What percentage of students with disabilities do students with visual impairments account for

According to many studies around the world, the number of children with visual impairment and multiple disabilities accounts for a large proportion of the total number of visually impaired children (including children who are blind and have low vision). This article was researched on 206 visually impaired children aged 3-11 years studying at special educational centers of eight provinces in Vietnam such as: Hanoi, Ho Chi Minh, Da Lat, Hai Phong, Bac Ninh, Da Nang, Dong Nai, Lam Dong. The results showed that the percentage of visually impaired children accounted for 52.5% of the total number of visually impaired children. The degree of other disabilities associated with visual impairment is also different, mainly developmental disorders (visual impairment with autism spectrum disorder accounts for 49.5%, visual impairment with intellectual disability accounts for 24.75%). Children with visual impairment and hearing loss (deaf and blind) accounted for the lowest rate of 3.7%. Identifying exactly multiple disabilities that will help teachers and parents build individual educational plan suit of the child’s needs and abilities.

In the world, since the last years of the twentieth century, there have been many studies referring to the terms "children with multiple disabilities" and "children with visual impairment and multiple disabilities" like, Ann Silverrain. M (1984) 1, Pizzo, Lianna & Bruce Susan (2010) 2, Trief Ellen, Bruce Susan, Cascella & Paul (2010) 3; Nancy & Millie (2007) 4,… Studies have shown that children with multiple disabilities are children with two or more disabilities, this combination of disabilities requires specific intervention assistance, not just mechanical application of the methods reserved for individual types of disability.

Children with visual impairment and multiple disabilities have been mentioned by many national and international authors and summarized in the review section. Therefore, in this article we use the term Visual Impairment and multiple disabilities – VIMD, just like visually impaired children have other disabilities (Visual Impairment anh Additional Disabilities – VIAD) involves children with more than one type of disability with the primary form of disability being the visual impairment. In this view, children with visual impairment and multiple disabilities are visually impaired children with one or more additional hearing, developmental or physical disorders; the combination causes severe communication and developmental problems that prevent the child from being suitable for special education programs only for children with one of these types of disabilities 5.

According to the Statistical Report of the General Statistics Office in November 2018 on the results of the National Survey on People with Disabilities in Vietnam 6 from 2016 to 2017, children with disabilities (from 2-17 years old) account for 2.79% of the total population, in which children from 2 to 4 years old make up 2.74%, children 5 to 17 years old make up 2.81%; Boys with disabilities make up 3.00%, and Girls with disabilities make up 2.57%. Also according to this report, the rate of children with functional disabilities: hearing impairment 0.22%, visual impairment 0.15%, cognitive disability 0.74%, multifunctional disability 0.78%, communication 0.62% and most are neurological disabilities 2.21%. Also according to many other studies around the world, the number of children with visual impairments and other disabilities accounts for more than 50% of the number of children with visual impairments with single disabilities.

From the late twentieth century and early twenty-first century, Vietnam has started to pay attention to educating children with multiple disabilities in general and children with visual impairments in particular with the appearance of care and education centers for this group in big cities such as Hanoi, Ho Chi Minh, Da Nang, Hai Phong, Dong Nai, Lam Dong. However, the number of children with visual impairment and multiple disabilities attending school in Vietnam is still limited and this has a great impact on their care and education. There have been a number of Vietnamese authors researching the topic of children with visual impairment and multiple disabilities such as Hoang Thi Nho, Cao Xuan My 7, Pham Minh Muc 8, Nguyen Thi Hang 9, … However, the authors mainly research on teachers' difficulties in teaching children, children's characteristics, influencing factors, abilities and needs of children with visual impairment and multiple disabilities. Researches on the current situation of the proportion of children with visual impairment and multiple disabilities as well as types of disabilities associated with visual impairment have not been interested. Therefore, in this article, the author focuses on studying the situation of children with visual impairment and multiple disabilities in some inclusive and specialized educational centers in Vietnam to serve as a basis for building educational care programs for the target group 7.

2.1. Definition

According to the Code of Federal Regulations, 1999, people with multiple disabilities have a combination of two or more serious disabilities, eg, perception, movement, feeling. The definition of the US federal government, people with multiple disabilities includes people with more than one disability where the combination influences serious educational needs, which cannot be provided solely in programs special education for one of those deficiencies 5.

According to studies by Rosenberg, Westling, & McLeskey (2011), Children with multiple disabilities are children with significant limitations in learning, personal and social skills, and sensory development, some children may exhibit uncommon traits (self-stimulating or self-injuring behavior) and most have serious medical conditions 10.

