Australian Disability Clearinghouse on Education and Training

The primary responsibility of any tertiary institution is to provide the best possible academic experience for all students. Students may reach their goals and realise their potential in different ways – and this is true particularly for students who have a disability.

The Flinders University of South Australia, The University of Adelaide and the University of South Australia have policies and procedures relating to access and support for students with a disability. In meeting the academic needs of these students staff may need to consider varying their teaching, assessment, and supervision practices, or changing course structures.

Staff may encounter students who are mildly or severely haring or sight impaired, who have long or short term medical disabilities, mobility disabilities, psychiatric or psychological disabilities, or a learning disability.

Each of these six brochures presents information about a specific category of disability, providing a general description of the disability and its likely impact on participation and learning, a summary of the issues which staff may need to consider when teaching and assessing students with such a disability.

Acknowledgments

These brochures have been prepared by Ann Noble and Gerry Mullins of the Advisory Centre for University Education, The University of Adelaide, 1998.

The project was funded by a University of Adelaide Equity Grant, and a grant from the UniAbility Steering Committee of the three South Australian universities.

We acknowledge a debt to previous publications, particularly those prepared by Griffith University, the consortium of New South Wales universities, and the group of Western Australian universities.

The impact of hearing loss depends on the type, extent and timing of the loss. Some students may have lost hearing over a period of time – for example as a result of ageing, or of hereditary conditions. Others may have suffered permanent hearing loss as a result of workplace noise. Students with a hearing impairment may experience difficulty with certain sound frequencies, and may have difficulty when there is significant background noise. Some students may have the condition tinnitus – a high-pitched, ringing noise in the ear. Some will have had their hearing enhanced, though not entirely restored, with cochlea implants or hearing devices.

Other students may be deaf – prelingually deaf, or deaf as the result of illness in childhood. Deaf students may lip-read, use sign language, or a combination of these. A student who uses Auslan as a first language of communication may have difficulty with the grammatical and syntactical structure of English, and may have a limited vocabulary. Some deaf students may also have speech disorders.

People with profound hearing loss often prefer to be referred to as deaf rather than hearing impaired. They see this as a positive identity rather than a negative label.

The impact of hearing impairment on learning at university

The learning processes of students with hearing impairment may be affected in the following ways:

• Students who have been deafened in early childhood are very different to students who have lost hearing later in life in terms of educational disadvantage. For example, their range of vocabulary may be limited, which in turn may affect their reading ability.
• Deaf and hearing impaired students tend to be visual learners – and this is difficult in an environment where much essential information is delivered by word of mouth, and in no other way.
• The impact of hearing impairment is clear in respect of time. Students who need information transcribed from tape must sometimes wait for a significant period of time for this to happen. This means that they may fall behind other students in the class, and confidence and self-esteem may suffer as a result.
• Students with hearing impairment may appear isolated in the learning environment. The possibility for social contacts and for interaction with other students is often limited, and this isolation or separateness may have an impact on learning.
• Participation and interaction in tutorials may be limited. Students who cannot hear the flow and nuances of rapid verbal exchange will be at a disadvantage.
• Students with disabilities frequently carry emotional ‘baggage’ as a result of past learning failures and put-downs, and this can have a long-term effect on confidence, self-esteem, and on their approach to learning.
• Students with hearing impairment coming straight from the school system will have been used to a structured, controlled, supportive environment, and may feel uncomfortable taking some of the learning risks associated with the relatively unstructured and unsupportive environment of university. Anxiety about performing in front of others may affect participation in tutorials, particularly for students who have an associated speech disability.

Communicating with students with hearing impairment

Interacting with students with a hearing impairment should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

Some students will choose to disclose their disability; others will not. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs. In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what information, if any, would need to be shared with other members of staff, or with other students in the class.

• When communicating with students with a hearing impairment it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’.
• Because hearing will fluctuate for some students, the disability itself, and the difficulties arising from hearing impairment, may not always be obvious. Many students are uncertain of the affect of revealing their disability, or may lack the confidence to speak to a member of staff. It may be best for you to initiate discussion.
• If communicating with a student who is a lip-reader, ensure that you have positioned yourself appropriately, that you do not turn away as you are speaking, or cover your lips with your hands. It is not necessary to speak more loudly than usual. Students who lip read may pick up less than half of what is spoken. It may be helpful to ask regularly whether anything needs to be repeated.
• If a deaf student is using a signing interpreter, speak to the student, not to the signer. Do not speak too rapidly, particularly if difficult terms and concepts are being introduced with which the signer may not be familiar.
• Ask students about any adaptive technology they may be using to access information or to prepare assignments. It will always help to understand just what is involved for a particular student in the preparation of their work.
• Negotiate about teaching and assessment issues on the basis of individual need, and regularly review arrangements. You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match with their preferred learning style. This ensures that the curriculum offered is inclusive.
• Students may set unrealistically high standards for themselves, and so you may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if you make your expectations clear and explicit. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both student and staff member to have a written record of the decision arrived at.

