Tips for Teaching Students with Multiple Disabilities

March 20, 2021 21 min read

In this two-part series, Emma Haring and I discuss tips for teaching students with Multiple Disabilities. Emma has been a teacher in this type of class (we called it a medically fragile class in our district) for many years. She has a ton of experience and wisdom that she shares generously! In Part 1 (Episode 25), she gives a lot of tips on how to what your students like and dislike, how to care for them as people, and how to give them a voice (even if they are nonverbal). Pre-service, new, and even veteran teachers will want to have a paper and pen nearby to take notes!

Then be sure to join us again for Part 2 (Episode 26), which will focus more on the daily schedule and some of Emma’s favorite things to teach this population. Emma has also prepared a supplement to go with the episode, which includes sample schedules and other goodies.

Many terms for multiple disabilities are used in Special-Education-Land depending on where you live. So I want to briefly talk about the term multiple disabilities. Depending on where you are located, you may or may not use “multiple disabilities” to describe a classroom or disabling condition. To prove my point, I asked special ed teachers in a special education Facebook group how the term is used where they teach. Below are all the answers I received!

  • MPC – Medical and Physical Challenges
  • Medically Fragile Class
  • MD – Multiple Disabilities
  • MDS – Multiple Disabilities Support
  • MDO – Multiple Disabilities, Orthopedic
  • MDS – Multiple Disabilities, Severe
  • MDS – Multiple Disabilities Supports: Students with complex bodies and complex communication needs
  • SPMD – Severe-profound multiple disabilities
  • SXI- Severe Multiple Impairments 
  • SID/PID -Severe Intellectual Disability /Profound Intellectual Disability
  • LSS – Life Skills Support

“Multiple Disabilities” showed up the most, so I chose that term for the title! However, I am not using that term in the legal sense (Multiple Disabilities will have different legal definitions across the nation).

What are multiple disabilities? Again, that answer can vary. Below are some components to this disability which can affect student performance at school:

  • Motor impairment (i.e. movement)
  • Communication impairment (i.e. moderately to completely nonverbal)
  • Sensory loss (i.e. legally blind, moderate/profound hearing loss)
  • Fatigue
  • Cognitive impairment
  • Complex physical and/or medical needs (sometimes called medically fragile)

Please note that there can be students with one or more of the above components and that would never automatically make them eligible for a certain class setting. Everything depends on the student’s unique situation and IEP team determination.

Now let’s get into the interview with Emma. I am thrilled that she gets to share all her tips for teaching students with multiple disabilities. Listen or below or scroll down to the end for the written transcript.

Episode 25 Show Notes

Guest: Emma Haring

Emma Haring is a retired special educator whose career was over 29 years. She started out as Substitute paraprofessional in a Deaf/Hard of Hearing classroom while working on her teaching credential. Over the years she has taught elementary, junior high/middle school, high school, and adult transition students, sometimes with all those ages in the same class! For a significant portion of her career, she worked with students who had complex health issues and were medically fragile.

Resources and Links

Here are a few other special education terms used in this series:

  • Para – Refers to a special education para-professional (also sometimes calls para-educators or aides) that helps in the classroom.
  • OI teacher: Orthopedic impairment teacher
  • OT: Occupational therapist

Important Note about my FACEBOOK account: I got hacked by scammers and no longer have control of my Facebook Group “Help for Special Educators,” Lisa Goodell Equip Page, or my personal page. Please leave the group, and unfollow/unfriend the page. (I have started a new Facebook just for my art/stamping.)

Thank you to all my listeners for spreading the word, this podcast has been heard in over 50 countries! Click here to view and zoom in on the map.

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Disclaimer: The views expressed, and resources/links provided on this podcast are that of each guest and do not always represent the views of this podcast or the host. In addition, each listener is encouraged to research all strategies, lessons, curriculum, etc. before using them with students to be sure they are in line with their beliefs, their school district policies, etc.

About the Host

Lisa Goodell, helping to assemble robot kits for Texas students.

Lisa Goodell, M.A., launched the “Help for Special Educators” Podcast on April 1, 2019. She has taught for over 25 years, including third grade, resource/inclusion (RSP), and mild/moderate self-contained (SDC). Currently, she is an itinerant orthopedic impairment (OI) specialist/teacher for students birth to 21 years old in all general ed and special ed settings.

Lisa has a master’s degree in special education and six special ed and general ed teaching credentials. She has been honored as “Teacher of the Year” at both the elementary and secondary levels. She lives in rural Central California with her family and a bunch of cats.

