma during prenatal, natal and postnatal periods (e.g. insult from violence, absence of oxygen, radiation or other. damaging chemicals). Oxygen deprivation (hypoxia) due to knotted umbilical.cord, extremely short or long labour, breech birth, premature’ separation of placenta, bleeding before delivery, narrow birth passage, maternal starvation, delayed birth cry, etc., leads to brain damage. Postnatal * head injury or prolonged periods of unconsciousness or coma can ‘cause brain damage. This type of trauma may occur throughout the developmental period. 3. METABOLISM OR NUTRITION: In certain cases of ‘inborn errors of metabolism’, the CNS is grossly affected leading to MR. In these cases, the metabolism of one of these, i.e. proteins (amino acids), fats, carbohydrates and other important substances are affected at some stages of their normal cycle, causing accumulation of products in abnormal quantities, neuronal damage and destruction or may prove to be toxic and cause derangement of their functions, for example, galactosaemia (caused by carbohydrate disorder), phenylketonuria (amino acid metabolism is affected), hypothyroidism (thyroid gland functioning is affected). Gross malnutrition during the last six months of pregnancy or the first six months of pregnancy or the first six months of life hinders the development of brain cells resulting in as much as 40 per cent deficit in cells. Mental deficiencies canimage not availableimage not availableimage not available20 c. Age of Mother: The greater the age, the more are the chances of having a mentally retarded child. d. Malnutrition of Mother: Lack of important nutrients and oxygen causes underdevelopment of the brain of the foetus. ; e. Consumption of Chemicals: Drugs used in treatment. ‘ef cancer, chemical contraceptives, maternal alcoholism and smoking can cause mental retardation. f. Genetic and chromosomal disorders. . PRENATAL CAUSES: a. Maternal Illness: Mental retardation can also result from maternal illnesses like heart disease, shock, bleeding, low blood pressure, hypertension, anaemia, placental dysfunction, diabetes, hypothyroidism and malnutrition. : b. Hypoxia or Lack of Oxygen: The neurons cannot withstand oxygen deprivation for more than five minutes. Thus, total deprivation or low supply of oxygen can severely affect the growth of the brain during pregnancy. This happens if there is less oxygen inthe mother’s blood or due to premature separation of | placenta, bleeding before delivery, etc. c. Hypoglycaemia or Lack of Glucose: Glucose is important, for the brain for metabolic requirements. Lack of glucose could be due to maternal starvation, maternal diabetes, less blood supply to the ‘CNS and glucose metabolism abnormalities. d. Malnutrition: As the baby draws his nutrition from the mother when inside the womb, nutrition deprivation of the mother not only results in low birth weight, affects the capacity for survival and development but also predisposes these high-risk infants to mental retardation through various complications.image not availableimage not availableimage not available24 g. Emotional Deprivation: The lack of Tender’ Loving Care (TLC) can also lead to mental deficiencies. This is more common in urban areas as the families are small‘and parents do not get the time to spend with the child. PREVENTION Of late, preventive’ activities have received primary attention. Three steps are being taken from the point of view of public education: . 1. Dissemination of available knowledge on the ecology of mental retardation through public media like newspaper, radio, television. 2. To bring together the parents and the interested public to mobilise their efforts to channelise funds and family. - 3. Strengthening national-level organisations to coordinate and disseminate their efforts. In 1999, RCI had taken up massive programmes for orienting all the Primary Health Centre (PHC) doctors in the entire country to scan, identify and provide services for ‘early identification and prevention of mental retardation and other disabilities. Some of the common preventive measures being followed include: . 1. The pregnant mother is not exposed to X-ray in the first trimester of pregnancy. 2. The maternal age is restricted to 18-36 years. 3. Rh factor to be controlled through blood Hanafunioda,image not availableimage not availableimage not available28 Management Medical e Drugs to control fits and any infection. Educational e Physiotherapy is given to help the child overcome motor problems. * e Training through individualised programme plan for the child and an additional use of special tactile, hearing and other sensory inputs to help the child overcome any visual problems if present. HYDROCEPHALY This is a condition where fluid accumulates in the brain, because of which the head appears big. Causes Genetic or environmental; under environmental, a hydrocephalic condition may be due to an infectious. disease during pregnancy. Associated Conditions Spina bidifa. e Hare lip. e Cleft palate. e Convulsions. Management Medical . Surgical intervention is necessary to drain the excess fluid in the brain. In some cases, there is a spon- taneous arrest in the accumulation of the excess fluid.image not availableimage not availableimage not available32 Clinical Features e Eyes slanted upward. e Tongue papilated or fissured, large and frequently protruding. e Little finger usually curved and short, a single crease in palm quite common. e Feet tend to be flat and broad with wide space between the first and the second toes. ¢ Joints are very flexible. e@ Delayed development in secondary sexual characterstics. Prevention There are a few tests that can be done during the early weeks of pregnancy to detect the presence of Down’s Syndrome in the foetus. They are: e Amniocentesis performed in the 11 to 18 weeks of pregnancy. e@ Chorionbiopsy after 6 weeks. e Genetic counselling should be sought by parents where there is a history of the first born being affected with Down’s Syndrome. Management Medical Should be protected from diseases, as they are prone to circulatory, gastro-intestinal and respiratory disorders. All children should be tested for heart problems. Eye infections should be attended to. Special Education Education in functional academics, reading, writing, number work and training to improve performance in activities of daily living.image not availableimage not availableimage not available36 © Organisation of the classroom so that distractions are kept to the minimum. AUTISM A pervasive disorder that severely impairs a person’s abilities, particularly in the areas of language and social relations. It is sometimes present at birth and in all cases becomes obvious by the thirtieth month of a person’s life. Incidence Statistics indicate that 3 or 4 out of every 10,000 children have this disorder and nearly 60—70 per cent of them have mental retardation of varying degrees of severity. It affects three times as many boys as girls. Causes Previously thought to be psycho-sociological, recent findings clearly indicate that autism is possibly caused by: e Brain abnormality, before, during or after birth. e@ Untreated PKU, rubella, stomach diseases. e Chemical exposures during pregnancy. © Biochemical imbalances. © Genetic factors. To date, the exact cause for autism has not been found. Characterstics e Autistic lonliness, severe social isolation, unable to relate to people as people. Eye contact for short duration only, in response to people’s attempts to engage them in simple conversation. © Obsessive desire for sameness, often