OLDVERSION_Module 2 EN

Module 2 Disabilities and Learning Difficulties – definition of terms

MODULE TOPICS

Learning disabilities

Specific learning difficulties

Other disabilities

Impact of disabilities and learning difficulties on the educational process

01

Learning disabilities

1.1 Learning disabilities

Now that you know the differences, let's look at the main learning disabilities that are classified according to neurodevelopmental disorders: The DSM-V (American Psychiatric Association, 2013) emphasises that the term ‘intellectual disability’ is the most commonly used term in both medical and educational settings. This manual includes intellectual disability under ‘Neurodevelopmental disorders’, and defines it as follows: ‘Intellectual disability (intellectual developmental disorder) is a disorder that begins during the developmental period and includes limitations of intellectual functioning as well as adaptive behaviour in the conceptual, social, and practical domains’ (APA, 2013, p.17). According to the DSM-V intellectual disability can be mild, moderate, severe or profound. This manual establishes these categories according to the conceptual, social and practical domains, referring to the adaptive behaviours explained in the previous section.

The concept of learning disability refers to a lifelong condition in which a person is unable to respond voluntarily to any kind of educational action. As defined in the Educational Disability Regulations 2005 and the Disability Discrimination Act 1992, a learning disability is a ‘disorder or dysfunction that causes a person to learn differently from a person without a learning disability or dysfunction, which places pupils with a learning disability in a specific group with learning difficulties’. The Diagnostic and Statistical Manual of Mental Disorders recognises learning difficulties as ‘specific learning disabilities’. In general, pupils with learning difficulties have an average or below average IQ. In these cases, there is often a mismatch between the pupil's potential performance and his or her actual performance in school. In addition, learning difficulties are often neurologically based and permanent. The main difference between a learning disability and a learning difficulty is its impact, i.e. its consequence. On the one hand, a learning disability usually refers to a condition that has a pervasive impact on educational or academic situations, whereas a learning disability simply covers a wider range of areas, not just learning. It can affect mobility, communication, vision, hearing, among other aspects of daily life.

Intellectual disability

+ INFO

1.1 Learning disabilities

Autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the way people interact with others, communicate, learn and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms usually appear in the first two years of life. All people with ASD are different, but they all share at least two key diagnostic features:

• Problems with social skills.
• Restrictive and repetitive patterns of behavior, interests or activities.

These characteristics are present in all cases, regardless of culture, race, ethnicity or socioeconomic status.

One condition of a person with Down syndrome will be intellectual disability.

Down syndrome is a genetic condition that occurs when a person has one extra copy of chromosome 21, instead of the usual two. This excess genetic material causes a delay in physical and intellectual development and is associated with distinctive physical characteristics, such as a flattened face, upward slanting eyes, low muscle tone and a short neck.

+ INFO

+ INFO

1.1 Learning disabilities

In addition to the presence of primary difficulties, the following symptoms appear:

• Decreased eye contact in interaction activities.

• Absence of gestures, such as pointing to show interest in an event or object.
• Poor ability to imitate the actions of others.

These are primary indicators that lead to atypical development of social communication skills, language and symbolic and social play, which will affect peer relationships, the development of complex social skills based on understanding intentions and beliefs, and participation in joint activities. In addition, repetitive behaviours and routines appear which, at first, may be seen as ‘manias’ of the subject, but which sometimes become obsessions and may be related to the subject's desire to create a predictable environment for him/her, or also to atypical processing of sensory information (smells, colours, textures, etc.). It is assumed that the symptoms of ASD have their origin in a neurological disorder that manifests itself behaviourally, i.e. through specific behaviours that have a different presentation according to the age of the person and depending on whether cognitive competence and the level of language development are affected. Therefore, the cognitive competence and the level of language development are key to attend the diversity and heterogeneity of autism.

The DSM-V establishes five diagnostic criteria for ASD:

• Level 1 - 'Needs support'.

A person with ASD symptoms at this level experiences problems in social interactions due to communication deficits. They have difficulty initiating social interactions and their responses are often perceived as bizarre. Rigid patterns of behaviour make daily functioning difficult and ineffective, and it is difficult for a person with ASD to replace them with new ones. Problems with organising and planning activities limit independence.

• Level 2 - 'Requires significant support'.

Social functioning is difficult despite support from others. The person rarely initiates social interactions, deficits in verbal and non-verbal communication are more pronounced. Social interactions are often limited to simple verbal exchanges, often around specific interests. Rigidity of behaviour and low tolerance of change cause significant difficulties in adapting to many situations.

