Objective: To outline the implications of additional disabilities on learning and development.

• Many students with visual impairments have additional disabilities. The additional disability can include but may not be limited to one or more of the following: (a) intellectual disability; (b) physical disability; (c) sensory disability (deafblindness); and (d) emotional disability/autism.
• Bear in mind the impact that combined disabilities have on the student’s ability to learn and participate in the world around her. A combination of disabilities is not simply one disability plus another disability; the combination has a cumulative impact that creates significant barriers for the child and her ability to interact with the world.
• Children with blindness or low vision are sometimes improperly diagnosed with an intellectual impairment due to the challenges they encounter when they have an additional disability. For a child with a visual impairment and cerebral palsy, the response time may vary if she has to use her body to communicate. It is important to be sure that the reason for the delayed response is clear. If extra time is needed to make the motor movements necessary to respond, the child may not have an intellectual impairment.
• A physical disability combined with a visual impairment has a tremendous impact on the child’s ability to travel and access the world. Orientation and mobility techniques will need to be specialized. The child’s ability to gain information tactually may be reduced if physical access is limited.
• An additional sensory impairment (e. g., deafblindness) significantly impacts the child’s access to information. With reduced vision AND hearing, the child is significantly limited in her ability to obtain information from the world, and incidental learning is even more reduced. Communication with others presents a significant challenge.
• Emotional disability/autism combined with visual impairment can have an impact on interaction with the world. Due to possible communication difficulties and reduced social awareness/social skills, the child may tend to avoid interactions with others and/or lack the ability to communicate with others in a typical manner. However, be cautious about labeling a student as autistic, because many of the mannerisms that may look like autism (rocking, hand flapping) are not unusual for a visually impaired child who is seeking sensory stimulation.
• Children with visual impairments and additional impairments require an education team comprised of educators and related service personnel (OTs, PTs, SLPs, O&M, etc.) who are experienced with children with visual impairments and additional disabilities and can provide an educational program appropriate for their needs.