becoming very upset even with small changes in their environment.image not availableimage not availableimage not available40 the muscles needed for speech are affected, it may be hard for them to communicate their thoughts and needs. Ataxia or Poor Balance Difficulties in beginning to sit and stand, falls often and clumsy use of hands. Ataxic cerebral palsy is uncommon and is often mild although the development of movements may be considerably delayed. Mixed Forms Symptoms of more than one type are noticed. The most common combination is spasticity and athetosis, less frequent is that of ataxia and athetosis. e Hemiplegic — paralysis affecting the arms and legs on one side of the body. Monoplegic — paralysis of one limb or region of the body. Paraplegic — paralysis of the legs and lower body. Triplegic — paralysis of three limbs. Quadriplegic — paralysis of all four limbs. Management—A Team Approach Medical © Drugs are given to control fits; about one-third of the cases have fits, and visual problems are found in about one-fourth of the cases. Deafness due to auditory damage is found along with athetosis. e Surgery is carried out to correct severe stubborn contractures. Physiotherapy and Occupation Therapy To help the child’s movements and prevent contractures.image not availableimage not availableimage not available——— CHAPTER 4 HISTORY OF SPECIAL EDUCATION IN WESTERN COUNTRIES In the bygone years, most children born with disabilities did not survive long; they died at birth or infancy. The earliest written reference to mental retardation is the therapeutic papyrus of Thebes dated 1952 BC. In the twelfth century, the English King Henry II enacted legislation. For the first time, a distinction could be made between people with mental retardation and those with mental illness. By the latter half of the sixteenth century, Pope Gregory I issued a decree that instructed the faithful to assist those who are crippled. In the Middle Ages, the churches took over the responsibility of caring for individuals with handicaps by providing foster care and shelter for them. However, the concept of special education and systematic services for persons with disabilties took shape in Europe only in the early 1800s. The first person who initiated systematic training to educate children with mental handicap was Jean Marc Gaspard Itard (1774-1838). He picked up a wild boy ofimage not availableimage not availableimage not available——— CHAPTER 5 HisTORY OF SPECIAL EDUCATION “IN INDIA The concept of mental retardation was first mentioned in the Arthava Veda. A much older system of philosophy, the Sankhya, contains a statement on different types of intellectual disabilities. According to the Garba Upanishad, babies with birth defects were ‘born to parents whose minds are distressed’. The Pathanjali Yoga Sutras deal with yoga as a therapy in which mental retardation has also been taken into consideration for this therapy. The great physician Charaka had given various causes of mental retardation and discussed the different types and classification. Clear reference to persons with mental retardation can be traced in the Sangam literature (200 BC-AD 200) by Erayanar and Avviayar and more recently by Thiruvalluvar.image not availableimage not availableimage not availableimage not availableimage not availableimage not availableimage not available56 child the monitor of the class, or the captain of the play team, or the leader of a group, etc. Sensory Reinforcers: Sensory reinforcers refers to the unconditioned characteristics of sensory events that increase the probability of the behaviours that they reinforce — auditory, visual and tactile. Basic Principles of Delivering Reinforcement 1, Reinforcement must be dependent on the child exhibiting the target behaviour. In other words, no appropriate behaviour, no reinforcement. . Reinforcement should be provided immediately after the target behaviour occurs. . During the initial stages of behaviour management programmes, the target behaviour is reinforced each time it occurs. . Once the specific behaviour is acquired, the teacher may use only intermittent reinforcement. . A tangible reinforcer should always be accompanied with a social reinforcer (praise, hug and so on). The goal of behaviour management is to fade out tangible reinforcers and have the behaviour appear only for social and intrinsic rewards.image not availableimage not availableimage not availableimage not availableimage not availableimage not availableimage not available64 with whether a child performs skills as per the criterion set or not. It compares the performance of an individual to the pre-established criterion. In criterion-referenced tests, the skills within a subject are hierarchically arranged so that those that are learned first are tested first. 3. INTERVIEW: Information is also gathered on the student’s social skills and the management of the student in various environments through interviewing parents, family members, others and the student himself. 4, OBSERVATION: Systematic observation is another extensively used technique in collecting information leading to planning as well as evaluation. It provides extremely valuable data concerning the learning and development of specific students. Before the observation, one needs to identify the purpose for which a student is being observed. 5. ERROR ANALYSIS: The method used to determine the process or strategies a student uses while doing the academic tasks is called error analysis. It helps in selection and evaluation of teaching strategies, gathering pre- referreal information and planning and evaluation of IEP. Consistency in error pattern is an indicator to the teacher on the student’s learning style which helps her to adopt the required teaching style to suit the need. 6. CURRICULUM BASED ASSESSMENT (CBA): CBA is one type of criterion referenced testing. CBA test items are drawn directly from the teaching materials and are a highly effective way of monitoring and modifying methods of instruction. Fuchs and Fuchs (1990) have identified two specific forms of CBA: precision teaching and mastery teaching. In precision teaching, a lesson is broken down into a hierarchy of skills. Measurement procedures allow the teacher to analyse the child’s performance at each step in the skill hierarchy.image not available66 provides an adaptive behavioural assessment kit comprising materials to be used in assessment of each mentally handicapped child. The MDPS helps to record the challenging behaviours (problem behaviours) which can be taken care of through the IEP. The administration procedure involves receiving information on what skill behaviours the child can or cannot perform currently. This information is derived by direct observation of the child’s parent/caretaker, interviews or by means of testing during assessment. The child’s performance is rated on each item along two discretions, depending on whether the child does or does not perform the target behaviour listed in an item on the scale. The data, recorded both graphically and numerically from MDPS, helps the teacher to set goals and draw a behaviour profile of the mentally challenged individual. Besides, it helps in the evaluation of a child’s progress over a period of time. MDPS has provision to represent the evaluation of data both graphically and numerically and present them weekly, quarterly and annually. The reliability and validity of this scale has been established. Behavioural Assessment Scales for Indian Children with Mental Retardation (BASIC-MR) The BASIC-MR was been