• Level 3 - 'Requires very significant support'.

There are significant limitations in both verbal and non-verbal communication. A person functioning at this level may use single words, often only to meet their needs. He or she may respond only to direct messages, and respond minimally to efforts by others to make contact. It is extremely difficult to cope with change and a limited, rigid behavioural repertoire severely limits daily functioning. (DSM-5)

1.1 Learning disabilities

ADHD (Attention deficit hyperactivity disorder) It is a biological disorder, neurological in origin, caused by an imbalance between two neurotransmitters in the brain: noradrenaline and dopamine, which directly affect the areas of the brain responsible for self-control and inhibition of inappropriate behaviour. The most significant symptoms are inattention, hyperactivity and impulsivity. However, behind them, we find various difficulties in executive functions:

• Difficulty in attending to certain stimuli.
• Planning and organising an action.
• Reflect on the possible consequences of each action.
• Inhibit the first automatic response in order to change it for a more appropriate one.

Which processes are altered? Those related to motivation and reward, as well as a dysfunction in the neural networks related to the capacity for introspection and self-awareness.

ADHD (Attention deficit hyperactivity disorder)

+ INFO

1.1 Learning disabilities

Specific Learning Difficulties

Specific learning difficulties are a group of neuropsychological conditions that affect a person's ability to acquire and use academic skills, such as reading, writing and mathematics. These difficulties are not due to intellectual disability, lack of educational opportunities or sensory problems, but to differences in the way the brain processes information. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) defines Specific Learning Difficulties under the term ‘Specific Learning Disorder’. In the next chapter we will focus more deeply on this last point.

Back to topics

02

Specific learning difficulties

2.1 Specific learning difficulties

Kost (1974) defined dyscalculia as a disorder distinct from other mathematical alternatives, emphasising its heritability and/or congenital involvement of the brain substrate responsible for mathematical functions.

Dyscalculia

+ INFO

The concept of learning difficulties can affect any area of academic performance, such as the ability to concentrate, motivation, memory, and organisation. However, they are not necessarily related to a neurological or specific disorder whereas specific learning difficulties affect specific areas of academic performance and are often present despite adequate instruction and normal educational opportunities. In short, all specific learning difficulties are learning difficulties, but not all learning difficulties are specific. Among the most common specific learning difficulties are:

Dysgraphia is characterised by an inadequate arrangement of graphic signs, which makes reading and comprehension very difficult. It forms part of the written language disorders together with dyslexia and dysorthography. It occurs after the period of learning to write.

Dyshgraphia

+ INFO

The term ‘dyslexia’ refers to a specific and significant deficit in the development of reading skills that cannot be explained by intellectual level, visual acuity problems or inadequate schooling.

Dyslexia

Back to topics

+ INFO

03

Other disabilities

The World Health Organisation (WHO) defines the concept of disability as:‘The result of a complex relationship between a person's health condition, his or her personal factors, and external factors representing the circumstances in which that person lives. Because of this relationship, different environments can have different effects on an individual with a health condition. An environment with barriers, or no facilitators, will restrict the individual's performance/fulfilment; while other environments that are more facilitating may increase it’ (WHO, 2001).The WHO uses a comprehensive classification of disabilities that covers various aspects of health and functioning. In particular, the WHO classification system is based on two main tools: the International Classification of Function, Disability and Health (ICF) and the International Classification of Diseases (ICD).

Sensory disabilities

Psychological or emotional disabilities

1. Visual impairment is defined by the WHO as an impairment of visual ability that cannot be adequately corrected with conventional lenses, surgery or medical treatment, and that affects a person's ability to carry out daily activities. Visual impairment ranges from low vision to blindness.

Psychological or emotional disabilities refer to mental or emotional conditions that significantly affect a person's ability to function in daily life. These disabilities can interfere with the way a person thinks, feels, behaves, or relates to others. Often, these conditions require treatment, support, and accommodations to help the person manage the associated challenges.

+ INFO

2. According to the WHO, hearing impairment refers to a partial or total loss of the ability to hear, which may affect one or both ears. This disability can range from mild difficulty hearing sounds to profound hearing loss that significantly affects a person's ability to communicate and participate in daily life.

Go to next page for more info

+ INFO

Motor disabilities

Multi-disability/multiple disabilities

Bonals and Sánchez Cano (2007) define motor disability as an ‘impairment of the motor apparatus caused by a deficient functioning of the nervous system, the muscular system or the bone-articular system, or an interrelation of the three systems, which makes the functional mobility of one or several parts of the body difficult or impossible’.

