Functional assessment of students with severe disabilities.

Amanda is a 9-year-old child who is a 4th grader at University Heights Elementary School. Like her peers, Amanda's favorite food is pizza, favorite music is by Hillary Duff, and she enjoys interacting with other students in her class. Amanda also is very different than her peers. Amanda was born with severe, mixed (spastic/athetoid) cerebral palsy affecting her ability to do simple things such as sit, stand, and walk. She has very limited fine motor control (can barely hold and release objects). Besides her physical disabilities, Amanda has a severe intellectual disability, cortical blindness (very limited vision), heating loss, and no verbal language (nor does she seem to understand what is said to her). Currently Amanda receives adapted physical education services by an adapted physical education specialist two days per week. However, she needs to find out much more about Amanda's abilities and challenges before creating an appropriate, individualized education program (IEP).

As an adapted physical education specialist, assessment is critical for developing an individualized physical education program that meets the needs of the student (Kelly & Melograno, 2004). Assessment helps in determining: (a) student's present level (abilities and challenges), (b) curricular content and specific activities that should be presented to the student, (c) how to present this content to the student, and (d) the setting where the student should receive services (Block, 2000).

For children with more severe disabilities, assessment can provide additional information about the student's abilities and how best to work with the student. This information includes functional motor and functional sensory abilities, best position for various physical activities, and the student's likes and dislikes. This additional information can then be used to create a truly functional adapted physical education program for the student. Unfortunately, there are really no adapted physical education assessment tools currently on the market designed to provide a comprehensive, functional assessment of a child with severe, multiple disabilities (Horvat, Block, & Kelly, in press; Jansma et al., 1999). The purpose of this article is to share a simple assessment tool designed specifically for adapted physical education specialists who work with students with severe, multiple disabilities. In addition to reviewing this functional assessment tool, an example of how the assessment tool was used to assess a child with severe, multiple disabilities, strategies developed from this assessment, and further recommendations for future assessments are presented.

Functional Assessment of Students with Severe Disabilities

To assess a child with severe, multiple disabilities, the Functional Assessment of Students with Severe Disabilities (FASSD) was created (Block, Lauer, & Jones, 2004). This assessment tool focuses on the following eight areas.

Medical and Health Background

This introductory section of the FASSD, filled out in collaboration with the student's parents, teachers, and therapists, includes general background information such as the student's primary and secondary disabilities, restrictions or contraindications, medications, and any other general health/medical background information. Purpose of this section is to understand the student's disability and health status, and prevent activities or positions that might have negative effects on the student's health status (Block, 2000; Horvat, Block, & Kelly, in press). Questions range from a more detailed description of the student's primary and secondary disabilities, medications the student is taking, and other therapies the student receives. Below is an example of some of the questions found in this section of the FASSD.

Does the child have a feeding tube?            --
Does the child have a shunt?                   --
Does the child have scoliosis?                 --
Does the child have any dislocations? Where?   --

Functional Positions and Movement Analysis

The heart of the FASSD is the analysis of functional positions/movement. The focus is finding positions allowing the student to be most functional, whether it is moving his/her head, legs, or arms (Campbell, 2000; Szezepanski, 2005; Finnie, 1974). Functional positions include lying on back, lying on stomach (with and without a wedge), sitting in a wheelchair, sitting on a matt, and standing in a stander or gait trainer. In each of these positions the child is assessed on the ability to move head, arms, and legs, as well as the ability to grasp and release.

For each category of functional position there are five possible scores ranging from 1 to 5; (1) cannot move, (2) non-functional movement, (3) limited functional movement, (4)fair functional movement, and (5) very. good functional movement. Scoring criteria in this section are subjective and a little vague. Nevertheless, information from this section can provide adapted physical educators with a good sense of which limb the child can move most functionally and what position promotes the most active and functional movements. For example, results from this portion of the test indicate to the adapted physical education specialist that the best position for the student to move arms and grasp and release might be prone over a wedge, while the best position for this child to move legs or kick objects is standing in a gait trainer. With this information the adapted physical educator could then create a functional motor or leisure program matching the student's abilities. Assessment might reveal one child bowls by sitting in a wheelchair with a ramp presented to his right side, then pushing the ball down the ramp with his elbows, while another student bowls standing in a gait trainer, pushing the ball down the alley using her foot. Below is an example of the functional position and movement analysis portion of the FASSD.