Teaching a group of students which includes students with hearing impairment

• Encourage students with hearing impairment to seat themselves toward the front of the lecture theatre where they will have an unobstructed line of vision. This is particularly important if the student is using an interpreter, lip-reading, or relying on visual clues, or using a hearing aid which has a limited range. Use the FM (frequency modulation) hearing system or induction loop if these are available in the lecture theatre. Hearing aids may include transmitter/receiver systems with a clip-on microphone for the lecturer. If using such a microphone it is not necessary to change your speaking or teaching style.
• Ensure that any background noise is minimised.
• Repeat any questions asked by students in the lecture or class before giving a response.
• Do not speak when facing the blackboard. Be aware that moustaches, beards, hands, books or microphones in front of your face can add to the difficulties of lip-readers. Students who lip-read cannot function in darkened rooms. You may need to adjust the lighting in your teaching environment.
• It is difficult for a student watching a signer to also take notes from an overhead or blackboard. Neither is a signer able to translate, at the same time, both your words and any information given on an overhead. It is important then that all information should be available in handout. Provide written materials to supplement all lectures, tutorials, and laboratory sessions. Announcements made regarding class times, activities, field work, industry visits, etc should be given in writing as well as verbally.
• Allow students to record lectures or, preferably, make copies of your lecture notes available. Flexible delivery of teaching materials via electronic media is also particularly helpful for students who have difficulty accessing information in the usual ways. For deaf students new technology, and the internet in particular, can be used to bridge many gaps.
• Ensure that lists of the subject-specific jargon and technical terms which students will need to acquire are made available early in the course.
• Any videos or films used should, where possible, be captioned. When this is not possible, you will need to consider alternative ways for students with hearing impairment to access the information.
• In tutorials, assist students who lip-read by having the student sit directly opposite you and ensure, if possible, that they can see all other participants. Control the discussion so that only one person is speaking at a time.
• Students with hearing impairment, especially those with an associated speech disorder, may prefer to have another student present their tutorial papers.
• Language abilities are often affected by hearing impairment. Many students with hearing impairment have lower reading levels, and a limited vocabulary, particularly those deafened in childhood. Provide reading lists well before the start of a course so that they can begin reading early. Consider tailoring these reading lists when necessary, and provide guidance to key texts. Allow assignments or reviews to be completed on an in-depth study of a few texts rather than a broad study of many.
• Do not make students over-anxious about making mistakes, asking questions, getting through the work, or meeting learning goals. It may be helpful for students with a hearing impairment to have an individual orientation to laboratory equipment or computers to minimise anxiety, particularly in cases where class sizes are large, and where it may be difficult to see or hear the demonstrator.

Approaches to teaching which assist all students to learn include:

• Making sure students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by:
  
  ©  previewing new topics and showing how the new
       material fits in with other parts of the subject
  
  ©  making explicit what you expect students to
       learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and
       making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
  Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits in with their previous learning and experience, to work out what they don’t yet know but need to know next.
  Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their own experiences and values.
  Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests and activities.
  Providing appropriate and adequate feedback on how students are progressing with their learning, particularly on their achievement of learning goals.
  Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn, that is, when teaching is student-centred. Where possible, provide short ‘electives’ within a subject, and introduce a variety of learning tasks – project work, problem-based activities, and resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. Have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of student self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial or lab groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw for their own learning.
• Ÿ They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career or further study options available to students.
• Ÿ They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with hearing impairment

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a hearing impairment may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on learning you can consider alternative assessment strategies.

• When their range of vocabulary is limited, students may require the use of a thesaurus or dictionary during exams. A personal computer with spelling and grammar functions may be required.
• Provide alternatives to those assignments which are based on interviews or questionnaires, and be flexible with assignment deadlines, particularly if students have had to wait for taped material to be transcribed.
• Provide extra time in examinations, particularly extra time for reading questions. Some students will prefer to have questions and instructions ‘signed’ to them.

There are some good assessment practices which will enhance the learning of students with hearing impairment (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know on what basis to negotiate for assessment accommodations or alternatives.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists or separate parts are more likely to be followed and correctly interpreted.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in approach, in organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance, and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. You (and your department) should regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.

Learning disability is the result of nervous system dysfunction which may cause the learner to receive and process some information inaccurately. The most common learning disability found in the tertiary environment is dyslexia. Other learning disabilities are dysgraphia and aphasia.

Research indicates that approximately 5% of tertiary level students have a learning disability which can cause significant difficulties in perceiving and/or processing auditory, visual or spatial information. Manifestations of the disability may vary somewhat over time. Many students who have been diagnosed as learning disabled in childhood have already established avoidance or protective or compensatory strategies to minimise the impact of the disability. However, these strategies may not necessarily be appropriate at university.

Learning disability is to all intents and purposes a ‘hidden’ disability. Often the first indication for staff will be a discrepancy between the knowledge or ability a student demonstrates in class or in discussion, and results on written assignments or in examinations.

While it is never desirable to generalise about any disability or to rely on stereotypes, there are a number of characteristics considered common to students with a learning disability. Difficulties resulting from errors in perceiving and processing information are manifested particularly in written work: through unusual and inconsistent spellings; reversals or transpositions of letters in words, or of numbers in figures, formulae, dates; omission of parts of words or sentences, or omission of auxiliary words, pronouns and prepositions; and lack of proper order or demonstrated sequence in writing and mathematical calculations. Students may also mispronounce or misread words, and have difficulty acquiring new vocabulary or a new language. Reading rate is generally slower than average, though not necessarily in all areas. Students may exhibit difficulties in time and task management, and in prioritising and organising generally.

The impact of a learning disability on learning at university

Making changes, and adjusting to new situations have been shown to be especially difficult for students with learning disabilities. Students may begin university with an unclear understanding of their own disability, though some will be very clear about their particular strengths and weaknesses. It is important to recognise that a student with perceptual or processing impairment will have difficulty with some academic tasks, but not with others. Performance may appear uneven.

The learning processes of students with learning disabilities may be affected in a number of ways:

• Deficiencies in short-term memory and cognitive processing limitations are common. This means that students may have difficulty following sequences or complicated directions, and with integrating material from a number of sources. Problems following or creating a sequence will interfere with many things in the learning environment: following and understanding the structure of a lecture; remembering facts presented chronologically; seeing the relationship between a main idea and subordinate ideas in a text.
• Students with a learning disability sometimes report information overload and confusion resulting from having more ideas (and having to hold on to them) than they can manage to translate into acceptable words or structures. They may have difficulty in moving from the role of writer to that of reader, and objectively viewing the ideas, organisation, and style of their written assignments, and achieving coherence in writing.
• Students may have difficulty with the ‘search and locate’ strategies required in library work, and in independent learning generally.
• When reading rate and reading comprehension are slow, difficulties are compounded when large amounts of material must be dealt with in a short space of time, or when many new words or concepts must be learned and incorporated into understanding.
• Visual memory skills may be poor. By comparison, oral language and discussion skills are often exceptional, though students are likely to be extremely reluctant to read aloud.
• Manual dexterity or coordination problems may be evident, often a result of difficulties in judging distance. Students may also have difficulty interpreting two- or three-dimensional models or diagrams, and following maps or directions.
• Heightened anxiety levels are common in test or performance situations. Anxiety about performing in front of others may affect participation in tutorials. Students will deal with anxiety in any number of ways – from medication to meditation, or simply by avoidance.
• Being labelled ‘learning disabled’ has a considerable impact on emotions, confidence and self-esteem. Students will often have behind them years of negative attitudes and dismissive feedback about their abilities, and this will have an impact on learning.
• Students with a learning disability coming straight from the school system may have been used to a structured and controlled learning environment, and may be uncomfortable taking some of the learning risks associated with the relatively free and unstructured environment of university.