Multiple disabilities is a condition used to describe the simultaneous presence of multiple disabilities in the same person.

+ INFO

+ INFO

Psychological or emotional disabilities

Major depressive disorder

Post-traumatic stress disorder

Bipolar disorder

Anxiety disorders

Schizophrenia

Bipolar disorder (WHO) is a mental health condition characterised by mood swings from one extreme to the other.

According to the WHO, anxiety disorders are a group of mental conditions characterised by excessive fear or worry, which may be persistent and difficult to control. These disorders are characterised by a feeling of anxiety that is disproportionate to the actual situation, which can significantly interfere with the person's daily life.

According to the World Health Organisation (WHO), Post Traumatic Stress Disorder (PTSD) is a mental disorder that develops after a person has been exposed to an extremely traumatic or stressful event. This event may involve a real or perceived threat of death, serious injury, or sexual violence. PTSD is characterised by symptoms that can severely affect a person's daily life and ability to function.

Schizophrenia (WHO) is characterised by a significant impairment in the way reality is perceived and by changes in behaviour.

Major Depressive Disorder (MDD), according to the WHO, is a severe mental disorder characterised by a persistently low or depressed mood and a significant loss of interest or pleasure in most daily activities. This disorder negatively affects the way a person feels, thinks and manages daily activities, such as sleeping, eating or working.

Back to topics

04

Impact of disabilities and learning difficulties on the educational process

Lack of access

4.1 Difficulties in Achieving Educational Levels

Lack of vocational guidance

At the World Conference on Special Educational Needs held in Salamanca, Spain, in 1994, the foundations were laid for thinking about educational systems that embrace all children, regardless of their physical, intellectual, social, emotional, linguistic, or other characteristics. These principles were reinforced by the 2030 Agenda for Sustainable Development, specifically by Goal 4, which urges educational systems to ensure inclusive and equitable quality education and to promote lifelong learning opportunities for all. The transition from school to adulthood presents an additional challenge for young people with disabilities and/or learning difficulties. These obstacles can impact their ability to obtain the necessary education, which will affect their social and employment integration.

+ INFO

not designed to meet the specific capabilities

4.2 Intervention and Support Strategies

Next, we will look at which intervention and support strategies are best, distinguishing between coaching and mentoring strategies:

Mentoring Strategies:

Coaching Strategies:

• Offer tutoring adapted to the unique needs of each student.
• Utilize multisensory learning.
• Materials and activities should be adapted and accessible for students with difficulties.
• Provide visual, technological, or manipulative materials.
• Adjust strategies as necessary and regularly monitor the student’s progress.
• Identify areas of success and improvement using formative assessments.
• Implement tutoring programs from the early stages to identify and address issues before they become more serious problems.
• Include parents and caregivers in the process to ensure comprehensive support.

• Help students set realistic and achievable goals based on their specific abilities and needs.
• Use the SMART method (Specific, Measurable, Achievable, Relevant, and Time-bound). More information in Module 5.
• To maintain motivation, use positive reinforcement methods.
• Celebrating achievements, even if they are small, helps improve self-esteem.
• Teach students to make decisions about their learning and to take responsibility for their progress.
• Provide tools for self-assessment and reflection on their work process.
• Include sessions that help students improve their communication and interaction skills.
• Encourage teamwork.

VS

Disabilities and learning difficulties

Learning disability

Specific learning difficulties

Other disabilities

Motor disabilities

Sensory disabilities

Multi-disability

Psychological or emotional disabilities

• Intellectual disability
• ASD
• ADHD
• Specific learning difficulties

• Dyscalculia
• Dysgraphia
• Dyslexia

• Visual disabilities
• Hearing disabilities

• Anxiety disorders
• Major depressive disorder
• Bipolar disorder
• Schizophrenia
• Post-traumatic stress disorder (PTSD)

Congratulations, you've completed 2/5 modules!

Thank you!

What would you call a person with ASD without specifying your disorder? Here are some recommended ways:

• Person with ASD or person with autism: Focus on the person first, not the diagnosis. Example: ‘a person with ASD’ or ‘a person with autism.’

• Neurodivergent person: This term includes people with ASD and other neurological differences. It is in contrast to the term ‘neurotypical,’ which refers to people without conditions such as ASD. Example: ‘a neurodivergent person’ and ‘a neurotypical person.’

• Person on the autistic spectrum: This phrase is also used to describe someone with ASD without making comparisons that may be perceived as negative. Example: ‘a person on the autistic spectrum.’