The authors of Mastropieri & Scruggs (2014), Allman, C. B., Lewis, S. Spungin, A. J (2014) 11 have stated that: A child with multiple disabilities is a child with two or more physical defects that significantly affect the ability of individuals to learn and live in the absence of something. In environmental settings, this term does not include deaf and blind children. Children with multiple disabilities can have a combination of disabilities such as: speech language, motor, learning skills, intellectual disability, hearing loss, visual impairment and / or brain damage. Children with multiple disabilities have serious limitations in 5 main groups of domains such as intellectual function, adaptive skills, motor skills, sensory functions and language skills. The limited extent of these areas will affect each child's ability to learn 11.

The term "multiple disability" is often used to describe a child with more than one disability affecting participation in activities and learning. There are many different interpretations of the term "multiple disability". According to the Individuals with Disabilities Education Act (IDEA): “A child is considered to have multiple disabilities if the child has two or more disabilities that require attention to education. can not respond in the organized way for children with disabilities”. The term Visual Impairment and Multiple Disabilities (VIMD) is the same as for children with additional disabilities (Visual Impaitment anh Additional Disabilities – VIAD) refers to children with more than one type of disability is the visual impairment 5.

The study of the authors of Gates and Kappan (1985), Kirchner (1990), Rogow (1998) showed that visually impaired children with other disabilities accounted for about 49-60% of the total number of visually impaired children. According to the author Ashman (1994), visually impaired children with mobility impairments (including children with cerebral palsy) account for about 44% of the total number of children with visual impairment and multiple disabilities 5. Besides, Miller, Menacker, and Batshaw (2002) have studied and found that two-thirds of children with developmental disabilities will have additional visual problems.

Also regarding the number of children with visual impairment and multiple disabilities, in the study "A Review of Research on the Literacy of Student with Visual Impairment and Additional Disabilities" published in the Journal of Visual Impairment & Blindness, New York, Vol. 103, Iss 10, 2009, the authors Parker, Amy, Pogrund, Rona 12 conducted a study on children with visual impairments from birth to 22 years old in the United States and the results were: the number of children visually impaired children with other disabilities accounts for about 65 % of total visually impaired children (including children who are blind and children with low vision).

In the study of Grimmet, Eric S Summer, Sharon, Parker, 2008, Evidence – Based Communication Practices for Children with Visual Impairment and Additional Disabilities, Journal of Visual Impairment & Blind, New York 13, they studied on 202 children with visual impairment from birth to infancy, the results show that about 60% of these 202 children are accompanied by other disabilities such as hearing impairment, mobility impairment, and mental retardation and cerebral palsy.

According to Holden- Pitt & Diaz, 1998; Karchmer, 1985; McCracken, 1998, children with severe and profound hearing loss are more likely to have additional disabilities such as intellectual disability, autism spectrum disorder, visual impairment, learning disability, attention disorder, behavior and emotional or motor disability 5.

Boder, Christy & Bruce Susan (2015) in the study “Communication and Language in learners who are deaf and multiple disabilities”, American Annals of Deaf, Washington, Vol 160, Iss 4 14 have also found that children with multiple disabilities make up more and more of the total number of children with disabilities. In which, about 30-40% of children with hearing impairment have at least one or more accompanying disabilities, mainly visual impairment, intellectual disability, autism spectrum disorder and especially deafness and blind or others.

Besides, the authors Erin (1989), Alexander (1990) & Groenveld (1993) and Wiliiam Mac L & Lee, M (2002) 15 showed that the percentage of children with visual impairment and cerebral palsy accounts for about 80%, with epilepsy is 60%, hydrocephalus 20%, hearing impairment 10% and intellectual disability, autism is about 80%. Thus, the number of children with multiple disabilities including children with visual impairment and autism spectrum disorder is increasing in the group of children with visual impairments and the care and education for this group of children needs specific programs and methods.

In Vietnam, there is no research on the number of children with multiple disabilities, but only beginning to mention the term "children with multiple disabilities". According to a study by the Institute of Educational Sciences Vietnam in 2005 about the number of children with disabilities, Vietnam has about 150,000 children with visual impairment (including children with visual impairment and multiple disabilities), in which blind children accounted for about 15,000, the rest are the children with poor vision. There are 24.22% of the total number of children with disabilities attending classes, about 31% of the total number of visually impaired children go to school, and very few of them are children with visual impairment and multiple disabilities.