Communicating with students with a learning disability

Interacting with students with a learning disability should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

That a student has a learning disability may not be evident to staff until after the first complex written assignment or examination. Some students will choose to disclose their disability; others will not. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs. In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what, if any, information would need to be shared with other members of staff, or with other students in the class.

• Students with a learning disability frequently carry emotional ‘baggage’ as a result of past failures and put-downs in the education system, and may find initiating discussions with lecturers difficult.
• When communicating with students with a learning disability it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’.
• Negotiate about teaching and assessment issues on the basis of individual need. You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match with their preferred learning style. This ensures that the curriculum offered is inclusive.
• Students returning to education after a significant absence may set unrealistically high standards for themselves. You may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if you make your expectations clear and explicit. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both student and staff member to have a written record of the decision arrived at.

Teaching a group of students which includes students with a learning disability

• Provide reading lists well before the start of a course so that reading can begin early. Consider tailoring reading lists, and provide guidance to key texts. Allow work to be completed on an in-depth study of a few texts rather than a broad study of many.
• Whenever you are introducing procedures or processes, or giving directions, for example in a laboratory or computing exercise, ensure that stages or sequences are made clear, and are explained in verbal as well as written form.
• Use as many verbal descriptions as possible to supplement material presented on blackboard or overhead. Students with a learning disability often have a marked preference for an auditory mode of learning.
• Present information in a range of formats – handouts, worksheets, overheads, videos – to meet a diversity of learning styles.
• Use a variety of teaching methods so that students are not constrained by needing to acquire information by reading only. Where possible, present material diagrammatically - in lists, flow charts, concept maps etc. Keep diagrams uncluttered, and use colour wherever appropriate to distinguish and highlight.
• Ensure that lists of technical / professional jargon which students will need to learn are available early in the course.
• Students with a learning disability find it difficult to listen and write at the same time. Being able to record lectures will assist those students who have handwriting or coordination problems, those who write slowly, as well as those who have a tendency to mishear or misquote. Students will be more likely to follow correctly the sequence of material in a lecture if they are able to listen to the material more than once.
• Repetition is important for students with a learning disability. Wherever possible, ensure that key statements and instructions are repeated or highlighted in some way.
• Students with a learning disability are generally not efficient users of time, and so will benefit from discussion on time management and organisation issues. Such discussions can be built in to tutorial activities.
• Extra tutoring in subjects where processes and sequences are important may be desirable.
• Students with a learning disability may benefit from having oral rather than written feedback on their written assignments.
• Do not make students over-anxious about making mistakes, asking questions, getting through the work, or meeting learning goals. It may be helpful for students with a learning disability to have an individual orientation to laboratory equipment or computers to minimise anxiety.

Approaches to teaching which assist all students to learn include:

• Making sure students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by:
  
  ©  previewing new topics and showing how the new
       material fits in with other parts of the subject
  
  ©  making explicit what you expect students to
       learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and
       making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
• Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits in with their previous learning and experience, to work out what they don’t yet know but need to know next.
• Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their own experiences and values.
• Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests and activities.
• Providing appropriate and adequate feedback on how students are progressing with their learning, particularly on their achievement of learning goals.
• Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn – that is, when teaching is student-centred. Where possible, provide short ‘electives’ within a subject, and introduce a variety of learning tasks – project work, problem-based activities, and resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. Have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of student self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial or lab groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw in their own learning.
• They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career or further study options available to students.
• They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with a learning disability

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but you are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a learning disability may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on performance you can consider alternative assessment strategies.

• Allow extensions to assignment deadlines if extensive reading has been set. Consider setting alternative assignments in which students have the opportunity to work on a few selected texts rather than having to read extensively.
• Students with a learning disability may take longer to organise thoughts and sequence material. In drafting an essay some students will write, read on to tape, listen and then correct. This all takes time. Students will benefit from discussing their outlines, with particular attention being paid to appropriate relationships and connections between points.
• If a student has submitted an unsatisfactory assignment, rather than giving a fail grade, discuss the shortcomings of the paper with the student, and allow resubmission, perhaps on another, but related question.
• Students with a learning disability will need extra time in an examination for reading and analysing questions, and for planning their answers. Some students will request that examination questions be read to them. Some students may prefer to dictate their answers to a scribe. They will need a venue which is quiet and distraction-free.
• Many students with a learning disability will prefer oral assessment to written. Allow students to read written examination responses aloud and correct as they read. Some students need to hear what they have written in order to determine whether they have written what they intended. Some students may prefer a combination of oral and written assessment – with greater weighting for the oral component. An oral examination is not an easy option for students. Give the same time for an oral examination as for a written exam, but allow extra time for the student to listen to, and refine or edit taped responses. In your assessment, allowance should be made for the fact that spoken answers are likely to be less coherent than written answers.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists, or distinct parts are more likely to be correctly interpreted.
• Because students with a learning disability find it difficult to read multiple choice questions in a way that allows them to appreciate subtle changes in the arrangement of words, short answer questions will be a better test of their knowledge.
• Many students with a learning disability are chronic misspellers, and use dictionaries only with great difficulty. Allow students to use a word processor in examinations so that they have access to a spell checker.

There are some good assessment practices which will help students with a learning disability (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know what they are required to demonstrate.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this, though students with a learning disability will need extra time if this option is used.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in approach, in organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance, and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. You (and your department) should regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.