So...how do we refer to a person who does not have ASD?

• Neurotypical people: Refers to people whose neurodevelopment and behaviour is considered typical or standard, without conditions such as ASD. Example: ‘Neurotypical people may have different challenges compared to neurodivergent people.’

Generally speaking, the first classification is made according to the nature of the disorder. Thus, most authors distinguish between:

• Acquired dysgraphia

Acquired dysgraphia is characterised by the presence of a brain lesion which affects some areas of the brain and leaves others intact, so that certain psychological mechanisms are altered, but others continue to function perfectly. There are different types of acquired dysgraphia: a. Dynamic frontal aphasia and planning difficulties b. Agrammatism and planning difficulties. Agrammatism and difficulties in the construction of syntactic writing. c. Conduction aphasia and agrammatism due to short-term memory deficit. d. Central dysgraphia and word retrieval disorders e. Peripheral dysgraphia and motor disorders.

• Developmental dysgraphia

Developmental dysgraphia is the difficulty in learning to write in a subject who has no organic, sensory or intellectual impairment or any other cause that justifies it. In this sense, it presents the diagnostic criteria of specific learning disorders. There are different types of developmental dysgraphia: a. Phonological dysgraphia b. Superficial dysgraphia c. Mixed dysgraphia. Superficial dysgraphia c. Mixed dysgraphia d. Other dysgraphia - Mirror writing Other dysgraphia - Mirror writing and letter reversal - Delayed handwriting

Below are the strategies and solutions we propose to overcome these challenges: To ensure that young people with disabilities have access to high-quality education, inclusive education must be a central approach. This involves eliminating physical and learning barriers, providing adaptations and accessible technological resources, and training teachers in inclusive methodologies. To provide individualized assistance, students with disabilities need to have a support team that includes therapists, psychologists, counsellors, and trained personnel. These supports are essential for their emotional and social development, as well as their academic success. Young people with disabilities must receive vocational guidance and training programs tailored to their skills and interests. These programs should help this group develop the necessary competencies to access the labor market. Young people with disabilities can receive guidance and supervision in their first work experiences through sheltered or supported employment programs. Additionally, to promote the employment inclusion of people with disabilities, partnerships with businesses and organizations should be encouraged. Preparation for adulthood should include programs that teach independent living skills, such as managing personal resources, health care, mobility, and socialization. These programs help young people with disabilities to integrate more fully into society. Governments must implement public policies that promote the inclusion of young people with disabilities in education and employment. This includes reducing bureaucratic barriers to education and employment, as well as facilitating access to scholarships, technical aids, and specialized training. Coaching and mentoring are powerful tools to support young people with disabilities and learning difficulties on their path to educational success and the transition to adulthood. These personalized interventions not only provide academic support but also emotional, social, and professional assistance, helping young people overcome barriers, build self-confidence, and reach their full potential. With the right approach, coaching and mentoring can be crucial for these young individuals to achieve higher educational levels and a fuller, more autonomous adulthood.

The latest version of the DSM-V (Diagnostic and Statistical Manual of the American Psychiatric Association, 1994) does not include dyslexia as a category. The manual speaks of Specific Learning Disorders and, within this category, includes the specific learning disorder with reading difficulties in which dyslexia would be included. On the other hand, ICD-10 includes the category of ‘Specific Reading Disorder’ as part of Specific Developmental Disorders of School Learning. Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterised by difficulties in:

• Reading comprehension or mathematical reasoning ability.
• Reading speed or fluency
• Word reading
• Often persist into adolescence, even if positive progress has been made.

The WHO classifies hearing impairment according to the degree of hearing loss and its impact on communication:

• Mild deafness: the hearing threshold is between 20 and 40 dB.
• Medium deafness: the hearing threshold is between 40 and 70 dB.
• Severe deafness: the hearing threshold is between 70 and 90 dB.
• Profound deafness: the hearing threshold is higher than 90 dB.
• Cophosis or total loss: the hearing threshold is higher than 120 dB.

The causes of hearing impairment can be diverse and include congenital and acquired factors. Congenital causes include prenatal infections such as rubella or cytomegalovirus. Complications during birth, such as oxygen deprivation or severe jaundice, can also cause hearing damage. Acquired causes, on the other hand, include ear infections, such as chronic otitis media; prolonged exposure to loud noise; use of ototoxic medications; and natural ageing, known as presbycusis, which is progressive age-related hearing loss. In addition, head injuries and infections such as meningitis can cause hearing damage, and in some cases, hearing impairment can result from untreated chronic diseases such as diabetes, which affects the blood supply to the ear.

