Educating people with profound intellectual and multiple disabilities (PIMD)creates a number of challenges. One general challenge relates to identifying and successfully implementing instructional programs for developing and enhancing the person's adaptive behavior, such as teaching communication and social skills and increasing their overall level of engagement. The purpose of this chapter is to provide an overview of three main instructional approaches that have been applied to enhance engagement and adaptive behavior functioning among people with PIMD. These approaches are (1) intensive interaction, (2) systematic instruction, and (3) assistive technology. Two case studies are included to illustrate the use of assistive technology—specifically augmentative and alternative communication devices and micro-switches—with two adolescents with PIMD. This overview and the case studies suggest that the use of systematic instructional tactics to establish functional use of assistive technology can be an effective instructional approach for people with PIMD.
TopBackground
The term PIMD describes a population that presents with severe to profound intellectual disability and significant physical impairment (Bellamy, Croot, Bush, Berry, & Smith, 2010; Maes, Lambrechts, Hostyn, & Petry, 2007). Such individuals also often have additional sensory impairments, such as limited sight and impaired hearing. They may also have serious health problems, such as having seizures and requiring tube feeding or ventilation.
The combination of intellectual and physical impairments can severely restrict the person’s learning and the acquisition and performance of communication, self-care, daily living, academic, social, and recreation/leisure skills. The presence of additional sensory and/or medical problems can further complicate instructional efforts and, in turn, their overall level of functioning and quality of life (Gulati & Sondhi, 2018). An additional factor complicating educational efforts is the observation that many such individuals often appear to be passive and seemingly under-responsive to learning opportunities and environmental stimulation (Arthur, 2003; Arthur-Kelly, Foreman, Maes, Colyvas, & Lyons, 2018). Furthermore, persons with PIMD present with very little or no speech and language development. The lack of responsivity and limited speech and language are likely to severely limit their ability to interact with others and their engagement in meaningful social activity (Atkin & Lorch, 2014; Belva, Matson, Sipes, & Bamburg, 2012; Greathead et al., 2016; Lancioni et al., 2019; Schweigert, 2012).