According to Rosenberg, Westling, & McLeskey (2011) 10, the identification of a child with multiple disabilities should begin with a medical diagnosis. Questions that need to be answered before educating a child include: (1) the student's current abilities in key areas including academic, social development, and physical and wellness needs; (2) What general curriculum goals are appropriate for the student, and to what extent and how the student may participate in the general curriculum; (3) Additional teaching areas to be implemented; (4) What services and related supports will be required to provide the child with an appropriate education.

Kelley (1998) highlights that 16 “Deaf-blindness is as varied as the etiology, level of vision and/or hearing loss, and the age of onset of both the sensory disabilities”. Following this definition, Deaf-blindness refers to the concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness” (Vaughn, Bos and Schumm, 2007, p.165). In Australia, the prevalence rates are now estimated as 10:100,000 (Ward, 1994, cited in Kelley, 1998). Also, there are over 70 known causes of deaf-blindness and these are usually split up into two main groups: acquire and congenital. Children with Deaf-blindness may be defined as having many different etiologies.

Deafblindness is a type of abnormal disability where the combination of both hearing and vision loss seriously affects a child's participation in activities. In the absence of combination of these two senses, deaf and blind children have significantly limited opportunities to learn knowledge and skills from the surrounding environment. Deaf-blind child's world shrinks, children seem isolated and extremely passive in participating in the activities 5.

Most deaf-blind children have multiple disabilities, severely affecting the development of cognitive, language, motor, communication and social interaction. Especially in communication problems, children have difficulty in hearing and seeing, so it is very difficult to choose means/tools to communicate with those around them. For deaf-blind children, communication and learning are mainly by touch

Impaired children with intellectual disabilities are children with impaired vision accompanying visual impairment and intellectual disability. The diagnosis of children with visual impairment associated with intellectual disability must comply with the prescribed visual impairment and intellectual disability level criteria (IQ less than 70 when using the IQ scale suitable for visually impaired children). All skills of children with visual impairment and intellectual disability in all areas of development: language, cognition, mobility, self-service, social skills,... are often significantly below average in their whole life 5.

A child with visual impairment and intellectual disability often has limitations in the ability to perceive environmental information, problems with sound recognition, recognize and memorize information, have difficulty understanding problems, processing information obtained from the surrounding environment. Children with visual impairment and intellectual disability thường often find it difficult to study and perform tasks in learning activities. It is estimated that about 3% of children have visual impairments and intellectual disability of those with disabilities 5.

Children with autism often have difficulty processing information through the senses. Children with visual impairments with autism will have a harder time understanding body language, gesture, and responding to external stimuli with verbal and non-verbal language 17.

To recognize a child with visual impairment with autism, attention should be paid to the signs 17:

+ Signs related to communication and social interaction: word repetition, failure to follow simple commands, limited ability to imitate and maintain conversation, poor eye contact.

+ Behavioral signs: stereotyped behaviors such as turning, tiptoeing, rocking, playing with only one object, lack of sensitivity or sensitivity to certain sensory stimuli,...

+ Other signs: stiffness in everyday activities, wanting to be alone, difficulty in perception of human existence or things, bad memory, limitation in using language,...

In addition to the above groups, there are also a number of other groups of children with multiple disabilities such as: children with visual impairments with language disabilities, mobility impaired children with hearing or visual impairments, children with learning difficulties with sensory disabilities. .

Cerebral palsy is a disorder that affects a child's mobility including movement, balance and posture. This condition occurs due to some brain damage or from a brain injury before, during birth or after birth. Types of injuries that can lead to cerebral palsy affecting a child's mobility are: infection, head injury during or after birth, brain damage due to poisoning, asphyxiation due to lack of oxygen, congenital malformation of feet, hands ...

Visually impaired children with mobility disabilities are a combination of visual impairments and mobility and movement defects of the muscles, joints, and bones. This combination leads to many difficulties in controlling and coordinating the body muscles, greatly affecting the areas of perception, language, communication, especially movement and participation. into learning activities. For children with visual impairments and mobility impairments, their ability to walk and explore their surroundings is limited. As a result, children have fewer opportunities to learn from their surroundings and interact with them. Lack of control of the muscles also limits the ability to make gestures, verbal language in communication and participation in activities. Most children with visual impairments and mobility impairments have problems with imitation, expression of needs, and implementation of self-service skills. For children with visual impairments and cerebral palsy, physical therapy and rehabilitation are very important to help children develop independent mobility. It is estimated that about 50% of children with cerebral palsy-related mobility disabilities who have difficulty controlling the eye and fruit muscles will experience squint, squint, and visual impairment 5.