Lying on Back
 1 = Cannot move this body part or cannot grasp and release when
     placed in this position
 2 = Can move this body part, but movement is not functional (random
     or purposeless) when placed in this position
 3 = Has limited but some functional movement or grasp/release when
     placed in this position
 4 = Has fair functional movement or grasp/release when placed in this
     position
 5 = Has very good functional movement or grasp/release when placed in
     this position

                         Trial 1                  Trial 2
                 Score   left/right/mid   Score   left/right/mid
head             --      --               --      --
left arm         --      --               --      --
right arm        --      --               --      --
left leg         --      --               --      --
right leg        --      --               --      --
grasp--left      --      --               --      --
release--left    --      --               --      --
grasp--right     --      --               --      --
release--right   --      --               --      --

Functional Stationary Positions

This short section of the FASSD provides a detailed analysis of the child's ability to maintain balance when placed in unsupported sitting or standing position. It is important for adapted physical education specialists to know whether or not a child has the potential to learn how to sit or stand independently, and thus target these skills as potential goals for a particular student. This section is similar to items found in the Mobility Opportunities Via Education (MOVE) Program (Bidabe, 1995). Items progress from the greatest ability (e.g., sits independently for 30 seconds or more) to least ability (e.g., needs significant support to sit). Scoring for this section and several sections that follow utilizes a 5-point scale:

Five-Point Scale
1 = Never
2 = Sometimes, but very inconsistent (demonstrates this
    ability less than 25% of the time)
3 = Sometimes, but more consistent (demonstrates this
    ability about 50% of the time)
4 = Usually, but still some inconsistency (demonstrates
    this ability about 75% of the time)
5 = Most of the time (demonstrates this ability about 90%
    of the time or more)

For example, a child who is inconsistent in his ability to sit for 5 seconds would receive a score of 3 (demonstrating this ability about 50% of the time). Below is an item from this section of the FASSD. Note how items in this section can to be used for developing IEP goals, short term objectives, and benchmarks, as well as on-going assessment. For example, an IEP goal for a child might be to sit for 30 seconds or more independently with benchmarks of sitting for 5, 10, and 20 seconds independently. Similarly, the scoring criteria can be used as benchmarks for an IEP or for criteria for successfully meeting an objective such as sits for 10 seconds inconsistently (<25% of the time), more consistently (<50% of the time), very consistently (<75% of the time).

Sitting                                 Trial 1   Trial 2
                                        Score     Score     Comments
Sits independently for 30 sec. or
  more                                  --        --        --
Demonstrates righting response in
  sitting                               --        --        --
Sits for 20 seconds independently       --        --        --
Sits for 10 seconds independently       --        --        --
Sits for 5 seconds independently        --        --        --
Needs minimal support to sit            --        --        --
Needs significant support to sit        --        --        --

Functional Mobility

Most tests used by adapted physical education specialists measuring mobility focus on locomotor skills such as walking, running, and jumping (e.g., Bruininks-Oseretsky Test of Motor Proficiency, Test of Gross Motor Development--II). These locomotor items are beyond the ability of many children with severe, multiple disabilities (Block & Block, 1999; Special Olympics, 2006). Functional mobility in the FASSD analyzes the student's ability to move from point A to point B on more basic mobility skills such as rolling, walking (independently or with an assistive device), using a wheelchair (manual or electric), or crawling or creeping. Included in the analysis are preferred mobility methods (e.g., does the child prefer walking with a walker or pushing a wheelchair?), and distance the student can travel (e.g., walking independently for 10 or more steps; taking 2-3 reciprocal steps). These items are similar to mobility items found in the MOVE Program (Bidabe, 1995) and Special Olympics Motor Activities Training Program (MATP) (Special Olympics, 2006). Scoring uses the same 5-point scale used in the previous section. And, as was the case with previous items on the FASSD, scoring on these items also allows for easy translation to IEP objectives and benchmarks. Results from this section can help the adapted physical education specialist determine if mobility is possible for this child, which type of mobility is most appropriate, and where to start teaching a student to improve mobility skills. Following is an example of an item from the functional mobility section of the FASSD.