developed by Reeta Peshwaria and S. Venkatesan of the National Institute of the Mentally Handicapped, Secundrabad as a part of the project to develop materials for teachers in using behavioural technology for mentally retarded children in special schools. It has been designed to elicit systematic information on the current level of behaviours in school-going children with mental retardation between 3-16 or 18 years of age. The scale is relevant for behavioural assessment, and can also be used as a curriculum guide for programme planning and training, based on the individual needs of each child with mental handicap. The scale has been field tested on a select sample population.Children with Special Needs: All That You Wanted to Know 67 The scale is in two parts — BASIC-MR Part A and BASIC-MR Part B. The Part A consists of 280 items grouped under seven domains, that is motor activities of daily living (ADL), in motor, language reading-writing, number-time, domestic, social and pre-vocational. Part B consists of 75 items grouped under 10 domains, like violent and destructive behaviours, odd behaviours, hyperactive behaviours, rebellious behaviours, anti-social behaviours and fears. These help to assess the current level of problem behaviours in the child. The child’s performance on each item of Part A is rated along a descriptive scale, namely, Independent (score 5), Clueing (score 4), Verbal prompting (score 3), Physical prompting (score 2), Totally dependent (score 1) and Not applicable (score 0). The test administration of any item within any domain can be stopped after five consecutive failures by the child. The rest of the items need not be administered and they should be scored zero. As such, maximum scores possible for the child in each domain continue to be 200. Functional Assessment Checklist for Programming (FACP) The Department of Special Education, National Institute for the Mentally Handicapped, Secundrabad, developed a series of educational assessment checklists to facilitate programme planning for each child with mental retardation from pre- primary to pre-vocational skills level. There are seven checklists in this series and each is addressed to the different levels of the child’s functioning, namely pre- primary, primary I, primary II, secondary, pre-vocational I, pre-vocational II and care-group. The skill required at each level has been carefully selected, and written objectively at each level, excepting the care-group, where the checklist covers a broad domain of skills, such as personal, social, academic, occupational and recreational.68 The checklist provides for periodic evaluation. Generally, teaching goals and objectives are set quarterly and the progress is evaluated at the end of three years in a given level. Space is provided for recording assessment and evaluation data over a period of three years. The Portage Guide to Early Education The Portage Guide was designed in 1975 as a home-based intervention programme for pre-school children between 0- 6 years, suffering from developmental disabilities. It was originally developed in Portage, Wisconsin (USA), and is now being used in many parts of the world. It provides a flexible model for early intervention, which assists children to attain their optimum development by involving their parents and families in the education of their own child. It consists of three parts: 1. A manual, 2. A checklist of behaviours in which to record the individual child’s progress and the level of skills; 3. An illustrated set of cards comprising the curriculum, which contains suggestions for teaching the skills listed on the checklist. The Upanayan Package The Upanayan package is another assessment tool for early intervention for children between 0-2 years. It is a systematic and comprehensive programme, developed for early intervention as well as infant stimulation. It is also an effective guide for screening, assessment, training and evaluation of the child in all his developmental areas. The key features of this package are: 1.A checklist of 250 discrete skills in the five developmental areas of motor, language, cognition, self-help and socialisation for use in assessment, for arriving at the current level of performance and for setting priority goals and objectives for intervention.Children with Special Needs: All That You Wanted to Know 69 2. A format to record assessment profile and progress of the child, both graphically and numerically. 3. A set of activity cards, consisting of indigenously developed and well-illustrated step-by-step activities for each of the 250 skills, for use in working out concrete lesson plans for intervention. The activities have been evolved using all the multi-sensory inputs. 4. A set of individualised programme plan (IPP) forms for use in recording the priority goals and objectives. 5. A kit of materials for assessment. 6. Upanayan-user manual giving guidelines for evolving the IPP. Curricular Action Plan (CAP) CAP offers a standard procedure for recording the student's progress and maintaining cumulative records for noting acquired skills. Teachers, parents and school administrators can have an overall view of ‘what is being taught’ in the current year and ‘what is to follow’. CAP has been prepared at three levels: 1. Elementary level — for 2-10 years. 2. Secondary level — for 11-16 years. 3. Vocational level — for 17 years and above. For each level, different domains, particularly relevant for that level, are selected. Under each domain, various skill activities are listed. Each level of the set contains: 1. Curricular Action Plan (CAP) 2. Individual Record Sheet (IRS) 8. Annual Report Form (ARF) 4. Behavioural Observation Form (BOF)7 0 Guidelines for Assessment e The items contained in any checklist must provide sufficient information for assessment and programme planning. e Items must be worded appropriately and clearly, for easy application. e Items measuring the behaviour must be grouped under the appropriate domain for which it is prepared. e Behaviour, in the items, should be observable and measurable. e Items must be developmentally sequenced in each domain. e As a teacher directly handles the children in the classroom, he/she has a major role in the assessment process. He should build certain desirable traits in them, to be an effective assessor. e Assessment should not give a number, which will not have any effect on programming, instead the criterion- refevenced test should lead the teacher to evolve the programme. e Different problems associated with the child’s learning must be considered while assessing the child. This helps the teacher to prepare an effective programme. e Each assessment technique has a distinct advantage when used with different types of children in different situations and, therefore, the best method is to employ a variety of assessment techniques.— CHAPTER 8 PROGRAMME PLANNING INTRODUCTION As each child with mental retardation has unique needs, he needs individual attention and an educational plan, which is exclusively made keeping in mind his/her unique needs. As this plan caters to a child’s individual requirement, it is called Individualised Education Programme (IEP). Training Programme for children with MR involves: 1. Development of IEP 2. Task Analysis. Definition TEP is defined as a document, written by a team of professionals and parents, to provide students with one or more handicap, an appropriate intervention.72 Characteristics of IEP The major components of an IEP are: 1. General background information about the child. 