Check out her TeachersPayTeachers store, “Lisa Goodell.” You can also get more information by listening to the beginning of Episode 1.


NOTE: An artificial intelligence transcription service converted the audio file of this podcast episode into the written words below. The file is mostly accurate, however, be aware that spoken words and conversations are not the same as a conversation in a magazine article or novel. This means that will be some inaccuracies or accidental errors (i.e. missing punctuation, missing words, etc.). I do proofread it and correct some things, but thank you for your patience and grace since I’m sure there are parts that the AI and I both miss.

Tips for Teaching Students with Multiple Disabilities

Lisa (00:00):

Episode 25: Tips for teaching students with multiple disabilities.

Do you ever find yourself barely able to hold your head above water waves of IEP data collection assessments, parent conferences, not to mention lesson plans and seasonal activities are all crashing around you. You need help, but not just from anybody. Grab the lifeline that is the Help for Special Educators podcast. We will equip you with creative solutions and teacher-tested strategies. So you can navigate the rewarding, but difficult job as a special ed teacher. This is Lisa Goodell, your host

Lisa (00:54):

In this two-part series, we will discuss tips for teaching students with multiple disabilities. Before I get into my interview, I want to briefly talk about the term multiple disabilities. Depending on where you are located, you may or may not use that term to describe a classroom or a disabling condition. I asked special ed teachers in a special education Facebook group how the term is used where they teach. Here are the answers I got back. (I’ll state the words first, then the abbreviation, if one was given.):

  • medical and physical challenges or MPC,
  • medically fragile class (no abbreviation given),
  • multiple disabilities or MD. And there’s lots of variations of that.
  • multiple disability support MDS,
  • multiple disabilities orthopedic MTO,
  • multiple disabilities, severe,
  • severe profound, multiple disabilities, or SPMD,
  • severe multiple impairments,
  • severe intellectual disability/profound intellectual disability. So that’s SID/PID,
  • And life skills support LLS.

So you can see that the term multiple disabilities showed up the most. So that’s the term that I chose. Multiple disabilities was also used a lot in my textbooks for when I got my credential. What are multiple disabilities? Again, the answer can vary. Here are some components to this disability that can affect student performance in school:

  • Motor impairment: The student is going to have trouble with some type of movement, whether that is upper body, lower body, hands, fine motor, gross motor, students might not be able to walk or stand. They might use mobility devices, such as a wheelchair, a walker, or a stander.
  • Also it can impede communication, and that usually would mean moderately to completely nonverbal (so it’s going to be more than an articulation loss).
  • Sensory loss, which could be perhaps the student is legally blind. They might have a moderate or profound hearing loss, or be deaf.
  • Another common thread with multiple disabilities would be, they might have a lot of fatigue. They’re not going to have a lot of stamina as far as standing walking, concentrating, etc.
  • Cognitive impairment is another component.
  • And the last term kind of covers a lot of things would be complex, physical and or medical needs. Sometimes the term medically fragile is used.
Tips on Teaching Students with Multiple Disabilities

But please note too, that there can be students that have one or more of those components that would not actually be eligible for a specific class setting for medically fragile or multiple disabilities. Everything depends on the student’s unique situation and the IEP team determination. So if you’re ever out in public and you see someone who may have one or more of those components, don’t just assume that they cannot talk or they don’t understand what’s happening. You always want to give someone the benefit of the doubt. Basically, we probably underestimate how much a person understands when they have some type of physical disability. I hope that introduction helps some of you who this topic might be new to. So let’s go to the interview today.

Lisa (04:33):

I’m speaking with Emma Herring, a special ed teacher from central California. And for many years, she taught students that had intense medical needs in a medically fragile or multiple disabilities classroom. I first met her when I would go into her classroom as an itinerant orthopedic impairment (OI) teacher. So I loved collaborating with Emma. She was really fun to work with, and I was just always in awe of her knowledge and devotion to her students. So I’m happy to introduce you to Emma today.

Emma (05:08):

Thank you for inviting me to do this. I am really excited.

Lisa (05:12):

I’m really glad that our listeners will get to hear from you. So the first thing I’d like you to do is just briefly introduce yourself.

Emma (05:19):

My name is Ms. Emma Herring, and I am a retired educator and I taught for over 29 years.

Lisa (05:27):

So tell us how you ended up getting into special education.

Emma (05:30):

I guess I was probably in second grade, I decided I wanted to become a teacher. And as I grew older, for some reason, I had this affinity, this idea that I wanted to teach students who were deaf and hard of hearing, I was in school during the multiple subject credential, because in California, at the time we had to have two credentials in order to specialize, get their multiple subject credential and then get a specialist credential.