Sitting                                  Trial 1   Trial 2
                                         Score     Score     Comments
Moves chair independently, avoids
  obstacles, changes directions, stops
  and starts                             --        --        --
Moves chair forward 20' or more
  independently                          --        --        --
Moves chair forward 5-10' or more
  independently                          --        --        --
Moves chair forward 1-5' or more
  independently                          --        --        --
Places hands on rims of chair
  independently                          --        --        --
Places hands on rims of chair with
  assistance                             --        --        --

Functional Physical Fitness

Traditional measures of physical fitness in children focus on tasks above the ability of most children with severe disabilities (e.g., pull ups, mile run, sit and reach) (Payne & Isaacs, 2005; Horvat et al, in press). Functional physical fitness in the FASSD measures basic strength, flexibility, and car diorespiratory endurance with reference to daily activities, as well as specific physical activities. Strength is measured in terms of a child's ability to kick or throw a ball a certain distance or pick up objects of different weights; functional cardiorespiratory endurance measures how long a child can participate in daily physical activities before getting tired; and functional flexibility measures general range of motion in arms and legs with reference to basic physical activities, such as reaching up to grab an object off a shelf, or bending down to pick up an object off the floor.

Scoring is slightly different from previous sections with scores ranging from 1 (unable to do even very simple tasks requiring strength, endurance, or flexibility) to 5 (more than enough fitness to complete most tasks of daily living). This section of the FASSD is designed to be broad and indicate if strength, flexibility, and/or endurance need to be targeted for instruction. For example, if a child scores significantly inadequately for upper body strength (cannot even hold light objects in hands for more than a second), then the adapted physical education specialist would want to target activities to improve the student's grasp and upper body strength. Following is an example of an item from the functional physical fitness sub-test:

1 = Significantly inadequate fitness; unable to do even very
    simple tasks that require fitness
2 = Inadequate fitness for most simple tasks, but child does
    have some very basic levels of fitness
3 = Needs to improve in fitness, but child has enough
    fitness to complete some (about 50%) of the
    basic tasks observed
4 = Adequate fitness--child has enough fitness to complete
    most of the fitness tasks (75% or more) of
    the tasks observed
5 = Very good fitness--child has more than enough fitness
    to complete tasks--this is an area of
    strength for the child

                                        Trial 1   Trial 2
                                        Score     Score     Comments
Functional upper body strength
(e.g., throw things, hold things,
carry things)                           --        --        --
Functional lower body strength
(e.g., kicking a ball, jumping,
walking)                                --        --        --
Functional Upper body flexibility
(e.g., bend to pick up objects,
ROM to perform simple activities
requiring stretching, bending)          --        --        --

Ball Skills

Ball skills are an important part of any comprehensive adapted physical education assessment. As was the case with locomotor items, tests such as the BruininksOseretsky and the Test of Gross Motor Development require a level of ball skill proficiency beyond the ability of most children with severe disabilities (Block & Block, 1999; Special Olympics, 2006). The ball skills section of the FASSD examines more basic ball skills such as grasping and releasing objects, as well as play with various size balls. Again, this is a functional analysis with focus on simple grasp and release for students with severe cerebral palsy, muscular dystrophy, and similar conditions. For more able-bodied students (e.g., autism or intellectual disabilities), the ball skill portion examines very basic ball skills such as rolling or throwing a ball to a partner, catching a tossed ball, kicking a stationary ball, and hitting or knocking a ball off a tee. Scoring again is on a 5-point scale ranging from 1 (never) to 5 (90% of the time). Results can be used in part to determine a student's particular interests in activities involving balls, as well as the student's present level of performance in basic ball skills that can lead to the creation of an individualized sports or recreation program. And, as with other sub-tests, scoring is designed for easy transition to IEP goals, objectives, and benchmarks, as well as on-going assessment. Below is an example of some of the ball skill items from this section of the FASSD.

