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Complex Access or Significant Cognitive Disabilities

January 27, 2023

The Significant Disabilities program at Region One Education Service Center provides technical assistance and professional development to school personnel and parents to help all children succeed in school. Our ultimate goal is to help those in the "front lines" help those special learners achieve their potential.

Significant Disabilities Defined

Significant disabilities are also identified as “low-incidence” disabilities by the U.S. Department of Education (USDE.) Low-incidence disabilities are defined by the USDE as a visual impairment or a hearing loss, or a simultaneous visual impairment and hearing loss, a significant cognitive impairment, or any impairment for which a small number of personnel with highly specialized skills and knowledge are needed in order for children with that disability to receive early intervention services or a free appropriate public education. Children with low incidence disabilities comprise less than one-half of one percent of the school-age population. (NCLID, 2006)

The Texas definition of a student with a significant cognitive disability is a student who:

  • exhibits significant intellectual and adaptive behavior deficits in their ability to plan, comprehend, and reason, and ALSO indicates adaptive behavior deficits that limit their ability to apply social and practical skills such as personal care, social problem-solving skills, dressing, eating, using money, and other functional skills across life domains;
  • is NOT identified based on English learner designation or solely on the basis of previous low academic achievement or the need for accommodations; and
  • requires extensive, direct, individualized instruction, as well as a need for substantial supports that are neither temporary nor specific to a particular content area.

Medically Fragile Defined

The term “medically fragile” comes from a memorandum of understanding defining responsibilities for providing services to children who are medically fragile – October 27, 1994.

Medically fragile describes a student who:

  • has a serious ongoing illness or a chronic condition that has lasted or is anticipated to last at least 12 or more months or has required at least one month of hospitalization, and
  • that requires daily ongoing medical treatments and monitoring by appropriately trained personnel which may include parents or other family members, and
  • requires the routine use of a medical device or the use of assistive technology to compensate for the loss of usefulness of a body function needed to participate in activities of daily living; and
  • lives with ongoing threat to his or her continual well being.

Deaf-blindness Defined

The term deaf-blindness means concomitant hearing and visual impairments, the combination of which causes such severe communication and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness. Code of Federal Regulations 300.8(c)(2)

In meeting the criteria for deaf-blindness, the child with deaf-blindness is one who:

  • Meets the criteria for auditory impairment and visual impairment;
  • Meets eligibility criteria for visual impairment and has a suspected hearing loss that cannot be demonstrated conclusively, but there is no speech at an age when speech would normally be expected, as determined by a speech-language therapist, a certified speech and language therapist, or a licensed speech-language pathologist;
  • Has documented hearing and visual losses that, if considered individually, may not meet the requirements for auditory impairment or visual impairment, but the combination of such losses adversely affects the student's educational performance; or
  • Has a documented medical diagnosis of a progressive medical condition that will result in related auditory and visual losses that, without special education intervention, will adversely affect educational performance.
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