A wide range of medical conditions may interfere with students’ ability to attend lectures and tutorials, complete assignments by due dates or be assessed in the usual ways. These conditions include epilepsy, asthma, diabetes, kidney disorders, cystic fibrosis, cancer, hepatitis, chronic fatigue syndrome (CFS) and HIV/AIDS. While some of these conditions are lifelong, others, such as CFS, for example, may last for periods ranging from a few months to several years.

Students with neurological diseases may also have mobility and/or vision impairment. Students with epilepsy may have damage to the part of the brain which affects speech. There may be a lack of balance and coordination with some conditions, as well as chronic fatigue. Other common disabling characteristics include severe headaches, backache, joint pains, blurred vision, weakness or numbness in limbs, and breathlessness, often triggered by stress. Students receiving treatment for cancer may have long and debilitating periods of nausea and fatigue.

Additionally, respiratory and cardiac diseases, which are debilitating, may affect mobility and impair the strength, speed, endurance, coordination and dexterity that are necessary for moving and manipulating equipment, and for writing.

Symptoms may fluctuate, varying in severity even over relatively short periods of time. Some medical disabilities are progressively degenerative. The course of some diseases is highly unpredictable.

The impact of a medical disability on learning at university

The impact of a medical disability on learning will vary according to the disability. Students may be affected in the following ways:

• Some medical conditions leave students vulnerable to a wide range of infections and viruses, and frequent absenteeism owing to hospitalisation and/or medication changes may be the first indication teaching staff have of the existence of a medical condition.
• There may be striking inconsistencies in performance. Some students may have difficulty persisting with tasks especially when physical discomfort is an issue. There may be intolerance to extremes of heat or light, and to some chemicals.
• Some medications may result in lethargy and concentration difficulties. This may mean that students do not participate actively in tutorial discussions. Participation may also be affected when energy levels are low, and in those whose speech is affected by the disability.
• Mood swings and depression may be associated with chronic medical conditions.
• Students may sometimes exhibit extreme anxiety, particularly if there is a history of unexpected ‘episodes’ in public.
• Some students will have had gaps in their educational experience as a result of periods of hospitalisation, and thus will often lack confidence in their learning abilities.
• Students with medical disabilities coming straight from the school system may have been used to a structured and controlled learning environment, and may not feel comfortable taking some of the learning risks associated with the relatively free and unstructured environment of university.

Communicating with students with a medical disability

Interacting with students with a medical disability should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

Some students will choose to disclose their disability; others will not. Students may be both sensitive and anxious about discussing a ‘hidden’ medical disability. Some students will experience fluctuations in symptoms and changes in different stages of some diseases, so difficulties associated with a medical disability may not always be obvious. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs. In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what information, if any, would need to be shared with other members of staff, or with other students in the class.

• When communicating with students with a medical disability it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’.
• Ask students if you can be of assistance, for example in organising the physical environment to minimise the impact of extremes of temperature, light or sound disturbance, to facilitate concentration.
• Students may benefit from your suggestions about re-scheduling academic tasks and negotiating changes to due dates etc.
• Ask students about any adaptive technology they may be using to access information or to prepare assignments. It will always help to understand just what is involved for a particular student in the preparation of their work.
• Avoid generalising limitations that exist in one area of a student’s work to other areas. Negotiate teaching and assessment alternatives on the basis of individual need. You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match with their preferred learning style. This ensures that the curriculum offered is inclusive.
• Because of gaps in schooling or lengthy periods of hospitalisation students initially may be very unsure of what level to pitch their work at. They may set unrealistically high standards for themselves, and so you may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if you make your expectations clear and explicit. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both student and staff member to have a written record of the decision arrived at.

Teaching a group of students which includes students with a medical disability

• Students with a medical disability may have frequent or unexpected absences from class. Flexible delivery of teaching material via electronic media is particularly helpful for these students. Consider taping your lectures so that students who are absent do not have to rely on other students for their learning materials.
• Workload may need to be negotiated so that students do not become over-anxious about absences. Students who are frequently absent will benefit from advance notice of topics to be covered, and assignments to be completed. You may need to be flexible about attendance rules and deadlines, the number of academic tasks to be completed, and the amount of material students are expected to access from different locations.
• Academic activities which take place off-campus (such as industry visits, interviews or field work) may pose problems. Advance notice of such visits is important. For students who are unable to participate because of their disability, supplementary laboratory practicals, films or videos may be arranged as options to visits or field trips.

Approaches to teaching which assist all students to learn include:

• Making sure students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by:
  
  ©  previewing new topics and showing how the new material fits in with other parts of the subject
  
  ©  making explicit what you expect students to learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
• Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits with their previous learning and experience, to work out what they don’t yet know but need to know next.
• Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their own experiences and values.
• Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests and activities.
• Providing appropriate and adequate feedback on how students are progressing with their learning, particularly on their achievement of learning goals.
• Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn – that is, when teaching is student-centred. Where possible, provide short ‘electives’ within a subject and introduce a variety of learning tasks – project work, problem-based activities, resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. Have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of student self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw for their own learning.
• They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career and further study options available to students.
• They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with a medical condition

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a medical disability may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on performance you can consider alternative assessment strategies.

• Allow extensions to assignment deadlines if extensive reading has been set, particularly if a student’s attendance has been interrupted, and opportunities for accessing information have consequently been limited.
• Consider redistributing the weighting of assignments. For example you might set six assignments for a semester, but inform students that only the best four marks will be counted. Students who have been unwell will thus have some choice about what and how many assignments to submit.
• Provide extra time in examinations or split papers to accommodate students with reduced writing speed. Some students with a medical disability may need rest breaks.
• Take-home examinations may be options, particularly for students with kidney disease, cancer etc. It is important for these students to be in an environment where they can use their usual support systems.
• When a medical condition enters an active phase, any assessment should be postponed. If the cut-off date for withdrawal without fail has passed, students should be counselled to seek advice from the Disability Liaison Officer about their situation.

There are some good assessment practices which will help students with medical disabilities (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know what they are required to demonstrate.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists or distinct parts are more likely to be followed and correctly interpreted.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in approach, in organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance, and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. You (and your department) should regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.