2. The current level of performance in specified skills. 8. Goals and short-term objectives. 4. Methods and materials required to achieve the objective. 5. Time required to achieve the objective. 6. The persons assigned in training the child to achieve the objective. 7. Evaluation to assess whether the objective has been met or not. A well-planned IEP has information on the programme that has been designed for the child by the various specialists who make up the team of experts, and who provide services to the child. For example, the IEP must contain programmes according to the needs of the child in physiotherapy, occupational therapy, speech therapy and behaviour management, in addition to that, special education. Hence, a good IEP is evolved in consultation with a team of specialists and with whom the special educator coordinates. The IEP is developed keeping in mind the financial status, family background and the child's medical history. For example, if the details show that the child belongs to a rural family—with parents without formal education— the IEP should contain more sketches and less of written matter, and the materials used should be those which are easily available in a rural setting. If the history shows that the child has epileptic fits, which has not been attended to, he would have to be referred to a doctor for medical attention.Children with Special Needs: All That You Wanted to Know 73 The IEP specifies the goal for the child, which the teacher wishes to achieve in an academic year. These goals are of two types: (a) Long term or annual goals, i.e. the goals that are achieved in an academic year, and (b) Short-term goals, which are the breakup of the annual goals. The IEP also mentions the teaching strategies which the teacher wishes to employ for teaching specific skills to the child and also contains the evaluation procedures, which help the teacher to periodically measure the student’s performance, monitor the effectiveness of the programme and make necessary changes in the programme, if needed. The following criteria may be considered for preparing an IEP: 1. The Age of the Learner: Beyond a certain age, remediation and academic deficits may not be desirable and some form of compensatory skill may be more appropriate. 2. Prerequisite Skills: Priority should be given to those skills which must be mastered before other skills can be learnt. 3. Community Validity: The skills should be ones that the student can quickly recognise as being common in the community. TASK ANALYSIS Task analysis is training the mentally handicapped child, in the performance of the assigned skills through a step-by- step breakup of the task. It is a procedure by which an instructional task is broken down into its entire relevant sub-task providing a step-by-step description of the component of the main task.— CHAPTER 9 CURRICULUM OUTLINE PRE-SCHOOL, PRIMARY, SECONDARY AND PRE-VOCATIONAL The skills that are needed by persons with mental retardation for daily living are ever-increasing, as society becomes more and more complex. The curriculum must encompass all the functional domains including self-care, gross and fine motor skills, language and communication, academic and vocational skills, household management and living skills, social and leisure-time skills. There are many ways of organising educational programmes for mentally handicapped children. Most special schools have the following system of education: Pre-school, primary, secondary (junior high) and pre-vocational (senior high) classes. In addition, many schools are also offering infant stimulation programmes. Infant stimulation programmes focuses on encouraging the sensory and _ intellectual development of the child from 0-3 years.Children with Special Needs: All That You Wanted to Know 75 PRE-SCHOOL CLASSES The early childhood years are viewed by many as a critical time for both intellectual and social development of any child. Pre-school programmes have the ultimate goal of reducing the risk of infants and young children of disadvantaged families from becoming mentally retarded. Many pre-school classes for those with mild retardation emphasise on what are commonly referred to as readiness skills as prerequisites for later learning. Pre-school classes for children with retardation start at a lower level and the training may take as long as two or three years. Readiness skills includes the abilities to: 1. Position oneself and attend to the teacher for the required length of time. . Discriminate auditory and visual stimuli. . Follow directions. . Develop language. . Increase gross and fine motor coordination. . Develop self-help skills. Noasown . Interact with peers in group situations. The pre-school level is also a good time to involve parents in the education of their children. Parents can be the effective teachers to stimulate cognitive and verbal developments in their children. While preparing a training curriculum for the pre-school level children with mental retardation, the following basic considerations must be taken into account:76 1. Children learn through relating to people and objects around them. This is their first step in organising information from the external world. Hence, interaction between children and their environment must be encouraged. 2. Providing children with experiences that stimulate all the senses. Multi-sensory approaches to teaching facilitates both assimilation and accommodation. Assimilation refers to the use of mental schematic ability to comprehend new objects in the environment; in older persons it refers to adult tendencies to see and interpret things according to pre-existing ideas. Accommodation, on the other hand, is an adjustment of schematic ability to new objects, events and ideas. 3. Teachers’ offering stimulation as the child has difficulty in organising the world. Children must be given opportunities to become more aware of their physical and mental selves and gain control over their actions and thoughts. 4. Programmes should be developmental in the most basic sense and focus on the child’s actual functioning level. Knowledge of the normal sequence of cognitive development helps the teacher in providing appropriate intervention programmes. 5. Teaching strategies should be consistent, structured and controlled. Cognitive goals should be set and activities devised with concept in mind. Action-oriented activities will ensure that the goal set is achieved. 6. Time must not be wasted in teaching activities that do not have a functional value in the immediate environment as well as in the later stages of the individual life. Ability to formulate concepts depends on the cognitiveimage not availableimage not availableimage not available80 dressing, maintaining good health practices in nutrition and general cleanliness and preliminary home economic skills. 2. COMMUNICATION SKILLS: Listening and speaking skills, enrichment of vocabulary, engaging in conversation with a familiar group of persons, engaging in conversation using the telephone. 3. SOCIAL SKILLS: Knowledge and practice of appropriate behaviour in public places, using transportation services like bus, taxi, auto, rail and air, following traffic rules, relating to family for various services such as telephone, telegraph, electricity, newspaper, milk delivery, gas, oil and so on, health services, emergency services like fire, ambulance, police, knowledge of various recreational areas, knowledge of geographical divisions and cities in states. 