Depending on the most noticeable symptoms presented by the subject, ADHD can be classified in three different ways: ADHD with inattention

• The main symptoms are constant distractions and difficulties in concentrating and paying attention.
• This is the least common form, accounting for only 10% of diagnosed cases.

Impulsive/hyperactive ADHD

• The predominant symptoms are hyperactive and/or impulsive behaviour.
• There are no concentration difficulties.
• It is more frequent in males than in females.
• It is the second least frequent type.

Combined ADHD

• Both hyperactive and impulsive behaviour and attention deficit are observed.
• This is the modality that corresponds to what we all traditionally consider as ADHD.
• It is the most frequent manifestation, as 60% of diagnosed cases are of this type.
• It requires a correct approach as the double affectation of both attention span and hyperactivity opens the door to complications that can have repercussions in adult life.

Moreover, many educational systems lack adequate adaptations in teaching methods, assessment, or curriculum structure, which hinders the progress of young people with cognitive or learning disabilities. Many teachers are not prepared to work effectively with students with disabilities or learning difficulties. The lack of training in inclusive and adaptive pedagogies can result in students not receiving the necessary support to fully participate in the classroom, limiting their educational progress. Within schools, young people with disabilities often face discriminatory or prejudiced attitudes from other students, teachers, and staff. This can lead to feelings of exclusion, low self-esteem, and a lack of motivation to continue studying. Social stigmatization can also lead to overprotection by families, preventing young people from developing independence and autonomy skills, which are essential for the transition to adulthood. An important barrier is the lack of vocational guidance tailored to the needs and capabilities of young people with disabilities. Often, these young individuals lack access to guidance programs that take into account their skills, aspirations, and real opportunities in the labour market.

In a depressive episode (WHO), a person experiences a depressed mood (sadness, irritability, feelings of emptiness) or a loss of pleasure or interest in activities. A depressive episode is different from usual mood variations. These episodes last most of the day, nearly every day, for at least two weeks. Several other symptoms may also occur, such as:

• difficulty concentrating
• excessive guilt or low self-esteem
• hopelessness about the future
• thoughts of death or suicide
• sleep disturbances
• changes in appetite or weight
• a pronounced feeling of fatigue or lack of energy.

Depression can cause difficulties in all areas of life, including community and home life, as well as work and school. Preventing depression is crucial for maintaining good mental health and overall well-being. It's essential to pay attention to the early signs of prolonged stress, anxiety, or sadness and take proactive steps, such as maintaining a balanced routine, exercising regularly, and seeking emotional support from friends, family, or healthcare professionals. Additionally, avoiding social isolation and leading a healthy lifestyle, including a nutritious diet and adequate rest, can reduce the risk of developing depression. Don’t underestimate the symptoms; if you feel like you're sinking, seek help quickly because early intervention is essential to prevent the condition from worsening.

Within the literature on dyslexia there are many types and subtypes of dyslexia, while dyslexia as a syndrome or disorder can be classified more broadly to distinguish between:

• Acquired dyslexia

Within acquired dyslexia, different subtypes are established:

• Phonological dyslexia: the phonological route is impaired. They can read, but they carry out the process through the visual or orthographic route. This implies that the subject reads familiar words, but has difficulties when reading unfamiliar words or pseudo-words. When they have a visual representation of the word, they can read it, but when they do not, they cannot recognise it and make mistakes.
• Superficial dyslexia: This category applies to those subjects whose visual pathway is impaired and who read words by applying the rules of phoneme-grapheme conversion. They read words, whether known or unknown, and can read pseudo-words, but have great difficulty reading words that do not follow grapheme-phoneme correspondences.
• Deep dyslexia: This category is associated with subjects who present disturbances in both the superficial and phonological pathways. The most characteristic errors are, in addition to those referred to in the two previous categories, semantic errors. They read a word by interpreting a form that is not related either to the visual form or to the phonological aspect of the word.

• Developmental dyslexia

Within developmental dyslexia, equivalent subtypes are also distinguished in their manifestations, although the distinctions are usually not so sharp and there is not such a clear distinction between them.

