Low-Incidence and High-Incidence Disabilities

Abstract

The categories of student disabilities are known as low-incidence and high-incidence. Low-incidence (LI) disabilities are rare, and high-incidence (HI) disabilities, which are more common, occur in about 1 in 10 school-age children. The number of students labeled with a disability has increased 151 percent in the past 20 years, partly as a result of the increased survival rate of premature babies, who are 2-3 times more likely to have HI disabilities such as learning disabilities (LD) and attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). While it is relatively easy to identify students who have LI disabilities, HI disabilities are harder to assess. If evaluation comes too late, there is a missed opportunity to prevent or at least reduce the impact of the disability on the child. Two ways that students are assessed for HI disabilities are (a) the aptitude-achievement model/IQ discrepancy approach and (b) response to intervention.

Overview

Although the Individuals with Disabilities Education Act (IDEA, 2004) lists thirteen separate disability categories (Table 1), students with disabilities are generally viewed as belonging to one of two overarching groups: low incidence disabilities (LI) or high-incidence disabilities (HI). LI disabilities are rare, and do not exceed 1 percent of the school-aged population at any given time (U.S. DOE, 2003); whereas HI disabilities comprise about 10 percent of all children in public schools.

According to the U.S. Department of Education, examples of LI disabilities include sensory impairments such as blind/low vision and deaf/hard of hearing, physical, and neurological disabilities such as orthopedic impairments, other health impairments, traumatic brain injury, autistic spectrum disorder, and developmental disabilities such as moderate to severe intellectual disability. Examples of HI disabilities include learning disabilities (LD), attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), speech and language issues, emotional/behavioral disturbances, mild intellectual disability, and developmental delays. Gifted/talented students are sometimes included in the HI category because they, too, require instructional modifications to meet their learning needs. When students identified as gifted also happen to have a disability, they are termed "twice exceptional."

History. In the U.S., special education originated in the early 1800s as a specific area of practice. By 1948, however, only 12 percent of students with disabilities received special education services (McLeskey & Landers, 2006). It was not until "widespread federal involvement in the 1960s and 1970s that most students with disabilities received special services" (p. 68). During this time, HI disabilities often went unrecognized and students with LD and ADD/ADHD remained in the regular classroom without special services, while students with LI disabilities tended to be served outside the regular classroom in special schools or self-contained settings for all or part of their school day.

Jackson (2005) explains that, "in the mid-1970s, Congress voted to ensure that no child, regardless of extent of disability, could be denied a free, appropriate, and public education (FAPE) in the least restrictive environment. At that time, an 'appropriate' education meant a special education—one that was individually designed to address the needs that resulted from the disability" (p. ix). The hallmark of this legislation was the Individualized Education Plan (IEP), specifically designed by a team of educators for each student with an identified disability.

While the IEP is still in place today, its emphasis has shifted away from designing a separate curriculum with separate learning objectives toward providing access to the general curriculum through modifications and accommodations. Law as stated in the Individuals with Disabilities Act (IDEA, 2004) mandates "that no child may be denied access to the general education curriculum—specifically, the curriculum that schools and school districts make available to all non-disabled students" (Jackson, 2005, p. ix). Equal access to the general curriculum implies that all students have the right to strive for the same educational goals. "Equal opportunity implies that accommodations are in place to remove or minimize the impact of disability on authentic performance, thus leveling the playing field" (Jackson, 2005, p. ix).

Statistics. The number of students labeled with a disability has increased 151 percent since 1989 (Ysseldyke, 2001). This increase may be attributed to the higher survival rate of significantly premature infants and advances that improve recognition of genetic and neurological factors that contribute to LI disabilities. For HI disabilities, the rate of LD and ADHD in premature infants is 2 to 3 times higher than in the overall population (US DOE, 2002). The U.S. Department of Education reports that "in the past 10 years, the largest increases in students identified for special education services were for the Other Health Impairment (OHI) category (319 percent), the orthopedic impairment category (45 percent) and the learning disabilities category (36 percent). Some of the exponential growth in the OHI category is the result of an increase in children identified as having ADHD, where a physician's signature is generally sufficient to trigger the eligibility process" (US Dept. or Education, 2002, p. 23).