4, ACADEMIC SKILLS: Continued training in improving reading skills, reading a variety of materials, small story books, following television programmes, radio programmes, referring to a catalogue, telephone directory, handbooks, reading maps, writing legiblly and accurately, spelling commonly used words, applying number skills in activities of daily living, adding and subtracting, multiplication and division, grouping objects in twos, fives and tens, understanding fractions to %, '/, and %, counting and writing upto 100, using common weights/measures, knowledge of name and identifying rupee notes, using money for purchases, recognising the value for money and engaging in the habit of saving, using the clock and calendar correctly, recognising the days of the week, week- ends, months and year. 5. MOTOR SKILLS: Developing physical skills necessary for common games and recreational activities. 6. PRE-VOCATIONAL SKILLS: Developing manual skills,image not availableimage not availableimage not available84 abnormality and neurological involvement are observed in persons with profound mental retardation. Restricted communication ability is another striking characteristic. Meaningful communication, if at all achieved is usually restricted to few non-verbal gestures or physical contact such as touching, pulling or patting. Most of them have additional impairment of hearing, vision or motor abilities. Educational Provisions At one time, persons with profound retardation died naturally at birth or were put to death at a very early age. In some parts of the world, they were isolated from society. Gradually, humanitarian concerns evolved. According to Hawett (1974), four distinct treatment determinants can be traced through the history of civilisation, namely, 1. Survival, 2. Superstition, 3. Science, 4. Service In primitive societies, ‘survival of the fittest’ was the belief and practice and, therefore, persons with deformities were killed or subjected to conditions that led to death. Later, the superstitions took over, considered such people as ‘possessed’ and, therefore, abandoned and alienated them from the society. With the development of scientific enquiry, such individuals were studied and research was carried out, leading to categorisation and classification. This in turn led to development of suitable services for them. The services ranged from institutionalisation to inclusion through the years upto the present day. The educational provisions for persons with profound retardation was considered necessary only after governments in various countries implemented laws for education of the disabled persons. For instance, in the United States, ‘Education for All Handicapped Act’ (1975),image not availableimage not availableimage not available88 sequences to each other. The children may perform any of the steps in pairs, holding hands or with arms crossed behind their backs. If a child has difficulty in galloping, he/ she may practice by lying on the back and making a bicycling movement with his/her legs in a one-two-one-two rhythm. If necessary, you can guide the legs. Have the children step through the spaces in a ladder when it is lying on the floor. You can also use lines on the floor, hula-hoops and so forth. 2. FINE MoToR ACTIVITIES: The following activities have been found to be useful in stimulating a child to be alert to his/her environment, become more aware of his/her hands, body to reach out and grasp. Gently rub the child's hands, arms, legs and feet with a variety of texture materials such as terrycloth, wash cloth, a sponge, a piece of carpet and ice. Tie bells on the child’s shoes or sew bells on elastic wristlets. Engage the child in sand and water play. Place ice cubes or toys in food colouring to colour the water or add bubbles for a variation. Bury objects in sand and help the child find them. Sit the child in sand, so that he/she can feel the sand on his/her feet and legs as well as on his/her hands. Drape a diaper or piece of material over the child’s head and face and encourage him her to pull it off (as in ‘peek- a-book’). Lightly wrap a brightly coloured yarn around and in- between the child’s fingers of one hand and encourage him/ her to pull it off with the other hand. Alternate hands.image not available90 5. SELF-FEEDING: The self-feeding skills begin with the basic training to suck, swallow and gradually chew, pick up and eat dry food independently, to eat when the food is mixed and given, and finally mixing and eating by self without spilling. Many of the profoundly retarded children have difficulty in sucking, chewing, swallowing. Positioning them properly before feeding them is very important. One common reason for inability to chew food in these children is their inability to move food with their tongue. Tongue control can be checked by placing the child’s favourite food item like jam/ chutney/honey on the corners of the mouth and see if he licks without difficulty. If there are physical limitations, he cannot lick the food. To encourage chewing, place the food at the inside of the cheek, next to the molars alternating sides. Initially, let the food be soft. 6. BRUSHING: To ensure oral hygiene, wash the child’s mouth immediately. In some places, it is a practice to apply toothpaste mildly on the teeth after a meal and leaving it as it is. This prevents the growth of germs and tooth decay. Many of these children have difficulty in spitting when their teeth is being brushed. With the advice of the dentist, it is all right to apply non-foamy toothpaste and leave it as it is after feeding. 7. TOILETING: Indication of toilet needs, using toilet when needed, and controlling urination/defecation until reaching the toilet are basic considerations. Using the toilet independently, washing oneself after toileting and flushing, dressing after toileting and maintaining privacy are the next part of the training content. Adaptation of toilet seats, attaching tubes to taps for ease of working after toileting are some examples of structural changes. The child has to be trained by maintaining aChildren with Special Needs: All That You Wanted to Know 91 toileting frequency chart. He should be appreciated for maintaining dry underclothes between toileting. 8. BATHING: If the children have motor deficits, comfortable seating arrangements should be made. Using a towel with rings for holding, or long brushes helps him in independently rubbing his/her back. Ensure that the bathrooms are not slippery. Initiate training for bathing when children enjoy staying in water. 