Lisa (05:53):

And that was the same way for me. Yes.

Emma (05:55):

Okay. So I was in a staff meeting during my student teaching and there was the teacher who was hard of hearing that the translator didn’t show up. I didn’t sign extremely well, but I had been taking classes already because I knew that that was my goal. And so I started very slowly trying to tell her what was going on in the meeting. And after a while, of course, we started talking a little faster and even sharing the jokes. And they had a position available so I could become a paraprofessional in the class. So it was wonderful. I really enjoyed my time and really got excited about the process of education. I was going to be able to really do this. I could really see myself in the position.

Then we decided that we were going to move from the Bay area down to central California. And I needed a job while I was going to school because I needed to finish my credential and started working in a school that was a center based school for students with moderate to severe disabilities. And I completely fell in love. I had to do some soul searching as I was falling in love because I had this idea that it was going to be students who were actually deaf blind. And I wanted to specialize in kind of both of those areas. And I realized that with this population, there were students who were hard of hearing, and there were students who had visual issues and there were students who had multiple challenges so that it really did still fit the image I had growing up.

Lisa (07:22):

That’s wonderful. It looks like the things that you wanted to do all ended up rolled into one position here.

Emma (07:29):

Yes, it was amazing. It felt like I had divine intervention for me. I’ve worked with students from kindergarten with multiple disabilities all the way through the adult transition program.

Lisa (07:42):

When I first met you, you were working at a center-based site with students who were medically fragile and were mostly non-verbal. And what really caught my attention was how you gave your students a voice, even though they didn’t really have a voice verbally. And I’ve seen you in action. And you’re just really good at knowing your students. I think new teachers would appreciate getting some tips when they come into a classroom with students who maybe cannot express their needs very clearly.

Emma (08:15):

One thing I do is I talk to parents, brothers, sisters, whoever can speak with me and ask them, how do you know when your student is happy? How do you know when your student is sad or angry? What kinds of things do you do at home? What activities do your students enjoy? How do you know if they enjoy it, it starts with if possible, a home inventory of just talking, even over the phone about those things. Sometimes we do home visits depending upon the severity of the needs, how quickly we need to learn things.

Lisa (08:45):

Are there any other things that you would ask the parents about?

Emma (08:48):

Some students have procedures that are really early in the morning, but they may have, have been up since 5:00 AM. So asking the parents what their schedules are like, what time they will go to bed. Are there any special procedures that they have to do early in the morning and medications, that’s really important so that, you know, even if they come from home, they may be tired when I get there. Children learn best when they’re not uncomfortable and in pain. And so it’s better to get brief, intense times to teach for them to learn something. If they have to rest a lot in between then to overwhelm them and overstimulate them. And then they get nothing.

Lisa (09:22):

And that’s where the schedule comes in, because you would schedule in some rest time.

Emma (09:26):

Yes. So we scheduled in rest times, it made be kind of an “active rest.” Maybe they have a switch that they’re operating and it’s reading them a story. The talking book library is a wonderful for getting books on tape. I had a student who loved science. It wasn’t like elementary school science. She wanted to hear about astronomy and all kinds of amazing things. And she would love her time to be able to listen to those books on tape with a switch. The only thing is for her with a switch, it was a lot of work. So her touching that switch, whenever the story would stop was a lot of work, but then she could rest in between. So you have to be aware of what position are they going to be in so that they can rest between strokes.

As they get older, you want to increase the time where I would say in a traditional school type setting where they’re upright, they’re in positions of 90 degrees sitting at a table, sitting with a tray on, but you want to be aware of how tired they are. What do they look like when they’re tired? How can you tell they’re tired? What’s resting, what’s normal? Some students can’t smile to laugh, but their lips go up a little bit If they’re happy. Some students have really brilliant smiles. Some students have really loud laughs. Some students just make this kind of slight sound when they think something’s funny. It takes a lot of observation to figure out what each student likes and doesn’t like, so that talking to the parents really helps.

Lisa (10:41):

Well, yeah, because then you’re not starting from square one on the first day of school, trying to learn about your students. You’ll already know some of their likes and dislikes.

Emma (10:50):

So you want to establish though that something is a yes or a no for them. I may start with holding the pictures up, fairly close to the student and just seeing if they can do eye gaze, left to right… Another student, you may have the same cards, but you may have them on their lap because this, as far as they can reach, some is on top of a tray table.