Mobility may be impaired by a number of conditions, some of which are permanent, others of a temporary or intermittent nature. These conditions include cerebral palsy, arthritis, muscular dystrophy, multiple sclerosis (MS), Parkinson’s disease and repetitive strain injury (RSI). Back or neck injuries may also affect general mobility. A stroke may result in temporary or permanent loss of feeling or movement of part of the body – frequently on one side.

Coordination and balance may be mildly or severely affected by any of these conditions. Movement may be impaired by muscle spasms, numbness or pain. As a consequence both manipulation of equipment and writing may be difficult.

Some students may be wheelchair users. Others will walk with the aid of callipers, crutches or walking stick. Some students may suffer chronic fatigue as a result of mobility difficulties, and for others there will be extreme fluctuations of energy from day to day.

Speech and vision may also be affected in students with cerebral palsy and multiple sclerosis for example, and in those who have suffered a stroke.

Mobility disability may also result from head injury (ABI – acquired brain injury). Increasing numbers of students are returning to university following vehicle or sporting accidents in which they have sustained some degree of brain injury. Resulting impairment may affect speech, vision, coordination, and the injury may also be responsible for personality disorders or depression.

Depression is also often associated with degenerative conditions such as multiple sclerosis. When speech is affected there may be difficulty communicating with and relating to others.

Some cardiac and respiratory diseases may also affect general mobility. Staff need to remember that some of these conditions are characterised by periods of remission so the disability will not always be visible, and will not always impact on the student’s ability to function in the university environment.

The impact of a mobility disability on learning at university

The impact of a mobility disability on learning will vary according to the specific disability. For most of these students, however, the issues of most significance relate to physical access (to classrooms, laboratories, equipment), participation (in field trips, off-campus visits) and the time and energy expended in moving around campus.

Students may be affected in the following ways:

• When there is limited time to move between venues, students may miss the beginning of a class.
• Fatigue is common for many of these students. Using facilities which others take for granted, such as toilets, food-outlets, libraries, and lecture rooms may be a major undertaking.
• Some students may experience functional difficulties: an inability to write using a pen; reduced writing speed; involuntary head movements which affect the ability to read standard-sized print; and reduced ability to manipulate resources in the learning environment. They may have difficulty turning pages or using computers.
• Students may have frequent or unexpected absences from class owing to hospitalisation or changes in their rehabilitation or treatment procedure. Earlier periods of hospitalisation may have meant gaps in schooling.
• Students with a long-standing mobility disability may carry emotional ‘baggage’ as a result of previous labelling and put-downs. Confidence and self-esteem may have been affected.
• Students with a mobility disability coming straight from the school system may have been used to a structured and controlled learning environment, and may be uncomfortable taking some of the learning risks associated with the relatively free and unstructured environment of university.
• Students with a mobility impairment may be isolated in the learning environment. The possibility for social contacts and for interaction with other students is sometimes limited, and this isolation or separateness may have an impact on learning.

Communicating with students with mobility disability

Interacting with students with a mobility disability should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

The fact that students have a mobility disability may not always be immediately apparent. Needs will vary, and difficulties may fluctuate. Some students will choose to disclose their disability; others will not. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs. In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what, if any, information would need to be shared with other members of staff, or with other students in the class. It is also important to ask students if physical assistance (for example opening doors or carrying books) is required.

• When communicating with students with a mobility disability it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’.
• Students using wheelchairs often complain of being patronised, and of being spoken to as if they are deaf, or in some way ‘not quite there’, or mentally deficient. Communicate just as you would with any other student.
• Do not lean on a student’s wheelchair or move it without seeking permission. Consider the wheelchair as part of the student’s personal space.
• Ask students about any adaptive technology they may be using to access information or to prepare assignments. It will always help to understand just what is involved for a particular student in the preparation of their work.
• Negotiate about teaching and assessment issues on the basis of individual need. You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match their preferred learning style. This ensures that the curriculum offered is inclusive.
• Sometimes students may set unrealistically high standards for themselves, and so you may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if your expectations are clear. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both student and staff member to have a written record of the decision arrived at.

Teaching a group of students which includes students with a mobility disability.

• Students who use wheelchairs, callipers or crutches, or who tire easily, may find it difficult moving about within the constraints of lecture timetables. Absence or lateness may be a result of the distance between teaching venues, so at the end of a lecture you may need to recap any information given at the beginning.
• Academic activities which take place off-campus (such as industry visits, interviews or fieldwork) may pose problems. Consider supplementary laboratory practicals, films, or videos as options to field trips.
• Students with a mobility disability may sometimes wish to use their own furniture, such as ergonomic chairs or sloped writing tables. Extra space may need to be created in teaching rooms, but this should be done unobtrusively. Some students with back problems may prefer to stand rather than sit.
• Some students may need to use a tape recorder or notetaker in lectures. Extra time is involved in processing information acquired in this way. It is common practice in some departments to routinely tape all lectures. This is a practice which will assist a variety of students, including those who may be absent from time to time because of their disability.
• Students may need extensions to deadlines for work involving locating and using library resources. Provide reading lists well before the start of a course so that reading can begin early.
• Social and academic isolation may be an issue for students who are unable to participate in some class activities. One-to-one sessions with a tutor may help fill this gap in participation.

Approaches to teaching which assist all students to learn include:

• Ensuring that students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by: 
  
  ©  previewing new topics and showing how the new
       material fits in with other parts of the subject
  
  ©  making explicit what you expect students to
       learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and
       making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
• Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits in with their previous learning and experience, to work out what they don’t yet know but need to know next.
• Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their experiences and values.
• Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests.
• Providing appropriate and adequate feedback on how students are progressing with their learning, particularly on their achievement of learning goals.
• Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn, that is, when teaching is student-centred. Where possible, provide short electives within a subject and introduce a variety of learning tasks - project work, problem-based activities, and resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. Have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of student self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial or lab groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw for their own learning.
• They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career or further study options available to students.
• They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with a mobility disability

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a mobility disability may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on performance you can consider alternative assessment strategies.