9. DRESSING: Fine motor coordination of buttoning, buckling and tying ribbons/pajamas/shoelaces are the difficult part of dressing for these children. Use Velcro instead of buttons, elastic bands, ribbons/tapes so that the children can dress independently. Provide shoulder button instead of back buttons for girls so that they can fix it on their own. 10. COMMUNICATION AND SOCIALISATION: The curricular content should also include independent mobility within the house, avoiding danger and hazards and carrying out simple, routine chores in the house such as drying clothes, sorting and transferring vegetables brought from the market into their respective places in the house and such other task. Ensure that the activity given to him is not harmful to him and/or any object at home. These children have minimum communication abilities, which have to enhanced to facilitate better socialisation. Many of these children are non-verbal or have limited expressive vocabulary. Encourage the use of gestures where possible and appropriate use of communication board. Above all, allow the child to express his needs. Do not be in a hurry to fulfil his needs before he asks. Wait for him to express and even if he is approximately close to the correct. expression reward him. Enhance listening and responding skills by providing a variety of opportunities.92 TRAINING STRATEGIES By and large, the strategies remain the same for all children with mental retardation, irrespective of their degree of retardation. However, those with profound mental retardation require patient and intensive physical prompting for an extensive period of time, accompanied by verbal instructions. Every task needs to be broken down to smaller units and taught piece by piece. Every near- successful attempt should be rewarded to reinforce the child’s learning; the reward can be gestures that please him or a material that he likes. Understanding abstractions are difficult for severely mentally retarded children. Therefore while teaching, use concrete objects as far as possible. As their listening skills are limited, work out the activity and show the child, and do along with him whenever appropriate. Learning by doing helps in learning faster and retaining the learnt skill. Always select activities that are age appropriate, necessary for his independent living and in line with the practices in the family. MULTIPLE DISABILITIES Put simply, multiple disabilities refer to more than one disability. For educational purpose, persons with multiple disabilities are defined as: If the combination of impairment causes such severe educational problems that they cannot be accommodated in special educational programme solely for one of the impairments, those children are considered multi- handicapped. — US Federal Register, 1977. This definition also indicates that educational provisions for single disability do not suit such children. Therefore, anyChildren with Special Needs: All That You Wanted to Know 93 person who has a combination of disabilities is multi- disabled. The combination can be mental retardation with hearing impairment and/or visual impairment, and/or loco- motor disabilities involving limbs such as those deformities arising from accidents, birth defects or cerebral palsy. A multiple disability can be a combination of any two or more of the above-mentioned disabilities. Since our focus is mental retardation, let us consider those who are mentally retarded with visual, hearing and/or loco-motor disabilities. Characteristics Many children with several mental retardation can have additional disabilities. It is also possible that children with mild or moderate mental retardation can have visual, audio or loco-motor disabilities. Mental Retardation with Loco-Motor Disabilities A considerable number of children with multiple disabilities have motor involvement. Many severely retarded are by nature non-ambulatory, others may have motor problems due to congenial deformity, cerebral palsy, or due to infections and accidents. Children with mental retardation and loco-motor disabilities are usually affected by cerebral palsy (CP). A small number are also seen with both defects. Many children with CP have average or above average intelligence, but a considerable number are mentally retarded. Types for School Readiness A child with CP can be spastic with tense, contracted muscles, athetoid with constant uncontrolled motion of head, limbs and eyes, rigid with tight muscles that resist efforts to make them move or ataxic with poor sense of balance leading to stumbling and/or falls.image not availableimage not available96 communication, socialisation and if he has potentials, functional academics. Many a time, even without learning academics, a child may learn vocational skills, which are routine and repetitive. This must be included at the pre- vocational level of the curricular programme. Adapted materials can be used, if needed, for teaching. For children with mental retardation and sensory impairment, mobility, communication, independence in daily living skills and social skills must be included in the curriculum. Body awareness is an essential component for all children in their curriculum. If the children are capable of learning functional academics such as time, money and measurements, they can be taught using adapted materials. Adaptations have to be child-specific. Whether sensory or motor difficulty, the aim of the curriculum should be to lead the child towards independent living. Given below are some simple adaptations for daily skills. The teacher needs to be innovative and creative in developing adaptions, keeping in mind the child’s functional level, need and the abilities. TEACHING STRATEGIES Teaching strategies are the same for children with single or multiple disabilities. Use of tactile sense and appropriate aids are essential for multiple-disabled children. Aids can be of two types, learning aids and functional aids. Learning aids are used during learning (such as blocks for counting) and are required once a task is learnt. Functional aids are required to perform a function, such as a hearing aid or a wheel chair. The teacher must use her wisdom in deciding when a child needs what kind of aids. Examples of activities for a sensory stimulation programme:Children with Special Needs: All That You Wanted to Know 97 Sense Stimulated Vision Suggested Activities . Have students walk along or trace taped patterns on the floor. . Have students track moving objects of differing sizes and colours. . Have students move through obstacle courses of increasing difficulty. . Using a mirror, identify body parts and imitate body movements. . Sort and match brightly coloured objects or designs with varying degree of contrast. . Hold favourite objects within reach and encourage movement and grasping. Hearing Touch . Tap rhythms and solicit imitation of sounds. . Place ring on a stick in response to specific sounds (students with severe motor disability can blink their eyes). . Encourage manipulation of objects that elicit pleasurable sounds (bell, musical toys, etc.). . Hide toy or noisemaker, which continue to emit sounds. Have students search for the object. . Musical games (‘Simon Says’, musical chairs, etc.). . Imitate child’s vocalisations and see if the child imitates you. . Sort and match common textures (fabric, sandpaper, etc.).98 Smell Taste . Rub the child with textures that feel pleasant; later, use this approach to teach naming of body.parts. . Have students feel objects of different temperatures (warm water, ice cubes, etc.). . Encourage students to feel the face of their parents and explore their own bodies (Donlon & Burton, 1976). Attach verbal or non-verbal labels to the activities. . Distinguish shapes tactually with form- boards or simple puzzles. . Let the student experience the terrain barefooted. . Encourage experiencing different smells around the home. . Expose the child to characteristic smells. . Provide community experiences. Smell of the supermarket, shoe store and restaurants are important sources of discrimination and learning opportunities. 