• Dysphonemic or auditory dyslexia: Subjects with this type of dyslexia are characterised by their difficulty in integrating letter sounds. For this reason, reading unfamiliar words or pseudo-words is more difficult for them and they read visually. Dysphonemic dyslexics have great difficulty in spelling when the word is presented orally. They sometimes have dyslalia or other articulatory disorders. When assessed with tests such as the WISC-R (Wechsler Intelligence Scale for Children), verbal IQ is often lower than manipulative IQ.
• Visual dyslexia: difficulties occur in the visual pathway, as there is an inability to perceive whole words globally and recognise them. They read by applying phoneme-grapheme conversion rules. They often have difficulties in right-left orientation, the quality of writing is poor (dysgraphia) and they produce letter and word reversals or develop mirror writing. When tests such as the WISC-R are administered, manipulative IQ is often lower than verbal IQ.
• Mixed or visuo-auditory dyslexia: this is the most severe subtype, with severe difficulties in both ways, making reading difficult and almost impossible

Characteristics of Post-Traumatic Stress Disorder (PTSD) according to the WHO:

• Re-experiencing the trauma: People with PTSD experience intrusive memories, flashbacks, or nightmares related to the traumatic event. These episodes can be so vivid that the person feels as if they are reliving the trauma.
• Avoidance of trauma reminders: Individuals with PTSD often avoid situations, places, people, or activities that remind them of the traumatic event. This avoidance can significantly limit their daily life.
• Increased reactivity: This includes symptoms such as hypervigilance, exaggerated startle responses, irritability, difficulty concentrating, and sleep problems. People may be constantly on edge, expecting something bad to happen.
• Changes in thoughts and mood: PTSD can lead to persistent negative thoughts about oneself or others, feelings of guilt or shame, and a loss of interest in activities that were previously enjoyed. It is also common for people with PTSD to experience a depressed mood or persistent negative emotions.

Motor disability affects movement, can be permanent or transitory and affects the person's daily functioning. As with other disabilities, to speak of a person with a motor disability opens the door to a very heterogeneous group, depending on the type of impairment, time of onset, stimulation, personality, etc. Broadly speaking, Cardona et al. (2007, in Castellano and Montoya, 2011) and Lobera Gracida (2010) distinguish two large groups:

• Physical disability only / peripheral physical disorders: The student has a very localised physical disability that may affect bones, joints or muscles. It may be the case that a limb is missing. They may be present from birth (e.g. malformations) or as a result of an illness or accident in childhood. Intellectual and perceptual abilities are usually intact. This would be the case, for example, of a person with lack of or difficulty in mobility in one leg.
• Disability associated with neurological damage: In this case there is an area of the brain that is affected and, as a consequence, the transmission of information is not correct, affecting movement. Pupils have problems with muscle tone, perceptual difficulties and coordination problems.

Motor disability can be categorised according to several criteria (Olmedo, 2008; Sarto and Vedia, 2013; Duk and Hernández, 2015; Fernández López and Pelegrín, n.d.) such as time of onset, according to aetiology, origin of the lesion, topographical location, degree of dependence, or muscle tone, mass and strength.

In other words, multi-disability is a severe disability of multiple expression, where two or more disabilities are associated, such as physical disability, intellectual disability, sensory disability or fragile health, which can be severe or profound. It causes an extreme restriction of aspects and possibilities of perception, expression, emotions and relationships. People with multiple disabilities experience delayed development and often require a high level of support and care in their daily life. These aspects or symptoms influence the quality of life of the person, but also, of course, their well-being and everything around them, such as their education and all their needs, both for themselves and their family or environment. Examples of multiple disabilities:

• Hearing and visual impairment: A person may have both significant hearing and vision loss, known as deafblindness. This type of multiple disability requires highly specialised communication strategies.
• Physical and intellectual disability: A person may have cerebral palsy (a physical disability) and an intellectual disability, which affects both mobility and cognitive ability.

If we refer to the DSM-V diagnostic criteria, the diagnosis of dysgraphia is made as part of the category of Specific Learning Disorders characterised by unexpected difficulties in written expression (e.g. making multiple grammatical or punctuation errors in a sentence, poor organisation of a paragraph, unclear written expression of ideas). In relation to writing itself, a subject with dysgraphia presents primary errors which are constituted by the set of formal elements of writing which are affected by dysgraphia, such as:

• The size of the handwriting.
• The shape of the spelling.
• Poor or inadequate slope of the spelling on the line.
• Inadequate spacing.
• Altered strokes.

In relation to global secondary manifestations or secondary errors, the most significant are the following:

• Incorrect graphic posture of the body when writing.
• Inadequate support of the writing tool and deficiencies in pressure and grip.
• The rhythm of the writer is altered.
• Layout (proportional distribution of text space).