• A reader or an oral examination (either presenting answers on tape or participating in a viva) are alternatives to the conventional written paper. An oral examination is not an easy option for students. Give the same time for an oral examination as for a written exam, but allow extra time for the student to listen to and refine or edit responses. In your assessment, allowance should be made for the fact that spoken answers are likely to be less coherent than written answers.
• For some students the combination of written and oral examination will be most appropriate. Allow students to write answer plans or make outline notes, but then to answer the question orally. Your assessment should be based on both the notes and the spoken presentation.
• Students may need to use a personal computer or a personal assistant in an examination. If so it may be necessary to provide extra space for equipment, or a separate examination venue if the noise from equipment (for example a voice synthesiser) is likely to be distracting for other students.
• Provide extra time in examinations for students who have reduced writing speed. Some students with a mobility disability may need rest breaks. Take-home examinations and split papers may be options, given that some students may need double time to complete examinations.
• Allow extensions to assignment deadlines if extensive research involving physical activity (for example, frequent trips to the library or collection of data from dispersed locations) is required.

There are some good assessment practices which will help students with a mobility disability (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know what they are required to demonstrate.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists or separate parts are more likely to be followed and correctly interpreted.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this. Students with impaired hand or arm function will need assistance to turn pages, and therefore extra time.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in the approach to teaching, organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance, and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. Ensure that you (and your department) regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.

Disabilities labelled as psychiatric or psychological may include schizophrenia, clinical depression, bipolar disorder, eating disorders such as anorexia nervosa, and anxiety disorders. Substance abuse and acquired brain injury (ABI) may have associated psychological disabilities, sometimes referred to as personality disorders.

These disabilities may be characterised by anxiety, erratic behaviour, panic attacks, attention deficit, fluctuating motivation, and disorganisation. These may also be features of post-traumatic stress disorder (PTSD).

These psychiatric / psychological disabilities may be transitory (induced by recent personal trauma) or of longer standing. Symptoms range from mild and episodic to severe and ongoing, so that students may sometimes require academic accommodations, and other times not. To all intents and purposes these disabilities are ‘invisible’.

Depression is one of the most common psychological disabilities evident in the university environment. Also common are various anxiety disorders. Anxiety may manifest itself in a number of ways. Students may withdraw from interaction with others. They may experience unpleasant physical manifestations – rises in temperature, sweaty palms, palpitations. Students taking prescription medication, may experience drowsiness, persistent thirst, vision difficulties, and problems with coordination.

The impact of a psychiatric or psychological disability on learning at university

The learning processes of students with a psychiatric or psychological disability may be affected in the following ways:

• The idea of being ‘sick’ or ‘different’ may have resulted in low self-esteem and lack of confidence, and this will affect approaches to learning. Students who are anxious about new situations and new people may isolate themselves in the university environment.
• Students may have frequent or unexpected absences owing to hospitalisation and/or medication changes.
• Staff may notice that students have rigid thinking patterns and inflexible approaches to tasks, a result of lack of confidence and anxiety about new experiences.
• Students may tend to rote learn because of anxiety, may lack confidence generally, and have difficulty performing consistently or following through on tasks. They may also worry about perceived inadequacies, without there necessarily being any evidence of these.
• Severe anxiety may significantly impair participation in tutorials and performance in examinations.
• There may be evidence of short-term memory loss which will affect both the ability to recall information, and attention span. Students may have difficulty following sequences, complicated instructions and directions, and with integrating material from different sources. They may be easily ‘overwhelmed’ by information.
• When students are unwell they may be inclined to misinterpret questions, comments or instructions, or be vague in their responses to questions. Some students may misinterpret non-verbal cues in particular. They may tend to impulsiveness and unpredictability and may sometimes appear obsessive, asking questions repeatedly, returning frequently to issues already covered, or repeating things.

Communicating with students with a psychiatric or psychological disability

Interacting with students with a psychiatric or psychological disability should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

Some students will choose to disclose their disability; others will not. There is still a considerable social stigma attached to psychiatric disability, as well as numerous persistent myths, so that disclosure and discussion of their disability may be particularly difficult for a student. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs. In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what, if any, information would need to be shared with other members of staff, or with other students in the class.

• When communicating with students with a psychological or psychiatric disability it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’.
• Negotiate about teaching and assessment issues on the basis of individual need. You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match their preferred learning style. This ensures that the curriculum offered is inclusive.
• Students returning to education after a significant absence may initially be very unsure of what level to pitch their work at, or may set unrealistically high standards for themselves. You may need to help students focus on more realistic and achievable standards and goals. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both the student and staff member to have a written record of that decision.
• Always allow sufficient time for discussions with students so that they do not get anxious about unfinished conversations or unresolved matters. Students who fear that they are misunderstood (both generally and specifically) may have difficulty asking for accommodations.
• If any disturbing or inappropriate behaviour is evident in the classroom this should be discussed with the student privately, and future behaviour agreed upon.

Teaching a group of students which includes students with a psychiatric or psychological disability

• Flexible delivery of teaching material via electronic media is particularly helpful for students who are unavoidably absent from class, or who cannot participate in classes for extended periods of time.
• Making reading lists and handouts available early in the course will assist students who may be frequently absent to continue with their learning, even though they may be unable to attend classes.
• Anxiety is prevalent among students with psychiatric disabilities. Severe anxiety may reduce concentration, distort perception, and interfere with the learning process. Students who are anxious about workload may benefit from tailored reading lists, with some guidance to key texts. You might allow work to be completed on an in-depth study of a few selected texts, rather than a broad study of many. It may also be helpful to provide an individual orientation to laboratory equipment or computers to minimise the anxiety likely for some students in unfamiliar learning situations.
• Emotional and behavioural changes associated with some psychiatric and psychological disabilities can make if difficult for students to participate in tutorials or to give presentations. It may be appropriate to organise one-to-one tutoring, or to ask the student to record their presentations on tape.
• Some students with a psychiatric or psychological disability may be over-sensitive to what they perceive as criticism from others. They may prefer verbal to written feedback on assignments.
• Being able to record lectures will assist those students whose attentional processing is affected by their disability, as well as those who, because of the effects of medication and/or short-term memory loss, may tend to misinterpret or misquote.