Grasp/Release/Toss
Child's position--gait trainer/stander--wheelchair--on back--on stomach
Type of ball used--
                                          Trial 1   Trial 2
                                          Score     Score     Comments
Grasps then tosses object
  independently 2'                        --        --        --
Grasps then tosses object
  independently 1-2'                      --        --        --
Grasps then tosses object
  independently 5-10'                     --        --        --
Grasps then tosses object
  independently 1-3"                      --        --        --
Grasps, holds, and drops object away
  from body                               --        --        --
Grasps, holds, and drops object
  independently                           --        --        --
Grasps and holds object; inconsistent
  release                                 --        --        --
Grasps and holds object; cannot release   --        --        --
Grasp and holds object for 10-15
  seconds                                 --        --        --
Grasps and holds object for less than
  10 seconds                              --        --        --
Graps and holds object with assistance    --        --        --

Sensory Processes

Many students with autism, cerebral palsy, and severe intellectual disabilities have secondary sensory disabilities (Orelove, et al., 2004; Snell, 2000). Also, children with autism often have sensitivity to certain types of sensory stimuli (Powers, 2000). Unfortunately, most tests used by adapted physical education specialists do not measure sensory processes (Horvat et al., in press). This section of the FASSD, which should be filled out in collaboration with the student's parents, speech therapist, and vision therapist, examines student's basic sensory abilities and disabilities. In addition, this section can reveal sensory preferences (e.g., strength in understanding visual information), as well as sensory stimuli that might bother the student (e.g., student might get upset in environment with loud noises, such as in a crowded gymnasium). There is no scoring system for this section. Rather, the evaluator simply checks off the item that best represents the child's visual abilities and visual sensitivity. (See box to the right for items from the sensory pro cesses section of the FASSD.) For example, a student who consistently is frightened and easily agitated by touch would receive a severely sensitive to tactile stimulation. This information could then be used to help the adapted physical education specialist: (a) realize visual and auditory cueing are better than physical prompts and physical assistance, and (b) understand the need to create a program that might help desensitize the student to touch.

Visual Abilities (note if the child wears glasses, cause of loss [if
                 known] child's visual activity, and if the child is
                 near or farsighted)
--Excellent--vision is primary mode for information
--Good, but minimal deficits; vision is primary mode for
  information
--Fair, but moderate deficit; vision is used but misses some
  information
--Poor with moderate deficit, residual vision is used, but
  minimally
--Severe deficit; vision is not used at all

Visual Sensitivity
--Enjoys visual stimulation
--Mildly sensitive to visual stimulation
--Severely sensitive to visual stimulation

Communication Skills

Communication problems often are present in children with severe disabilities (Orelove et al, 2004; Powers, 2000; Snell, 2000), yet this is another area not a part of tests used by adapted physical educators (Horvat et al., in press). The communication skills portion of the FASSD examines how best to communicate with the student (student's receptive ability), as well as the student's ability to communicate with teachers and peers (student's expressive ability). Receptive ability focuses on finding the best way to present information. For example, many students with autism prefer visual rather than verbal cues, and within the visual domain some prefer symbols while others prefer pictures or words (Savner & Myles, 2000). Other students can understand verbal cues if only one or two word sentences are used. Scoring is the same 5-point scale used for ball skills and mobility ranging from 1 (never) to 5 (90% of the time). Below is an example of an item from the communication section of the FASSD.