1. Experiment with various food. . Pair pleasant tastes with jobs well done. . Associate pleasant tastes with their referents. Either vocalise or sign their names. MULTI-SENSORY APPROACHES Multi-sensory approaches refer to the use of more than two senses (hearing and vision which are generally used for learning) for teaching a learner. As all sensory channels (including vision, hearing, taste, smell and touch) receive information and as each sensory channel has a distinct roleChildren with Special Needs: All That You Wanted to Know 99 in receiving the stimuli in the environment, it is very essential that they are effectively used. After vision and hearing, it is the tactile/kinesthetic senses that are used predominantly in the learning process. Historic Perspectives Looking back at the history of training for persons with retardation, we find that Itard used multi-sensory approach to train ‘Victor, the wild boy of Averyon’. In the nineteenth century, Madam Maria Montessori developed a programme of activities utilising various sensorial channels for training. Even today, Madam Montessori’s multi-sensory approach is in use, and has tremendous impact on the educational system, not only for special educators, but also for the general educators of non- disabled children. Though various cognitive and behavioural approaches emerged with the advances in special education, the use of multi-sensory approach is found to be best suited for persons with profound mental retardation. This is because since such children have sensory deprivation, use of other senses help in compensating for the loss, and thus learning. Application of Multi-Sensory Approaches for Children with Profound and Multiple Disabilities Smith, Patton and Ittenbeach (1994) describe unique characteristics that require special consideration in such children, as (a) communicative, (b) motoric, (c) medical and (d) behavioural. All these four require multi-sensorial training. Communication, for instance, does not involve just speech and hearing. Gestural communication is an extremely100 effective mode where a child does not speak or hear. This involves tactical and kinesthetic sense. Similarly, to improve the motor skills in such children, physio-occupational therapies and activities are included in the curriculum along with assertive devices, which provide multi-sensorial involvement. With technological improvement, children with multiple disabilities and profound retardation have devices that help compensate for their limitations. Computerised wheel chairs, head gears for holding pencils, telephone with visual indicators, talking books for the blind are but some examples for using multi-sensory approach in the technologically advanced era. CURRENT TRENDS IN THE EDUCATION OF CHILDREN WITH PROFOUND AND MULTIPLE DISABILITIES Concept of Zero Reject The Peoples with Disabilities Act (1995) in India, and the legal provisions in many countries (PL 94-142 in the USA, for instance) in essence advocate that all children must have access to education. This means that no child— whatever be the reason—should be rejected from the educational system. If such a ‘zero reject’ policy is to be achieved, children with profound and multiple disabilities must receive ‘appropriate education’. As we have seen earlier, appropriate curricular content include independence in daily living activities, mobility in the known environment, functional communication and if possible, academics. As many of these children are non-ambulatory, appropriate education should ideally reach them, rather than expecting them to reach schools. This means alternative educational provision in terms of home-based training should be provided to them.Children with Special Needs: All That You Wanted to Know 101 Home-Based Training and Parental Involvement As the training components predominantly involve self-help areas, parents and family members have to essentially become the trainers of such children. Involvement of parents, siblings and grandparents, if possible, has proved very effective in home training. Moreover, when the training is provided at home, the transfer of training is minimised as the child learns in his/her natural environment. Teacher Preparation Majority of the training programmes for special teachers focus on single disability. Among the programmes offered for training children with mental retardation, coverage of profound mental retardation is very limited. Thus, the teachers do not feel confident and competent in training children with profound and multiple disabilities. In addition, as mentioned earlier, the condition of such children need intervention by a team of experts including medical professionals, therapists and teachers. This demands that the teacher has competencies in being a team member to coordinate the interdisciplinary team. In the given situation, it is essential that teachers of children with single disability or should be given in-service training in the management of children with profound and multiple disabilities. The curriculum should include competencies in team management, training strategies, home-based and centre-based training and classroom management wherever appropriate. For further programmes, the pre-service programmes for special teachers should provide adequate training in theory and application for handling of children with profound and multiple disabilities.102 Use of Analysis of Biobehavioural States for Training It will appear, many a time, children with profound and multiple disabilities are seemingly oblivious to their environment. Yet, they do experience certain sensory input and respond, perhaps in their own manner. This interaction can be made more meaningful when the biobehavioural state of the child is studied. Extensive research has been done in these lines by Guess et al. at Kansas University. The underlying assumptions are, that the alertness in a person ranges from sleep stage through alert-awake-active stage, including 3 to 5 stages in-between, such as sleep- inactive, sleep-active, drowsy, daze, awake-inactive, awake- alert, agitated and crying. The team led by Dr Guess has analysed the biobehavioural stages very systematically under various circumstances including the time of the day, position of the child, place of interaction, personal material of interaction and so on which helps in arriving at the best condition under which the child is awake-alert. This situation is chosen for instructional input, as there is more likelihood of the child receiving the stimuli and thus enhancing learning. This sounds logical and needs to be studied further. In short, a good teacher will find ways of reaching out to her student rather than giving up on the effort.— CuapTER 10 TEACHING AND LEARNING STRATEGIES INTRODUCTION Teaching mentally challenged children requires extensive knowledge, broad range of professional skills and a positive attitude. Primary among the skills needed to teach them is the understanding and the use of a variety of effective and proven teaching strategies. A successful approach on one day might be the antecedent for a behavioural problem next day. It is, therefore, important to have in one’s instructional repertoire a variety of teaching strategies. VaRIOUS TEACHING STRATEGIES The various teaching strategies used by the teachers are given below. 1. TASK ANALYSIS: Task analysis is a teaching strategy, in which the task to be taught is broken down into teachable components and arranged in a sequential order. It does not specify how each component skill is to be taught but only104 describes the skills to be taught, each one being a component of the main task. It helps the teacher in pinpointing the student’s functioning level of a specific skill, and also provides basis for sequential instruction, tailored to each student's pace of learning. 2. SHAPING: It refers to sequential, systematic reinforcement of successive attempts at target behaviour until the behaviour is achieved. For example, to teach a child to kick a ball in the required direction, the teacher may begin rewarding the child even if he stands near the ball. Gradually, the child’s behaviour is shaped by rewarding at the end of every step, such as when the child gets closer to the ball, pushes it in any direction, kicks it in any direction and eventually kicks the ball in the specified direction. 