Approaches to teaching which will assist all students to learn include:

• Making sure students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by:
  
  ©  previewing new topics and showing how the new
       material fits in with other parts of the subject
  
  ©  making explicit what you expect students to
       learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and
       making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
  Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits in with their previous learning and experience, to work out what they don’t yet know but need to know next.
• Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their own experiences and values.
• Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests and activities.
• Providing appropriate and adequate feedback on how they are progressing with their learning, particularly on their achievement of learning goals.
• Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn – that is, when teaching is student-centred. Where possible, provide short ‘electives’ within a subject, and introduce a variety of learning tasks – project work, problem-based activities, and resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. You might have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of student self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial or lab groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw for their own learning.
• They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career or further study options available to students.
• They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with a psychiatric or psychological disability

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a psychiatric or psychological disability may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on progress and performance you can consider alternative assessment strategies.

• Absences due to hospitalisation or the effects of changes to medication may affect the number of assignments students are able to complete satisfactorily. In such cases you might consider redistributing the weighting of assignments. For example, you might set six assignments for a semester, but inform students that only the best four marks will be counted. Students who have been absent or unwell will thus have some choice about what and how many assignments they submit.
• Students who are anxious about performing in front of others may prefer to tape or video record any presentations which are to be assessed.
• Some students may need extra time in examinations or require a separate room free from the distractions which may contribute to anxiety or trigger panic attacks. Take home examinations may be an option for these students.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists or distinct parts are more likely to be followed and correctly interpreted, particularly by students who are anxious.
• Students with memory loss, reduced attention span or deficiencies in short-term memory will have difficulty with multiple choice questions. Short answer questions are likely to be a better test of their knowledge.
• When a psychiatric disability enters an active phase any assessment should be postponed. If the cut-off date for withdrawal without fail has passed, students should be counselled to seek advice from the Disability Liaison Officer regarding their situation.

There are some good assessment practices which will help students with a psychiatric or psychological disability (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know what they are required to demonstrate.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in approach, in organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. You (and your department) should regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.

The impact of a vision impairment depends on the type, extent and timing of vision loss. Some students have gradually lost vision over a number of years; others may have been blind since birth. Blind students will often be guide dog or white cane users. Other students may be light-sensitive, have low or limited vision, or have limited peripheral vision. Students may use a range of adaptive equipment, for example magnifiers, closed-circuit TV, or screen-reading software.

It is important to recognise that with some vision impairments, sight fluctuates. Some people who are declared legally blind have some vision. Students may have some days when vision or light tolerance is much better than on others.

The impact of vision impairment on learning at university

The learning processes of students with vision impairment may be affected in the following ways:

• Headaches often result from eyestrain. This may reduce considerably the study time available to these students.
• Students with vision impairment may access information in a variety of ways, for example Braille, audio-tape, or enlarged print. Braille readers cannot skim read, and may take up to three times as long as other students to read a text. Students with some vision may be large-print readers. Many will be unable to read examination questions and handouts in standard print, or read their own handwriting when answering examination questions, or take their own notes. Extra time is needed to carry out some tasks, such as locating words in a text when shifting from one reading medium to another.
• Students who need information put into alternative formats must wait, often up to six to eight weeks, for the material to be produced for them. This means that they will often fall behind other students in the class. Confidence and self-esteem may suffer as a result.
• Students with vision impairment may appear isolated in the learning environment. The possibility for social contacts and for interaction with other students is often limited, and this isolation or separateness may have an impact on learning.
• Participation and interaction in tutorials may be limited. It is difficult for students who cannot see the body language and interactions of others to feel comfortable about participating. Judging when it is appropriate to interrupt or to take a turn in discussion is particularly difficult.
• Students with a vision impairment coming straight from the school system may have been used to a structured and controlled learning environment, and may be uncomfortable taking some of the learning risks associated with the relatively free and unstructured environment of university. Anxiety about performing in front of others may affect participation in tutorials.

Communicating with students with vision impairment

Interacting with students with vision impairment should be characterised by respect for their rights to dignity, confidentiality and equity. How well academic staff are able to assist these students depends very much on the relationship they are able to establish with the student.

Some students will choose to disclose their disability; others will not. At your first lecture, you might invite any students who have a disability to contact you for a confidential discussion of their specific learning needs.

In that discussion you might feel it is necessary to ask students to provide documentation to verify their disability. In doing this, ensure that students’ rights to privacy and confidentiality are recognised. You might also ask students what information would need to be shared with other members of staff, or with other students in the class.

• When communicating with students with a vision impairment it is important to acknowledge that they are students first and foremost, not ‘victims’, ‘sufferers’ or ‘conditions’. Difficulties associated with the disability may not always be obvious.
• Do not speak in other than a normal speaking voice to students who are blind. Identify yourself by name, in case the person does not recognise your voice, and indicate verbally whenever you are entering or leaving the student’s presence. Keep doors closed or open, corridors clear, and keep objects in their usual place or inform the student when they have been moved.
• Ask students about any adaptive technology they may be using to access information or prepare assignments. It will always help to understand just what is involved for a particular student in the preparation of their work.
• Students with disabilities frequently carry emotional ‘baggage’ as a result of past labels and put-downs. This can have a long-term effect on confidence, self-esteem, and their approach to learning.
• Negotiate about teaching and assessment issues on the basis of individual need, You may like to consider negotiating individual study contracts which allow students to meet your expectations in different ways which match with their preferred learning style. This ensures that the curriculum offered is inclusive.
• Sometimes students may set unrealistically high standards for themselves, and so you may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if you make your expectations clear and explicit. If you have negotiated any adaptation to teaching or assessment with the student, it is good practice for both student and staff member to have a written record of that decision.