Receptive Language (note here if child uses a special
                   communication device)

                                  Trial 1   Trial 2
                                  Score     Score     Comments
Understands all types of verbal
commands                          --        --        --
Understands simple verbal
commands                          --        --        --
Understands one word verbal
commands                          --        --        --
Written words                     --        --        --
Picture symbols                   --        --        --
Real pictures                     --        --        --
Environmental cues
(e.g., foot prints)               --        --        --
Gestures or signs                 --        --        --
Demonstrations                    --        --        --
Physical assistance               --        --        --

Play Behaviors and Awareness of Others

One of the hallmark characteristics of children with autism is the lack of appropriate, reciprocal play behavior (Powers, 2000). Therefore, it is important to measure play behaviors in children with autism and similar developmental disabilities. Play behaviors measure the student's general play behaviors (e.g., very isolated play; watches others, but does not engage them; or tries to interact and play with other students). Awareness of others examines how attuned the student is to other students, and whether or not the student is troubled by the presence of peers; is aware of peers, but simply disinterested in interacting with them; or if the student is aware of peers, and seeks interaction with them. Scoring again utilizes the 5-point scale used for ball skills and mobility. For example, under the heading: play behavior with objects, a student would receive a 5 (consistently displays this behavior) for the statement plays alone, appropriate exploratory/sensory play if the student consistently plays alone with objects. This same child might receive a 1 (never displays this behavior) if the student never shares toys or objects with others. Following is an example of items from the play behavior section of the FASSD.

Play Behaviors (with objects)           Trial 1   Trial 2
                                        Score     Score     Comments
Shares objects with others; plays
  appropriately                         --        --        --
Parallel play with objects; plays
  appropriately                         --        --        --
Plays alone, appropriate exploratory/
  sensory play                          --        --        --
Plays alone, inappropriate use of
  objects                               --        --        --

Awareness of Others                     Trial 1   Trial 2
                                        Score     Score     Comments
Is aware of peers and seeks out peers   --        --        --
Is aware of peers; will play with
  peers if asked                        --        --        --
Is aware of peers; prefers to play
  alone                                 --        --        --
Wants to be alone; resists playing
  with peers                            --        --        --

Sample Assessment

The student was a 9-year-old female with severe mixed (athetoid/spastic) cerebral palsy, a severe intellectual disability, and questionable vision and hearing. The assessment took place in the student's special education classroom over a two-week period through three 30-minute sessions. During this time the student was placed in one of the various positions listed on the FASSD. For example, the student was placed on her back on a matt, and the teacher would call her name while putting an object in her view to try and gain her attention. If the student responded by moving her head, the teacher would check off the corresponding amount of functional movement. For example, when the student responded by picking her head up and looking in the general vicinity of the stimuli, then the form was marked noting she had some functional movement (score of 3) with her head when placed on her back.

This same assessment protocol was implemented for the student in the other positions to determine the student's functional movements in each position. In addition, functional physical fitness was measured as follows: (1) upper and lower body flexibility (ability to reach and stretch for objects, and ability to passively straighten out and bend her legs and arms); (2) upper and lower body strength (how heavy an object she could hold and her trunk strength as noted by her ability to sit up without falling); and (3) cardiorespiratory endurance (how long she tolerated activity before she laid down and wanted to sleep).

During the functional movement assessment the teacher was also able to get a general idea of the student's ability to hear and see, sensitivity to and enjoyment of touch, and basic receptive and expressive communication skills. Basically, the student had fair but moderate deficits in both hearing and vision, and excellent sense of touch (can consistently tell if he/she is being touched). In addition, the assessment revealed the student did not seem to be bothered by sounds or sights, but she did not like toys or people to touch her body (she would push such contact away). With regard to communication, the student required physical assistance to understand what to do, and she would communicate likes and dislikes with vocalizations and by pushing you away from her. Observations of the student's sensory processes and communication skills were confirmed through discussions with the student's special education teacher and teacher assistant, as well as the student's speech therapist. Play behaviors and awareness of others were evaluated by having a peer come and try and engage this student through talking, sharing toys, and lying next to the student. Functional mobility was not administered to this particular student, since she currently does not have any functional mobility.