8. CHAINING: Chaining refers to the actual process by which each of the response is linked to one another to form the behavioural chain. The identification of response sequence is done through a task analysis. Two types of chaining procedures are followed: a. Forward Chaining b. Backward Chaining Teaching from the first step to the last step is called forward chaining, whereas teaching from the last step to the first step is called backward chaining. 4. PROMPTING AND FADING: A prompt is a form of temporary assistance given to help the student to perform a task in the desired manner. When the student does not perform a task, a prompt (temporary assistance) is used to help the student to perform the task, and as the student learns to perform the task, the prompt will be faded away from use. The different types of prompting commonly used are:Children with Special Needs: All That You Wanted to Know 105 a. Physical prompting, i.e. teaching the student by holding his/her hands or head or legs, etc. b. Verbal prompting, i.e, giving verbal instructions describing every step of the behaviour that has to be performed in order to complete the task. c. Gestural prompting, i.e. using gestures or actions to teach the child a particular task. d. Clueing, i.e. giving verbal hints to student to complete the task. e. Modelling prompting, i.e. teaching a task to the students by demonstrating the task. 5. MODELLING: It is a method of teaching by demonstration, when the teacher shows how a specific behaviour is to be performed. Modelling involves creating a situation in which the child naturally observes other children indulging in target behaviours and getting rewards for that behaviour. This will make the child repeat the same behaviour and earn rewards. TECHNIQUES FOR INCREASING DESIRABLE BEHAVIOUR It is natural for a human being to strive towards improving of oneself and aim at achieving a better quality of life. A systematic and appropriate use of learning principles helps one to achieve this goal by initiating, maintaining or increasing desirable behaviours by way of reinforcement. Reinforcers are basically two in nature: 1. POSITIVE REINFORCEMENT: Presenting a reward or giving pleasant stimulus in order to ensure that the desired behaviour occurs again and again. Thus, the behaviour is established or maintained because a reinforcer is delivered. However, a reinforcer for one person may not necessarily be a reinforcer for another person.106 2. NEGATIVE REINFORCEMENT: This is the removal of an aversive stimulus in order to ensure that the child behaves in the desired manner again and again. For example, some cars produce a beep sound till the door is not closed properly. By closing the door properly, the beep sound is removed or stopped. The removal or stoppage of the beep sound (unpleasant stimulus) increases the desired response of closing the car door. Negative reinforcement increases the probability of the desired response by the removing aversive stimulus. TYPES OF REINFORCEMENTS A close observation or study of an individual’s needs, desires and physiological state help to determine the types of reinforcement to be used. Many items or expressions can act as rewards for mentally challenged children. Basically, there are two types of reinforcers: 1. PRIMARY REINFORCER: This includes items that have a survival value for an organism, such as food, water or the termination of pain. Children do not have to be taught the behaviour for which these items act as_ reinforcers, expression of hunger and so on. Food like fruits, chocolate, snacks, nuts, drinks like coffee, milk, soft drink, juice are reinforcers for specific behaviour. 2. SECONDARY REINFORCER: These are neutral stimuli that initially have no value in themselves for an organism. Through paring with a primary reinforcer, the neutral stimulus becomes a reward. For example, using money to buy food. Secondary reinforcers have been classified into different categories. They are: a. Material Rewards: Any material liked by the child like, marbles, toys, kites, top, flowers, bindi, bangles, ribbons, ete.Children with Special Needs: All That You Wanted to Know 109 These schedules are as follows: 1. FIXED INTERVAL SCHEDULE: In this, a reinforcer is delivered after a specified interval of time, provided the required response has occurred at least once after the interval has elapsed. For example, rewarding at different times, the child who is given the task of writing, like after every two minutes, subsequently after three minutes and so on for writing appropriately. 2. VARIABLE INTERVAL SCHEDULE: In this, a reinforcer is delivered after a predetermined but varying interval of time, provided that the required response has occurred at least once after the interval. For example, rewarding a child who is given the task of folding paper for making cover after every fifth cover is folded appropriately. 3. FIXED RATIO SCHEDULE: In this a reward is delivered after a predetermined number of responses has occurred. For example, rewarding a child who is given the task of folding paper for making cover completely after the second cover, then again after the third cover, the sixth cover, and so on. 4, VARIABLE RATIO SCHEDULE: Here, the reinforcement is delivered after a predetermined but variable number of response has occurred. For example, rewarding a child who is given the task of folding paper for cover, for making the second cover, then for making the third cover, then for making the sixth cover, and so on. CONTINUUM OF REINFORCEMENT Continuous Reinforcement — Variable Reinforcement (interval or ratio) > Fixed Reinforcement (interval or ratio) — Fading.110 GUIDELINES FOR THE IMPLEMENTATION OF REWARDS Presenting the reward is as important as choosing the reward. Proper care needs to be taken to ensure that the skill or the behaviour being rewarded is desirable in nature. 1. Reward only desirable behaviour—those behaviours which are to be rewarded and those which are not to be rewarded should be decided before the teaching begins. 2. Clear and specific instructions must be given while rewarding certain behaviours in children. 3. The desired behaviour must be rewarded immediately in the beginning of the programme. 4. Reward target behaviour every time after it has occurred (refer continuum of reinforcements). 5. Reward in appropriate amount/quantity, not too little or too much. 6. Combine the use of social rewards along with other types of rewards. 7. Change/alternate rewards. 8. Fading of rewards—as a child acquires the behaviour, the rewards need to be gradually removed to make him/her independent, and the skill performance alone will be the reinforcer. BEHAVIOUR MODIFICATION FOR INCREASING DESIRABLE BEHAVIOUR Behaviour modification for increasing desirable behaviours in a mentally handicapped person is planned after a detailed assessment is carried out of his current level of functioning and the deficits and assets in the skill behaviour.image not availableimage not availableimage not availableimage not availableimage not availableimage not availableimage not availableimage not availableimage not availableaa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.image not availableimage not availableimage not availableimage not availableaa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa 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