Children with Multiple Handicaps

Throughout Canada, changes are being made to facilitate and provide a positive inclusion experience for all children with special needs.  In our society, it’s important that we emphasize the dignity and value of each child.  The myth that only “some” children can be included is false, all children can be included with the proper community support. The key to a successful inclusion experience is team work and communication.  We need to remember that the parents\guardians are such a vital part of our team.

Here are some strategies that I’ve used as a preschool teacher.

Basic guidelines:

  • Project a positive attitude when working with the children.  Optimism is catchy.
  • Be flexible, be prepared to make changes, adaptation to the program and/or toys to ensure a positive inclusion experience.
  • Consult with the parents\guardians, your Resource Consultant and therapists about the different methods of carrying and positioning their child.

Strategies for Self-Help Skills:

Dressing/Undressing skills:

  • Make sure that when you are helping the child, you are also interacting with him. Talk about what you are doing. For example: “I’m putting your arm in your sleeve.”
  • If the child is able to sit with some adult support, have him sit between your legs and he can use your chest as a support.
  • Give him the opportunity to become familiar with and take part in the routine.

Toilet training:

  • You can talk to your Resource Consultant or therapists about adapted toilets, toilet seats, potty and possibly the installation of grab bars, if needed for support.
  • Involve the child, let him assist you if he can, if not, talk him through it. Talk about what you are doing for example: “I’m taking your diaper off. Your diaper is wet/dry.”


  • Talk to your Resource Consultant and the therapists about using adapted utensils, bowls and cups.
  • A child may require assistance from an adult. Talk about what the child is eating, the texture, etc. Use facial expressions. Give the child the opportunity to make choices as to whether or not he would like his food or something to drink first.  He could indicate his choice by smiling, tracking with his eyes, vocalizing and/or by using visuals.
  • Use hand-over-hand for feeding if needed. Encourage independence as much as you can.

 Strategies for communication:

  • Be a commentator. Label actions, objects, people and body parts. Stress “key words”. Interpret what is happening around the room for the child.
  • There are plenty of opportunities to let the child make choices. He may indicate his choices by smiling, tracking with eyes, visuals and/or vocalizing.
  • Respond to any verbalization.
  • Always tell a child when you are going to pick them up or push them in their wheelchair.  The child who has prior warning can indicate some anticipation of what is going to happen.

Strategies for play time:

  • An adult may need to be the actual physical support for the child to help them participate with the group. However, he will also learn from peer modelling.
  • Use hand-over-hand to teach a child what to do and how to do it. Always be aware of when you can and need to withdraw the physical support. Constant repetition and practice is a valuable teaching tool.
  • Use adapted toys. Children, who may otherwise be limited to specific play situations and experiences, can actively participate in similar play activities. Friendships develop by sharing, turn-taking and cooperating by using the adapted toys. They can be borrowed from your Resource Consultant and also from a toy lending library that has adapted toys for children with special needs.
  • Make use of the child’s equipment. For example: in the dramatic play area, the child’s tray can be used as a table and all the utensils, cups and bowls can be placed on the tray to have a picnic or dinner party. Be creative!!!
  • Make sure the child is at the same level as everyone else.
  • Give the child the opportunity to play in the different positions allowing him to stretch.
  • Dicem, sand bags and Velcro can also be used to make things more secure, stable, accessible and enjoyable.

Strategies for outside play:

  • The goal is to create a barrier-free environment.
  • Incorporate manipulative play panels on your fence such as pots, pans, funnels, aquarium tubing and plastic tubing.
  • Use the child’s tray as a table to put sand, toys, etc. Make sure that all children can access the tray, you may have to use a step stool or blocks for the other children to stand on so everyone can be at the same level.

As our own knowledge about the various ways we can support children with higher needs increases, we can focus more on the possibilities rather than the disabilities. Be creative!!!

Kim Nisula, past CISS Resource Consultant
Reprinted: ACCESS Integration, Winter 1996