I work hard to focus on each student when I ask a question. I usually start with something fun. If a student is eating, I will try, “Do you want a banana or an orange?” It matters that they have a choice. You have to have something that you know, that they like, I know this person really doesn’t want a banana. You’re never going to feed them a banana if they don’t want a banana, but you may ask them, “Do you want Apple sauce or do you want a banana?” And so how do they show you that they want the Apple sauce?

There are some students who will just look anywhere just to get you to leave them alone. And so they have to know that you’re there for the long haul, that you’re listening to them. You’re really looking at them. A lot of our students have checked out. They’re so used to people just doing things for them. They’re so used to people, just not even trying to find out what they want, that they will not even try. So the first part of the school year is also establishing that I really want to know. I really want to know what it is you want.

With students who already know icons, or already know pictures, or concrete objects. We worked really hard and yes, I want this. No I don’t. Thank you for making the choice. If we’re doing math and they get the answer wrong, The whole thing is the first part of the year is the fact that you’ve made a choice. Thank you for working hard at that. We appreciate hard work, letting you know what they want is hard work. They’re not always going to get it. like they’re not always get their song choice, but you acknowledge that they want it. This is what my choice would be. I want to hear “somewhere over the rainbow” by Judy Garland, every time you find something that they really like, you want to acknowledge it and honor it.

Lisa (12:33):

Right? What I think you’re really good at Emma is you’re able to treat your students like other people. You see them as who they are. You see their personality. And once they’re convinced that you do care about them, you are able to get so much more out of them. And I like those examples that you just gave to help others figure out how to do that.

Emma (12:54):

Thank you. At the beginning of the school year, we always put on the board, what is it this year that I have to accomplish for it to be a good year? Same thing I asked the parents, what is it that your student needs to learn this year so that it could be a good year? I had a student who, if she had to play golf, she was happy. So there was a golf tournament, she would learn anything she had to learn until she can get to play golf. That was what was important to her, that golf tournament towards the end of the school year. Another student, it was important for him to be able to, not all the time, but sometimes be the person that took things to the office and even if our students have really severe disabilities… I have students like that who wanted to go out of the room with you every time. And you can tell because their face would light up and they would get really happy. And if it wasn’t their turn to go, they might frown at the person going.

Lisa (13:36):

Sounds like those are the social butterflies.

Emma (13:38):

Yes. So if you know that your student is a social butterfly, you want to offer them things to make a social butterfly happy. Oh, there’s a note that has to go to another classroom because we’re doing a joint activity. And do you want to go? Yes or no? If they don’t answer or if they say no, honor it, it’s hard for people because you know, they really want to go. But after they’ve done it a few times, they will work to tell you Yes. Instead of no.

Lisa (14:03):

I think it’s a good idea even to build in activities like that, maybe you don’t really need to send a note over to the office or to another teacher, but you might just need to, because you know that that student would get something out of going somewhere else.

Emma (14:17):

Yes. And you’re building that choice-making. So you want to make those kinds of things where if they don’t answer you, they don’t get what they really want. So if they miss out on listening to a song because they wouldn’t say yes or no to the song, then it’s not gonna harm them.

Lisa (14:32):

I think for students that have medical situations going on, there are so many things they’re not in control of, that it’s good that you try to give them choices because in school they do have a choice about something where, when it comes to going to the doctor, when it comes to their different procedures at home, they don’t have a choice. They have to it.

Emma (14:51):

Yes. So true. One of the things about having a student trust that you’re going to honor what they’re saying to you. So you have a student who sometimes just wants you to choose for them. They know, you know, what they want and they think you just should make that choice. So they may say no, just to see whether or not you’re going to honor what they’re saying to you. Sometimes students will test that out. So if they say no to do you want to play with the blue ball or the red ball? And you know that their favorite color is blue and they choose red, then for that activity they’re using the red ball… Cause they made that choice. And usually next time when you asked them to take the blue ball, the red ball, they’re going to use the blue ball. Sometimes our students are so used to people, not really paying attention and caring that they will just throw away their choices.

Lisa (15:37):

I see. Yeah. And what if you were to say something about humor? Cause I know some kids will give the unexpected answer cause they’re trying to be funny in their own way, but they’re non-verbal.

Emma (15:49):

Yes. I’m trying to think of a really good example of that. Oh my gosh. Okay. So I had a student I’ll call “George”, who liked to nod their head a lot. Just, just nod their head a lot. So we had this wonderful instructional specialist that would come into the room. They say, So George, some people say, I’m funny. Do you think I’m funny and George’s nodding. Okay, cool. Thanks George. So Hey George, some people say that I’m really good looking. What do you think? And then George, like stops nodding…justs stops. George stopped nodding, and then just paused and waited and then burst out laughing. So I definitely worked hard to give them opportunities to be able to laugh. We had some students who of course liked it when people tripped. So sometimes somebody will pretend like, oops, just cause it, it would help somebody laugh.