Research was conducted in a number of care and education facilities for children with multiple disabilities in Vietnam to determine the ratio between children with visual impairment and multiple disabilities and children with visual impairments in general..

- Research on the rate of children with visual impairment and multiple disabilities compared to children with visual impairment in general.

- Study of the degree of disability associated with visual impairment

- Questionnaire survey: Questionnaires are sent to administrators, teachers and parents who have been supporting children with visual impairments to find out if they have additional disabilities.

- Interview method: Interviewing administrators, teachers and parents about issues related to children with multiple visual impairments.

- Method of mathematical statistics: using mathematical formulas to process the results obtained from the survey.

Study on 206 visually impaired children aged 3 years to under 11 years old studying in specialized centers in eight provices: Hanoi, Ho Chi Minh, Da Lat, Hai Phong, Bac Ninh, Da Nang, Dong Nai and Lam Dong.

+ About gender:

Through the above chart, it can be seen that out of 206 visually impaired children, the number of male children accounts for a higher rate (137 children, accounting for 65.5%); The proportion of girls is 69 children - accounting for 33.5%. This result shows that among children with visual impairment and multiple disabilities studied, boys are more likely than girls (Figure 1).

+ The level of visual impairment of children participating in the survey:

Among 206 visually impaired children, the rate of blind children (can distinguish between day and night) is quite high, 51.9% (107 children); children with poor vision are 74 children, accounting for 35.9%; the rest are totally blind (unable to distinguish between light and dark) children accounting for 12.2% (25 children). Thus, the above results show that the number of completely blind children accounts for the least percentage. Most children participating in the study were still able to distinguish between day and night. The study also showed that the number of children with low vision accounts for a large proportion of the total number of visually impaired children participating in the study (Figure 2).

2.4.5.1. Proportion of children with visual impairment and multiple disabilities among visually impaired children in surveyed areas:

The study on 206 visually impaired children aged 3 to 11 years old in special educational centers in Vietnam showed that: there are 109 visually impaired children with accompanying other disabilities (accounting for 52.5%) and the rest 97 children with only visual impairment, accounting for 47.5%. According to this result, the rate of children with visual impairment and multiple disabilities among the visually impaired children studied in Vietnam has similarities with some studies in the world. This ratio is clearly shown in Figure 3.

2.4.5.2. The proportion of disability types associated with the visual impairment

Among 109 children with visual impairment and multiple disabilities, the rate of visually impaired children with autism spectrum disorder accounted for the highest rate with 54/109 children, accounting for 49.5%; The percentage of visually impaired children with hearing lost accounts for the least 4/109 children, accounting for 3.7%. The remaining groups are the group of children with visual impairment with autism spectrum disorder and visual impairment with mobility impairment or other disabilities such as language and learning disabilities accounting for from 8.25% to 16.5% (Table 1). Thus, it can be seen that the proportion of children with visual impairment accompanied by developmental disorders accounts for a large proportion in the group of children with multiple visual impairments and multiple disabilities. Through interviews with teachers and school administrators, it is still difficult to distinguish children with multiple visual impairments. The teachers mainly accept the assessment results of medical institutions on the degree of visual impairment and other associated impairments such as hearing impairment, mobility disability, intellectual disability and autism spectrum disorder. For developmental disorder-related disabilities, a combination of different rating scales is needed to determine whether the child belongs to an intellectual disability or an autism spectrum disorder. Ms. Đ.T.T.T shared: “identifying defects associated with visual impairment will be the basis for teachers to make appropriate adjustments to organizing activities for children”. Since then, dren with multiple visual impairments and multiple disabilities can also integrate with other children at school.

The rates of disabilities associated with visual impairment are shown in Figure 4.

According to studies around the world, children with visual impairment and other disabilities account for 45-60% of the total number of visually impaired children. Thus, the research results of this article on the rate of children with multiple visual impairments in some Vietnamese educational care centers are similar to those in the world. However, the study just stopped at 3-11 years old and the number of visually impaired children participating in the survey was small (mainly children who were attending specialized educational institutions in 8 provinces of Vietnam). Currently, many children with visual impairment and other disabilities do not have access to care facilities and education, mainly children are at home. This group of children has not been surveyed by the study author. If the number of children not attending school were also surveyed, the results would be more effective.