ACCORDING To even the most conservative estimates, at least a quarter of deaf children have additional disabilities. Most teacher preparation programs do not sufficiently prepare teacher candidates for the challenges posed by these children. This article describes a professional develcpment effort to prepare in-service educators of the deaf to work with students with additional disabilities. Over a 3-year period, teachers selected these in-service topics: etiologies, vision conditions, behavior, transition, sensory integration, seizures, alternate assessment, and instructional strategies. In-class consultation was requested for support in the areas of formal assessment instruments, behavior, and student performance. Elements of effective professional development programs, such as honoring teachers' choices about topics and participation, responding to teachers' immediate classroom concerns, and providing in-class follow-up support, facilitated the success of this effort.
A significant portion of the population of children who are deaf have addi- tional disabilities. The present article provides a comprehensive review of the literature on the incidence and nature of these additional disabilities. The challenge of addressing the unique needs of these children is discussed. Guidelines from various deaf organiza- tions that are intended to influence teacher education programs in deaf- ness and additional disabilities are shared. Finally, a 3-year effort with a learning community of experienced teachers of the deaf at Boston's his- toric Horace Mann School for the Deaf and Hard of Hearing is described. Teachers voluntarily participated in this effort, which included both in-service and classroom supports for the purpose of improving their ability to serve the growing number of deaf children with additional disabilities.
Children Who Are Deaf or Hard of Hearing With Additional Disabilities
Over the years, various terms have been used to describe children who are deaf with additional disabilities. These terms include multiply disabled deaf child, multihandicapped deaf child, and deaf with multiple disabilities (D'Zamko & Hampton, 1985; Vernon, 1982). These terms evolved into the current usage, children who are deaf or hard of hearing with additional disabilities (Moores, 2001). In the present article we use this latter term to describe these children, except when discussing children who have concomitant hearing and vision losses, whom we simply refer to as "children who are deafblind," in keeping with the federal definition of deafblindness (Miles & Riggio, 1998).
Additional disabilities occur in tandem with deafness because the causes of deafness sometimes lead to these additional disabilities as well. Hereditary deafness is less likely to result in additional disabilities than other causes, although a third of the hereditary causes of deafness may result in additional disabilities. Usher syndrome is a hereditary cause of deafblindness that is transmitted as an autosomal recessive trait (both parents are carriers). There are three types of Usher syndrome, each associated with a somewhat different (though possibly overlapping) range of hearing loss and a different onset and progression of vision loss. Most children with Usher syndrome are congenitally deaf or hard of hearing and gradually lose their peripheral and night vision (Moores, 2001). Usher syndrome is not associated with intellectual disability. Waardenburg syndrome is usually transmitted as an autosomal dominant trait. There are four major forms of Waardenburg syndrome, each with different characteristics, but all types have in common a moderate to profound hearing loss (National Organization for Rare Disorders, 2003; Waardenburg' s Syndrome, 2003). Approximately two thirds of children with Down syndrome, the most common hereditary cause of intellectual disability, also have hearing loss (Roizen, 2002).
In 1982, Vernon identified the causes of what was then called multihandicapped deafness. …