In the United States, "22 percent of students with disability labels fail to complete high school, compared to 9 percent of students without labels" (Frattura & Capper, 2006). Less than 50 percent of students with LI disabilities graduate from high school with a diploma while about 20 percent receive a certificate of attendance (National Center for Education Statistics, 2005). Nearly "1 in 5 youth with disabilities out of school 3 to 5 years are not employed and are not looking for work, whereas 69 percent of young adults from the general population" find employment in the first few years out of school (Frattura & Capper, 2006, p. 356). In the 18 to 24 age bracket, only 31 percent percent of people with disabilities in the United States are employed, compared to 85 percent percent of those without disabilities (Houtenville, 2003). Not only do students with disabilities have difficulty securing employment, they are over-represented in the prison system—31 percent of state inmates and "23 percent of Federal inmates report having some type of disability; i.e., speech, learning, hearing, vision, physical, or cognitive" (National Center on Low-Incidence Disabilities, 2006).

Further Insights

Identification for Services. Since most children with LI disabilities possess sensory, motor, or neurological deficits, they are typically identified early in their lives and managed through a medical model. In contrast, children with HI disabilities such as LD and ADD/ADHD may be difficult to identify until they reach school age and begin to show signs of learning difficulties in the classroom. In 1997, during the "process of reauthorizing IDEA, the National Joint Committee on Learning Disabilities wrote a letter to the U.S. Office of Special Education Programs expressing concern that neither early nor accurate identification of HI disabilities—specifically, learning disabilities—was occurring" (Bradley, Danielson, & Doolittle, 2007, p. 8). Although there are controversies surrounding the identification process, educators agree that early intervention is key to preventing disabilities or at least ameliorating their impact in children who develop them (Jackson, 2005).

In general, SPED (special education) eligibility decisions are based on (a) whether a child is determined to have a condition (i.e., meets the criteria for one of the IDEA disability categories), and (b) whether the child has a demonstrable educational need (i.e., has difficulty learning or adapting to the school environment). It is pointless and costly to label a child with a disability if s/he is performing at grade level and does not need accommodations.

When identifying children with HI disabilities, a typical course of action is for a classroom teacher to refer the child for evaluation to determine if s/he qualifies for special services under IDEA. Evaluation is typically carried out by a school psychologist, psychometrician, or qualified special educator. Identification is typically made through a combination of teacher and parent checklists, pediatrician evaluations, classroom observation, grades, standardized achievement tests, and IQ tests. The pediatrician plays an influential role in whether a child is identified as ADD/ADHD. Sometimes a drug such as Ritalin is prescribed to see if the child improves her/his ability to concentrate on learning; the child's response to the drug contributes to the identification process.

Identifying and labeling children for special education services is a very sensitive matter. Some parents do not want their children to be identified as having HI disabilities because of the fear of stereotyping, stigma, and lowered expectations. Conversely, some parents want their children to be identified so that they can benefit from free public services. Understandably, parents are conflicted about whether to put their children on long-term drugs. From an educational standpoint, schools may be reluctant to qualify students with mild disabilities for services because special programs cost 130 percent more than general education. That is, if a school district spends $5,000 per student, a child labeled for SPED costs the district $11,500 per year (Frattura & Capper, 2006). While increased funding is not related to the number of children identified with LI disabilities, it does result in increased identification rates for HI disabilities. Increases in SPED funding do not seem to result in improvements in the quality of SPED programs (US DOE, 2002).

The Aptitude-Achievement Model. Typically, in order for children to be identified with a HI disability such as LD, the evaluation must reveal a discrepancy between their learning potential (as measured by an IQ test) and their academic achievement (as measured by standardized tests and grades). In other words, is the child living up to her/his assumed potential in the classroom? If there is a significant discrepancy, then the child is considered to have LD. If there is not a significant discrepancy between the child's IQ and achievement, s/he is considered a "slow learner" and usually does not qualify for special services.

The IQ discrepancy model, or aptitude-achievement model, is controversial for a host of reasons. Foremost is the widespread criticism that IQ tests are culturally biased (US DOE, 2002), which results in an overabundance of minority students qualifying for SPED. In addition, the IQ model sets an arbitrary cutoff that may vary from school to school, district to district, and state to state. Another problem arises when a student, for whatever reason, does not perform well on the tests, which are often administered in one sitting by a stranger. Reliance on the discrepancy approach can also result in students with LD not being identified until they have experienced multiple years of failure (Bradley, Danielson, & Doolittle, 2007). Clearly, no single test can determine eligibility for SPED, especially in the case of HI cognitive disabilities, which are invisible to the naked eye.

Response to Instruction/Intervention (RTI). Although many school districts still rely on the IQ discrepancy model for identification of students with LD, the "2004 reauthorization of IDEA removed the longstanding federal requirement to apply the aptitude-achievement discrepancy" and it permits response to instruction (RTI) to be used as an alternative "approach for identification" (Bradley, Danielson, & Doolittle, 2007, p. 9).