Once the entire assessment was completed, an assessment report was drafted and shared with key members of the child's individualized education program (IEP) team, including the child's parents. With the assessment completed, the next step was to develop a detailed long-term plan, long term goals, short-term objectives, and daily lesson plans corresponding with results from the assessment. For example, through the assessment the teacher determined this student had some basic ability to sit independently (1 minute or more, but inconsistently), but she did not have enough leg strength or pastural control for standing activities. Thus, one part of her adapted physical education program focused on improving her ability to sit independently, that in turn improved her functional trunk strength and pastural control. The teacher also found this student could grasp and hold objects for up to 10 seconds, and then release objects by putting them about 4 inches to her left (basically dropping objects on the floor away from her body). With this information part of her adapted physical education plan included increasing how long she would hold objects, attempting to get her to hold objects with two hands, and to reach and drop objects into a container rather than simply discarding objects. The teacher also found the student's favorite position for manipulating objects and interacting with peers was when she was on her back. Therefore, the student was placed on her back in lessons focusing on functional grasping and releasing and/or interacting with peers or teachers.

Information gained in this assessment also was used to teach the student how to use switches. Through correspondence with the student's special education teacher, a plan was developed regarding how switches were going to be used as part of the student's overall program. For the adapted physical education portion of the plan, switches would be used for leisure activities such as playing a radio or blowing bubbles. Using the information from the functional assessment was very valuable, because the teacher needed to know what position would allow the student to best use her grip and range of motion. The teacher also knew the student grasped better with her right hand and had better range of motion in her arms when sitting up in a supported chair.

Using both the information from the assessment, as well as from various team members, the teacher was able to order a switch operated by a koosh ball. When the student grabbed the koosh ball, the switch would light up and vibrate. The teacher began by having the student sit in a supported chair at a table, using hand-over-hand assistance to guide her to grab the switch. Changes were made through the lessons due to trial and error. While the teacher knew that was the most optimal position for the student to participate in these activities, the teacher also knew from the assessment that the student had poor vision. The teacher decided that an angled desktop better put the switch in the student's view. By providing the student with this type of desktop while she was sitting in her chair, the student not only had a better view of the switch, but also greater range of motion in her arms. In this position she also was better able to grasp the ball with one or both hands comfortably.

Things to Consider when Assessing Students with Severe, Multiple Disabilities

While the assessment was very successful to aid in developing an adapted physical education program for this student, there were a few challenges along the way. First, students with severe, multiple disabilities often are absent from school (the student described in the previous example typically misses about 1/4 of the school days during the academic year). Absences affected the teacher's ability to assess and work with the student consistently during the school year. When she returned to school, the teacher often had to start back at the beginning, because the student only retained a small amount of what she learned previously.

When assessing a child with severe, multiple disabilities, carefully read the student's file and consult with other team members to find out any information critical to the assessment process and how it will affect your assessment. Students can sometimes have positions that are contraindicated due to health concerns, such as a feeding tube or other medical apparatus. If a child does have a feeding tube but can still be placed in prone position, there is additional equipment that can be used, such as a donut pillow. If the physician does not contraindicate it, then using a donut pillow could allow the child to lie prone and prevent irritation of the feeding tube. It is important first to know these concerns, so the student is never placed in a position that could be uncomfortable.

Find out if you will have additional support from staff when performing the assessment and working with the student. Students with severe, multiple disabilities often require more support, because it can be difficult to move and position these students with only one teacher. Determine the need for extra support when planning activities, so such support can be provided. This is also important when the lesson includes transferring the child out of a wheelchair at any time during a session.