During a manic episode, a person experiences an extremely elevated mood and high energy levels; they feel very happy, excited, and hyperactive. They may also feel euphoric, abruptly change moods, and express their emotions intensely (for example, they might laugh uncontrollably or feel more irritable, nervous, and restless than usual). The mood and activity changes during a manic episode are accompanied by other characteristic symptoms, such as:

• an exaggerated sense of self-esteem or personal worth
• rapid speech and quick shifts from one idea to another
• difficulty concentrating and being easily distracted
• decreased need for sleep reckless or risky
• behaviors, such as overspending, engaging in risky sexual activities, drinking, or harming oneself or others
• delusions of grandeur (e.g., "I am a very famous person") or paranoid beliefs (e.g., "My neighbor is spying on me") that are persistent and unfounded.

In contrast, during a depressive episode, a person has a depressed mood and feels sad, irritable, and empty. They may also lose interest in activities they previously enjoyed and derive no pleasure from them. Other symptoms may also occur: low concentration excessive guilt or low self-esteem hopelessness about the future thoughts of death or suicide sleep disturbances changes in appetite or weight feeling very tired or having little energy. The depressive episodes of bipolar disorder differ from the mood fluctuations that most people experience in that the symptoms last most of the day and are present nearly every day for at least two weeks. Both manic and depressive episodes can cause significant difficulties in all areas of life, including activities at home, work, and school. Sometimes, the patient may need specialized care to prevent harm to themselves or others. Some people with bipolar disorder may experience hypomanic episodes, which involve similar symptoms to manic episodes but with less intensity, and they usually do not impair the person's functional capacity to the same extent.

The WHO recognises several types of anxiety disorders, including:

• Generalised anxiety disorder (GAD): characterised by excessive and difficult to control worry about various aspects of daily life, such as health, work, family, etc. People with GAD often feel constantly nervous, tense or on the verge of a breakdown, even when there is no clear reason to worry.
• Panic disorder: This disorder manifests itself through recurrent and unexpected panic attacks. A panic attack is a sudden episode of intense fear that causes physical symptoms such as palpitations, sweating, trembling, shortness of breath and a feeling of loss of control. These attacks can occur at any time and may be accompanied by a persistent fear of having more attacks.
• Obsessive-compulsive disorder (OCD): This disorder is characterised by the presence of obsessions (intrusive and recurrent thoughts) and/or compulsions (repetitive behaviours performed to relieve anxiety). Compulsions are rituals that the person feels they must perform to prevent or reduce anxiety or avoid a feared event.
• Specific phobias: These are intense and disproportionate fears of specific objects or situations, such as flying, heights, animals, receiving injections, etc. This fear causes active avoidance of the phobic situation or object, which can significantly interfere with daily life.
• Social anxiety disorder (social phobia): This is an intense fear of social or performance situations where the person fears being observed, judged or humiliated by others. This fear can lead to avoidance of social situations, which affects the person's ability to interact with others and lead a normal life.
• Separation anxiety disorder: This is a disorder commonly diagnosed in children, although it can also occur in adults. It is characterised by an excessive fear of separation from attachment figures, such as parents. The child may fear that something bad will happen to them or to themselves when they are separated.
• Agoraphobia: A disorder that involves an intense fear of being in places or situations where escape might be difficult or where help would not be available if a panic attack or other disabling symptoms are experienced. People with agoraphobia may avoid places such as crowds, bridges, or even being alone outside the home.

Schizophrenia (WHO) is characterized by a significant impairment in the perception of reality and behavioral changes such as the following: Persistence of delusions: the person has the mistaken belief that something is true despite evidence to the contrary.

• Persistence of hallucinations: the person hears, smells, sees, touches, or feels things that are not present.
• Experience of influences, control, or passivity: the feeling that one's own feelings, impulses, actions, or thoughts are not generated by oneself but are placed in one's mind by others, or removed from it, or that one's thoughts are being transmitted to others.
• Disorganized thinking, often manifesting as incoherent or irrelevant speech.
• Highly disorganized behavior, such as performing actions that seem strange or purposeless, or exhibiting unpredictable or inappropriate emotional reactivity that interferes with the ability to organize behavior.
• "Negative symptoms" such as significant speech limitations, restricted experience and expression of emotions, inability to experience interest or pleasure, and social withdrawal.
• Extreme agitation or slowed movements, or adopting unusual postures.
• People with schizophrenia often also experience persistent impairment in cognitive or thinking abilities, such as memory, attention, and problem-solving.

At least one-third of people with schizophrenia experience a complete remission of symptoms. Some people with schizophrenia experience recurrent worsening and remission of symptoms over their lifetime, while others experience a gradual worsening of symptoms over time.