The Department of Education reported that a major part of the RTI identification process, especially to establish education need and make this decision less subjective, is a careful evaluation of the child's response to instruction. From this perspective, "children should not be identified for special education without documenting what methods have been used to facilitate the child's learning and adaptation to the general education classroom. The child's response to scientifically based interventions attempted in the context of general education should be evaluated with performance measures, such as pre- and post-administration of norm-referenced tests and progress monitoring. In the absence of this documentation, it is possible that many children who are placed into special education are essentially 'instructional casualties' and not students with disabilities" (US DOE, 2002, p. 25).

RTI has been conceptualized as a multi-tiered prevention model. The first tier "consists of high-quality, research-based instruction in the general education setting, universal screening to identify at-risk students, and progress monitoring to detect those students who might not be responding" (Bradley, Danielson, & Doolittle, 2007, p. 9). The next levels differ in intensity (i.e., duration, frequency, and time) of the research-based interventions being delivered, the size of the student groupings, and the skill level of the service provider. It is generally agreed that 8 weeks is adequate to demonstrate the response or lack of response of a student to a well-matched evidence-based intervention. The final level consists of "individualized and intensive interventions and services, which might or might not be similar to traditional special education services. In most models, the lack of appropriate response to the more intensive and more individualized research-based instruction at this final tier results in referral for a full evaluation for special education eligibility" (Bradley, Danielson, & Doolittle, 2007, p. 9).

Viewpoints

Service Delivery & Settings. In addition to the debate surrounding how and when schools should identify children for special education services, there is heated controversy regarding where these services should take place and what they should entail. Location and type of services is termed "service delivery" or setting. Historically, students with disabilities, especially those with LI disabilities, were served in special schools or in self-contained classrooms without mingling with their typically-achieving peers. Except in the most severe cases, the current trend is toward a more inclusive education model, in which students with disabilities are integrated with their peers during as much of the school day as is feasible. According to recent statistics, 93.6 percent of students with disabilities spend at least part of the school day in a general education classroom—an average of 4.8 hours per day (Bradley, Danielson, & Doolittle, 2007).

For several decades, public schools have used a cross-categorical approach to educating students with HI disabilities, often placing students with LD, ADD/ADHD, mild intellectual disability, and emotional disturbances in the same classroom. While these types of students may share some similar social needs, they display considerably different cognitive and behavioral profiles. Even in an ideal world in which there were sufficient funding, instructors, and space, instructional grouping based on a single disability label is educationally unsound because every student has different learning needs, regardless of disability category (Sabornie, Evans, & Cullinan, 2006). One study found that students with emotional disturbances "who were taught in self-contained settings reported a significantly higher use of both alcohol and illegal drugs than either students with LD or students with emotional disturbances served in less restrictive settings" (Sabornie, Evans, & Cullinan, 2006, p. 100).

Numerous educators and researchers have noted that children with special needs benefit from learning alongside their peers because peers can serve as positive role models for social, behavioral, and academic performance. Typically-achieving peers also benefit from exposure to children who learn differently, thus enhancing their awareness and tolerance of diversity. According to Frattura & Capper (2006), educating students in inclusive education environments "results in higher academic achievement and more positive social outcomes for students with and without disability labels, not to mention that it is the most cost-effective way to educate students" (p. 357). Conversely, segregated education settings may "reinforce negative assumptions about students and teaching and learning, and not only does this model not build teacher capacity, it breeds teacher and student dependency" (p. 360).

Although the trend toward inclusive education has many benefits, it also has drawbacks. This model can cause classroom management issues and may place additional responsibility on the classroom teacher to modify instructional methods, materials, and assessments. Full inclusion may not be suitable for all students with severe LI disabilities. For students with significant developmental delays or multiple disabilities, classroom accommodations alone may be neither sufficient or appropriate. Even in a pull-out model, in which students spend part of their school day in a self-contained classroom and part in the regular classroom, valuable instructional time is lost during transitions, which can be disorienting and disruptive. For a variety of reasons, there are cases in which the least restrictive environment for students with LI disabilities cannot be found in their local public school. Thus, for some learners, especially those in rural areas, "the true path toward greatest access to the general education curriculum may be pursued more appropriately in a separate setting—for example, in a school for the deaf or a residential school for the blind" (Jackson, 2005, p. 13).