As you would with all other assessments, test the student at the same time during the day. Some students are more alert in the morning, while others may be more alert in the afternoon. Consistent scheduling of lessons and assessments insures more reliable and valid test results.

Selected References

Bidabe, L. (1995). Mobility opportunities via education (MOVE). Bakersfield, CA: Kern County Superintendent of Schools.

Block, M.E. (2000). A teacher's guide to including students with disabilities in general physical education (2nd ed.). Baltimore: Paul H. Brookes.

Block, M.E., & Block, V.E. (1999). Functional v. developmental motor assessment for children with severe disabilities. In P. Jansma (Ed.), The psychomotor domain and the seriously handicapped (4th. ed.) (pp. 89-100). Lanham, MD: University Press of America.

Block, M.E., Lauer, J., & Jones, K. (2004, April). Functional assessment of students with severe disabilities. Presentation at the Annual American Alliance of Health, Physical Education, Recreation and Dance Convention, New Orleans, LA.

Campbell, P.H. (2000). Promoting participation in natural environments by accommodating motor disabilities. In M.E. Snell (Ed.). Instruction of students with severe disabilities (5th ed.) (pp. 291-329). Upper Saddle River, NJ: Merrill/Prentice Hall.

Finnie, N.R. (1974). Handling the young cerebral palsied child at home (2nd ed.). New York: E.P. Dutton.

Forney, P.E., & Wolff, H.K. (2004). Sensorimotor development. In F.P. Orelove, D. Sobsey, & R.K. Silberman (Eds.), Educating children with multiple disabilities: A collaborative approach (4th ed.) (pp. 193-247). Baltimore: Paul H. Brookes.

Horvat, M., Block, M.E., & Kelly, L. (in press). Assessment in adapted physical education. Champaign, IL: Human Kinetics.

Jansma, P., Wallstrom, T., Walsh, M., Faison-Hodge, J., & An, M. (1999). Psychomotor domain testing of those with serious disabilities. In P. Jansma (Ed.), The psychomotor domain and the seriously handicapped (4th. ed.) (pp. 101-129). Lanham, MD: University Press of America.

Kelly, L.E., & Melograno, V.J. (2004). Developing the physical education curriculum: An achievement-based approach. Champaign, IL: Human Kinetics.

Payne, V.G., & Isaacs, L.D. (2005). Human motor development (6th ed.). New York: McGraw Hill.

Powers, M.D. (2000). What is autism? In M.D. Powers (Ed.), Children with autism (2nd ed.) (pp. 1-44). Bethesda, MD: Woodbine House.

Savner, J.L., & Myles, B.S. (2000). Making visual supports work in the home and the community: Strategies for individuals with autism and Asperger syndrome. Shawnee Mission, KS: Autism Asperger Publishing Co.

Szczepanski, M. (2005). Physical management in the classroom. In F.P. Orelove, D. Sobsey, & R.K. Silberman (Eds.), Educating children with multiple disabilities: A collaborative approach (4th ed.) (pp. 249-309). Baltimore: Paul H. Brookes.

Special Olympics International. (2006). Motor Activities Training Program--Coaches guide. Washington, D.C.: Author.

Martin Block is an associate professor and Director of the Masters Program in Adapted Physical Education in the Kinesiology Program, Curry School of Education at the University of Virginia. He is the author of the book: A Teacher's Guide to Including Students with Disabilities in General Physical Education. Dr. Block can be reached at [e-mail]. Aija Klavina is the founder and President of the Latvian Disabled Children's Youth Sports Federation. Formally trained and still practicing as a physiotherapist in Latvia, Aija also is a lecturer in the Latvian Academy of Sport Education, University of Latvia. Aija recently was elected as Secretary of the European Federation of Adapted Physical Activity. Jillian Lauer Hornbaker is an adapted physical education specialist with Loudoun County Public Schools, Leesburg, VA. Jillian has been working in Loudoun Co. for the past three years, and she and her colleagues recently created new assessment and referral tools in adapted physical education for the district