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Low-Incidence Disabilities

Definitions of disabilities categorized as low-incidence vary in scope. Broadly defined, low-incidence disabilities refer to a visual impairment or hearing loss, deaf-blindness, and significant cognitive impairment. For children, the definition extends to any impairment that requires individualized intervention services provided by professionals with highly specialized skills and knowledge in order for the child to benefit from his or her education. Thus, this definition includes individuals with autism, traumatic brain injuries, orthopedic impairments, or multiple disabilities. Although these classifications may be useful for data collection or communicating potential needs of clients with a particular disability, individuals within each disability category may be more different than they are alike and will likely require highly individualized services.

Even when a very broad definition is used, individuals with low-incidence disabilities compose a small percentage of the population. Nevertheless, it is likely that counselors will encounter clients with low-incidence disabilities in their practice. Individuals with disabilities, like all individuals, may present with a variety of physical, social, and psychological needs that may warrant professional intervention. In keeping with ethical standards, professionals should practice within the scope of their training and recognize when it may be more appropriate to refer to a practitioner with specialized training in the area of the client's disability.

This entry focuses primarily on issues related to providing services to individuals with visual impairments, deaf-blindness, and hearing loss.

Understanding Low-Incidence Disabilities

Deaf/Hard of Hearing

Within the medical field, hearing loss is typically defined by one's ability to perceive sounds of different frequencies and at different intensities. Hearing loss is classified as normal (0–15 decibel [dB] loss), mild (26–40 dB loss), moderate (41–70 dB), severe (71–90 dB), or profound (91dB or greater). In addition, hearing losses may be classified as conductive, sensorineural, mixed, or central auditory processing disorders. Hearing loss can also be defined by functional ability. For example, individuals who are able to communicate using the telephone are often considered “hard of hearing,” while those who primarily receive information visually rather than through auditory pathways are considered “deaf.” These medical and functional definitions do not necessarily correspond with an individual's cultural identity. Some clients who have a hearing loss may consider themselves culturally Deaf (indicated with the capital D), reflecting their pride in belonging to a community of individuals that share common experiences, a rich cultural heritage, and a shared language—sign language.

The deaf and hard of hearing population is neterogenous. Factors to consider when working with an individual who is deaf or hard of hearing include the cause, type, severity, and stability of hearing loss; age of onset; type of amplification preferred; preferred communication modality; presence of any additional disabilities; and cultural affiliation. The unique interplay of these factors differentially impacts the individual's language development, speech intelligibility, academic performance, self-concept, identity, behavior, and social and emotional development.

Visual Impairment/Blindness

Definitions of visual impairment vary but often refer to levels of visual acuity or functioning. Clarity of vision is typically defined in terms of visual acuity, measured on a scale comparing the person's vision at 20 feet with that of someone who has full acuity. Visual acuity ranges from normal vision (20/20 acuity) to profound low vision acuity (lower than 20/400). Visual acuity that approximates total blindness may also be designated by functional descriptions such as the ability to detect light. The term blindness typically refers to total vision loss, including no light perception, or significant impairment in sight, making it necessary for the individual to rely primarily on senses other than vision to interact with the environment. Legal blindness does not necessarily imply total blindness, and it is defined as corrected distance visual acuity of less than 20/200 or a visual field of 20 degrees or less in the better eye. Individuals with visual impairments demonstrate a wide range of vision functioning that may fluctuate on a daily basis due to a variety of factors.

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