Identification Testing. Because psychometric tests such as IQ tests have questionable value, are extremely expensive to administer, and do not inform instruction, some educators recommend eliminating them altogether, thus shifting the focus away from eligibility determination and toward ensuring that all students, regardless of disability, receive the services that they need in order to succeed in school (US DOE, 2002). In other words, instead of spending valuable time and money deciding who qualifies for SPED, spend the resources on providing a quality education for all. However, this view is also contentious. Some special educators fear that people are trying to abolish special education in favor of inclusive education models. This would disadvantage some students, especially those with severe LI disabilities, who will always need special services in order to learn functional life skills. These children may benefit greatly from participating with their peers during lunch, recess, art, or music, but would be inadequately served if they did not spend a portion of the school day receiving individualized instruction in personal care, mobility, communication, and so on.

Recommendations. The President's Commission on Excellence in Special Education Report states that "the current approach to all HI disabilities needs to shift from a failure model to a prevention model" (US DOE, 2002, p. 25). The practice of waiting to provide intervention until a child fails is "analogous to parking an ambulance at the bottom of a cliff to assist people who fall off the cliff.… Traditional eligibility determinations are like the ambulance at the bottom of the cliff—students are placed in them after they fail academically, socially, or behaviorally" (Frattura & Capper, 2006, p. 358). The Commission recommends the following four shifts in practice:

• Identify and Intervene Early. Implement research-based, early identification and intervention programs to better serve children with learning and behavioral difficulties at an earlier age. Include early screening, prevention, and intervention practices to identify academic and behavioral problems in young children.
• Simplify the Identification Process. Simplify the IDEA identification and eligibility determination process, and clarify the criteria used to determine the existence of a disability, particularly high-incidence disabilities.
• Incorporate Response to Intervention. Implement models during the identification and assessment process that are based on response to intervention and progress monitoring. Use data from these processes to assess progress in children who receive special education services.
• Incorporate Universal Design in Accountability Tools.

Ensure all tools used to assess students for accountability and the assessment of progress are designed to include any accommodations and modifications for students with disabilities (US DOE, 2002, p. 20).

Beckman (2001) also provides a list of guidelines for providing education for students with special needs:

• Responsibility for the learning outcomes of special education students is equally shared by the classroom teacher and the special education teacher.
• The classroom teacher is not only aware of the student's IEP goals, but plays a significant role in determining those goals and providing instruction to help the student reach them.
• Collaboration is valued: Time is allocated for teachers to collaborate with other teachers and parents regarding students.
• Expectations are not set according to a student's classification; it is recognized that a classification does not determine how much or how well the student will learn or perform.
• It is understood that good instruction incorporates variation in delivery, activities, expectations, and assessment to accommodate diverse learning strengths and needs.
• Accountability is considered a challenge, not a threat. As required by IDEA '97, students with disabilities are included in state and district assessments.
• Parents are considered to be part of the team (www.cec.sped.org).

In sum, "many of the diagnostic and prescriptive approaches of the past have resulted in practices in which the least capable students receive less curricula. An alternative approach to understanding student learning difficulties arises when assessments are applied to a school itself, or, more particularly, to a school's curriculum, instead of to students" (Jackson, 2005, p. vii). Historically, public schools have dealt with student failure in similar ways—by blaming the student for not fitting into a predetermined mold. Current trends are turning the process on its head by redesigning curriculum so that it reaches the widest variety of students possible rather than trying to retrofit an inflexible curriculum to each type of learner who passes through the school doors (Jackson, 2005). This type of curriculum is termed universally designed, in which the curriculum is created to fit the students, rather than the other way around (Rose & Meyer, 2002).

Terms & Concepts

Access to the General Curriculum: The notion that students with disabilities should, whenever possible, participate in the same core curriculum (e.g., math, language arts, social studies, science) as their peers rather than being taught in a specialized class with different learning objectives.

Aptitude-Achievement Model: A method of determining eligibility for special education services that compares students' IQ versus their academic performance.

High-Incidence Disabilities: Disabilities that occur somewhat frequently in the K-12 population, such as learning disabilities, ADHD, and mild intellectual disability. Antonym: Low-incidence disabilities.

Inclusive Education: A model of education in which students with special needs are integrated into the regular classroom as much as possible. Antonym: Segregated education.

Individuals with Disabilities Education Act (IDEA): A law passed in 1997 and reauthorized in 2004 that is designed to protect the rights of people with disabilities and mandates how, what, and where students with identified disabilities should be taught.

Individualized Education Plan (IEP): A set of specific instructional objectives created by a team of educators based on a thorough evaluation of an individual student's needs who qualifies for special education services. IEPs are typically updated every 1 to 3 years.