Teaching a group of students which includes students with vision impairment

• We often take for granted the amount of visual information received every day. Many blind students do not have a lifetime of visual experiences to draw upon. It may be necessary to consider the amount of assumed visual content in your subject when designing learning tasks.
• Do not make students over-anxious about making mistakes, asking questions, getting through the work, or participating generally. It may be necessary for students with significant vision impairment to have an individual orientation to laboratory equipment or computers in order to minimise the anxiety likely in an unfamiliar environment.
• For students with vision impairment your teaching style will need to be ‘verbal’. Think about how to communicate information to students who cannot see what you are doing.
• Verbalise what is written on the blackboard and on overheads. Talk through any calculations as they are made, or procedures as they are carried out. Read any printed information, and describe any charts or graphs being used. Additionally, this information will need to be available in written form so that it can be transcribed for Braille and large-print readers, and referred to at a later date for revision or assignments.
• Academic activities which take place off-campus (such as industry or workplace visits, interviews or field work) may pose problems, and on-campus alternatives may need to be considered.
• Consider supplementing laboratory practicals, experiments, or field trips, for example by audiotaping commentaries.
• Inform the student if you plan to use videos, slides or overheads and discuss alternative ways of accessing the necessary information.
• Because students with vision impairment are generally significantly slower than other students in completing reading tasks (reading is slower; considerable time is involved in getting material taped or Brailled), provide reading lists well before the start of a course so that reading can begin early. Consider tailoring reading lists, and provide guidance to key texts. Allow work to be completed on an in-depth study of a few texts rather than a broad study of many.
• The vision of some students may be affected by the glare from fluorescent lights or sunlight, and so you may need to attend to some aspects of your teaching environment. This should be done unobtrusively.

Approaches to teaching which assist all students to learn include:

• Ensuring that students know what and how they are expected to learn: that is, they are told, or they can accurately work it out for themselves. This can be done by: 
  
  ©  previewing new topics and showing how the new
       material fits in with other parts of the subject
  
  ©  making explicit what you expect students to
       learn from a lecture or tutorial
  
  ©  summarising the main points of a topic and
       making clear how that topic will be assessed.
• Integrating instructions on how to learn with content teaching.
• Designing the workload so that students have time to think, to reflect on what they have learned, to see how it fits in with their previous learning and experience, to work out what they don’t yet know but need to know next.
• Helping students see the relevance to their broader personal and vocational goals of their learning in a particular situation. Provide opportunities for students to relate what is taught in class to their own experiences and values.
• Demonstrating your interest and enthusiasm for your subject. For example, your students will better appreciate its intellectual challenge if you relate your teaching to your research interests and activities.
• Providing appropriate and adequate feedback on how students are progressing with their learning, particularly on their achievement of learning goals.
• Assessing students’ learning in line with what they thought they had to learn. Provide opportunities for students to learn how to deal with assessment tasks before the final assessment.

Students may also learn best when:

• They have some choice about what they learn and how they learn, that is, when teaching is student-centred. Where possible, provide short ‘electives’ within a subject, and introduce a variety of learning tasks – project work, problem-based activities, and resource-based activities.
• They can talk through the material with other students or with a tutor. You might provide opportunities for structured group activities in your subject so that students experience both individual and collaborative learning. Have students research selected areas of a topic independently, but then collaborate in small groups for the purposes of completing a report, assignment or presentation on the topic. There are many benefits to be gained from shared experiences in learning. Encourage the establishment of self-help, discussion or focus groups. Such groups could be organised on the basis of existing tutorial or lab groups, but can also be organised beneficially across years and levels. Students thus have experience of a wider range of approaches and attitudes from which to draw for their own learning.
• They can apply their learning in a practical or vocationally-relevant way. Project work can take into account various career or further study options available to students.
• They are able to move from the concrete to the abstract. In your explanations, begin with examples or applications of theory to ‘real life’ situations, and then move to discussion of the more abstract issues.

Strategies for assessing students with vision impairment

In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.

Students with a vision impairment may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on learning you can consider alternative assessment strategies.

• Allow extensions to assignment deadlines if extensive reading has been set. Consider setting alternative assignments in which students have the opportunity to work intensively on a few selected texts rather than having to read widely.
• Examination papers may need to be enlarged or Brailled, with tactile diagrams, maps etc. It may be necessary to provide heavy line paper, a scribe, or special writing implements.
• Some students may undertake examinations using a personal computer with voice synthesiser. Some may need a reader, an oral examination with the examiner, audiotaped questions, or large print papers. It may be necessary to provide extra space for equipment and specific personnel, or a separate examination venue if the noise from equipment being used is likely to be distracting for other students.
• Provide extra time in examinations. Some students with vision impairment will require double time for examinations, so time for rest breaks will be essential. Take home examinations or split papers are a preferred option under such circumstances.

There are some good assessment practices which will enhance the learning of students with vision impairment (and all other students in the class!):

• Know what you are testing, whether it be decision-making, strategic planning, creative application of information, data collection and processing, logical sequencing, or argument, and develop assessment tasks accordingly.
• Create assessment activities in which students have the opportunity to link their learning to what they already know, and to past experience.
• Make your expectations clear so that students know what they are expected to be able to demonstrate.
• Keep written examination instructions and sentences within examination questions short. Questions using bullet points, lists or separate parts are more likely to be followed and correctly interpreted.
• Avoid using assessment methods which encourage students to rote learn material. Open book examinations are one way of doing this. Remember that this will need forward planning so that printed material can be Brailled or enlarged before the exam.
• Make explicit the way in which marks will be allocated, both in discussion with the class beforehand, and on the examination paper.
• Provide optional pathways towards meeting stated objectives, options which allow for flexibility in approach, in organisation and assessment. You might provide project-based exercises in which students choose their own topic for exploration. Given the diversity of students, the greater the diversity in methods of assessment, the fairer the process. Make accommodations based on individual circumstance and need. Remember that students may need the opportunity to experiment to find the adaptation or accommodation which best meets their learning style or needs.
• Include self-assessment as a component of the course. Self-assessment involves discussion with students about the criteria according to which they assess their own performance, and the level of performance required for different grades.
• Discuss and collaborate on assessment alternatives with staff who have had previous experience teaching students with disabilities. You (and your department) should regularly review any alternative arrangements to ensure that these meet both the student’s needs (which may change over time) and stated course objectives.