Mild disability:

• Conceptual domain: In early childhood education not measurable. In primary and adult education, difficulties in learning academic skills in reading, writing, arithmetic, time or money. They need help to meet age-related expectations.
• Social domain: the individual is immature in social relationships when compared to age peers.
• Practical domain: the person can function in an age-appropriate way in personal care. They need help with complex daily living tasks.

Moderate disability:

• Conceptual domain: conceptual skills are markedly impaired and delayed compared to peers. In early childhood education this is evident in language and pre-academic skills, as they develop more slowly. In primary school these skills also develop more slowly.
• Social skills: notable differences in social and communicative behaviour. Use of less complex language than peers and relational skills closely linked to family and close friends.
• Practical domain: after a long period of learning, can take responsibility for personal needs (eating, dressing, etc.), hygiene and housekeeping.

Severe disability:

• Conceptual domain: reduced conceptual skills, little understanding of written language and numbers, quantities, time...They need support, as carers, throughout life.
• Social domain: very limited spoken language in vocabulary and grammar, often need measures of communicative augmentation. Simple speech and gestural communication.
• Practical domain: needs help for all activities of daily living and constant supervision.

Profound disability

• Conceptual domain: conceptual skills focus on the physical world and hardly on the symbolic world. Use of some objects for care, work or leisure. There may be a concurrent existence of motor and sensory impairments that hinder the use of objects.
• Social domain: very limited understanding of symbolic communication in speech and gestures. Understanding of simple instructions. Use, usually, of non-verbal communication.
• Practical domain: dependence on others for daily care, health and safety, although there may be some participation in activities.

The term ‘person with...’ is used, prioritising the person as a whole and not only his or her limitations.

ICD-11 defines dyscalculia as a learning disorder to be included as a developmental learning disorder with mathematical difficulties within the general classification of developmental learning disorders. Whereas the DSM-IV classifies dyscalculia as a specific learning disorder. People with specific learning disabilities may have difficulties in reading, writing and/or mathematics. Dyscalculia is an alternative term used to refer to a pattern of difficulties characterised by the following problems:

• Processing numerical information.
• Learning arithmetic operations.
• Calculating correctly or without problems.

Wilson and Dehaene (2007) developed a theoretical model of subtypes of dyscalculia associated with three different causes of dyscalculia:

• Basic deficits in numerical processing: subjects with this type of dyscalculia show problems at the level of quantity comparison and subitization, i.e. with deficits in number sense. These problems at the level of representation and manipulation of numerical quantities are also reflected in difficulties in all tasks involving the symbolic handling of numbers.
• Phonological processing deficit: People with this type of dyscalculia show problems at the level of verbal symbolic representation. This involves difficulties in: All mathematical skills are highly dependent on the ability to process and manipulate verbal information, such as reading and writing numbers, learning arithmetic facts, problem solving and counting sequences.
• Impaired working memory and executive functions: Individuals with this type of dyscalculia show: Delay in acquiring simple arithmetic strategies. Frequent errors in performing mathematical procedures. Poor understanding of the concepts underlying the use of procedures. Difficulties in sequencing the multiple steps of complex procedures.

Here we have presented a classification according to the origin of the injury, but you can look for more information on the others:

The motor impairments most frequently encountered by teachers in the classroom are cerebral palsy, paralysis of a limb, amputations, spina bifida and some muscular dystrophies. It is important to know the specific case in order to be able to prevent or limit certain impairments, however, the main thing is to know the specific characteristics of each case.

The WHO classifies visual impairment according to visual acuity and visual field into the following categories:1. Normal Vision:

• Visual Acuity: 20/20 (6/6) to 20/60 (6/18) with optical correction.

2. Moderate Vision:

• Visual Acuity: Less than 20/60 (6/18) but equal to or greater than 20/200 (6/60) in the better eye with best possible correction. Difficulty performing tasks requiring detailed vision, such as reading small print.

3. Severe Vision:

• Visual Acuity: Less than 20/200 (6/60) but equal to or greater than 20/400 (3/60) in the better eye with best possible correction. Significant limitations in visual function, affecting independence in daily activities.

4. Blindness:

• Profound Blindness: Visual acuity less than 20/400 (3/60) but equal to or greater than light perception.
• Total Blindness: No Light Perception (NPL).

Blindness implies a complete loss of functional vision, requiring the use of other senses for mobility and interaction with the environment. Globally, the main causes of visual impairment and blindness are as follows:

• refractive errors
• cataracts
• diabetic retinopathy
• glaucoma
• age-related macular degeneration