Least Restrictive Environment: The concept that students with disabilities should be educated in the same environment as their non-disabled peers as far as is reasonably possible. A restrictive environment, therefore, is any learning space that does not fully allow interaction with non-disabled peers. By law, students who have disabilities are entitled to a free appropriate public education (FAPE) in the least restrictive environment, provided by the public schools.

Low-Incidence Disabilities: Disabilities that occur very rarely in the K-12 population, such as blind, low vision, deaf, hard of hearing, mobility-impaired, or multiple disabilities. Antonym: High-incidence disabilities.

Response to Intervention: An alternative approach for determining eligibility for special education services based on students' response to early and intensive instruction.

Segregated Education: A model of education in which students with special needs are taught in a separate classroom or school from their typically-achieving peers. Antonym: Inclusive education.

Teacher Capacity: Increasing teachers' knowledge of a wide range of subjects, including how to design for and deliver curriculum to students with special needs.

Bibliography

Beckman, P. (2001). Access to the general education curriculum for students with disabilities. Council for Exceptional Children. Retrieved November 20, 2007, from https://eric.ed.gov/?id=ED458735 5

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Crepeau-Hobson, F., & Vujeva, H. (2012a). Assessment of cognitive ability of students with severe and low-incidence disabilities - Part 1. Communique (0164775X), 41, 12-13. Retrieved December 19, 2013 from EBSCO online database Education Research Complete. http://search. ebscohost.com/login. aspx?direct=true&db=ehh&AN=832 91118&site=ehost-live

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Frattura, E., & Capper, C. (2006). Segregated programs versus integrated comprehensive service delivery for all learners: Assessing the differences. Remedial & Special Education, 27, 355-364. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login. aspx?direct=true&db=e hh&AN=23174860&site=ehost-live

Houtenville, A. J. (2006). Disability statistics in the United States. Ithaca, NY: Cornell University Rehabilitation Research and Training Center. Retrieved November 20, 2007, from http://www.disabilitystatistics.org.

Individuals with Disabilities Education Improvement Act of 2004, P.L. 108-446, 20 U.S.C. §1400 et seq.

Jackson, R. M. (2005). Curriculum access for students with low-incidence disabilities: The promise of Universal Design for Learning. Wakefield, MA: National Center on Accessing the General Curriculum. Retrieved November 20, 2007, from http://www.cast.org/publications/ncac/ ncac%5Flowinc.html.

McLeskey, J., & Landers, E. (2006). Classic articles in special education. Remedial & Special Education, 27, 68-76. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=20081078 &site=ehost-live

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Ysseldyke, J. (2001). Reflections on a career: 25 years of research on assessment and instruction decision making. Exceptional Children, 67, 295-309.

Suggested Reading

Fuchs, L., & Fuchs, D. (2007). A model for implementing Responsiveness to Intervention. Teaching Exceptional Children, 39, 14-20. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=t rue&db=ehh&AN=25204849&site=ehost-live

Idol, L. (2006). Toward inclusion of special education students in general education. Remedial & Special Education, 27, 77-94. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&A N=20081079&site=ehost-live

Kurth, J., Gross, M., & Lovinger, S. (2012). Grading students with significant disabilities in inclusive settings: Teacher perspectives. Journal of the International Association of Special Education, 13, 41-57. Retrieved December 19, 2013 from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=t rue&db=ehh&AN=86730011&site=ehost-live

Murray, C., & Greenberg, M. (2006). Examining the importance of social relationships and social contexts in the lives of children with high-incidence disabilities. Journal of Special Education, 39, 220-233. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/ login.aspx?direct=true&db=ehh&AN=19405131&site=ehost-live

Okolo, C., Ferretti, R., & MacArthur, C. (2007). Talking about history: Discussions in a middle school inclusive classroom. Journal of Learning Disabilities, 40, 154-165. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=24186427 &site=ehost-live

Rude, H., Jackson, L., Correa, S., Luckner, J., Muir, S., & Ferrell, K. (2005). Perceived needs of students with low-incidence disabilities in rural areas. Rural Special Education Quarterly, 24, 3-14. Retrieved November 20, 2007, from EBSCO online database Education Research Complete. http://search.ebscohost.com/login.asp x?direct=true&db=ehh&AN=18378565&site=ehost-live

Spooner, F., & Browder, D. (2003). Scientifically based research in education and students with low incidence disabilities. Research & Practice for Persons with Severe Disabilities, 28, 117-125.