Lisa (16:43):

Tell me about your question of the day. I remember that being in your class.

Emma (16:48):

We, a lot of people coming in and out, coming in and out of our classroom. And so when people would come in on days that we had questions for the day, cause we worked on who, what, when, why, where, how questions? Those symbols. So we picked one of those symbols and then we would ask them a question. And so we could ask the student, do you want, should we ask this person when they come in? They will say yes. Or they would say no because some people, they really want it to see what they’re going to answer. Some people, they really didn’t want to know… Just like all of us. And so when the person would come in, we’d ask them the question of the day. And it was always a topic that we were learning. So if we were learning math, it was a math question. And often it was ones tens, a hundred…. Or we’re doing science or history or whatever. There was always a yes or no question that we would ask. And sometimes they were hard questions,

Lisa (17:33):

Right? Put somebody on the spot, when they come in!

Emma (17:35):

But the students, you can just see them kind of leaning forward in their chairs and watching them to see if they could come up with the answer. They had a lot of good humor. We’d try not to do anything that would be too embarrassing. And if the person looked really perplexed with the possibilities. There’s always a way to feed the answer without feeding the answer, because it depends. You don’t want to have anybody feel terrible. We had some people that come in and just be comedians though when it happened and they didn’t know the answer and the kids loved that.

Lisa (17:59):

But I like how you set up your class to make it be a fun place and a place of learning things and throwing in these humorous things too.

Emma (18:07):

It was a lot of fun. So we can make it as much fun as possible and…

Lisa (18:11):

That’s going to help them remember it too, because you’re going to remember what made you laugh and what was funny.

Emma (18:17):

Yes. And so if we can make it something that we laughed about, it was not where it’s going to hurt somebody else or have somebody feel bad. They didn’t want that to happen at all.

I do think there’s something I want to make sure I say. I have had students with a lot of medical issues. Some of them quite severe, some of them progressive. One thing I learned is that it’s important for students to be able to understand to the best of their ability what’s going on with their bodies, what’s their diagnosis. They’re going to hear them in meetings. When they go to the doctor, the doctor is going to be saying it to their parents, right? It’s important that you talk about it. And if it looks sad to talk about them being sad about it, if it looks frustrated, talk about, are you feeling frustrated about it? So that’s why yes and no, those choices are so important. Learning how that they’re going to respond to those things because there’s so much going on in their lives.

One of the things that I was just really a stickler about is not speaking over the students, but speaking to the students. If you have to discuss a health thing, speak as if the student is part of the conversation, whether they’re five years old or 22 years old, it’s just so important that they get the dignity of knowing that you respect them. Not just that you hear them, but that you respect them, you respect their humanness and that you respect their needs to be seen and heard.

Lisa (19:29):

Right. Absolutely. Well, Emma, I think that we could talk about this forever and ever. I really appreciate all your ideas and thoughts and just wonderful advice. And it just really shows so much even just in our conversation, how much you love your students and have cared for them over the years.

Emma (19:49):

Thank you, Lisa. You know, it has been an honor to work with students with moderate to severe disabilities. I feel blessed. I feel totally blessed to have been given the opportunity.

Lisa (20:02):

That’s the end of part one with my interview with Emma, we did actually talk forever and ever and so I divided the interview into two parts. So come back next time when Emma will be talking more about her schedule and some of her favorite things to teach. Check out the show notes and get a transcript of this episode at

Lisa (20:31):

Now, when I start to get stressed or overwhelmed about school stuff, I find it helps to take a moment to slow down, stop and focus on my breathing. Sometimes I also might say the serenity prayer aloud or in my head. Here it is, God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

I might also add a few of my own words. Here’s a sample for us special educators: Help us to listen and truly understand our students. Please give us words, actions and solutions, which will help in difficult situations. May our classrooms be peaceful places where teachers, staff, and students learn. And after that, I tried to go out and find someone else to help because helping others keeps me from selfishly dwelling on my own problems.

Thank you so much for listening. And I hope you heard something helpful during this episode that you can implement in your teaching. Remember, you are amazing what you do makes a difference and don’t let anyone tell you otherwise, go find someone else to encourage because they probably need to be reminded that they are amazing too.

Go listen to Part 2 of this interview with Emma!

Check out my other podcast episodes!

Tips for Teaching Students with Multiple Disabilities

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