Behavior state is potentially a major variable that affects the level of alertness and responsiveness of persons with profoundly handicapping conditions. Two studies were conducted involving 50 students with severe, profound, and multiply handicapping conditions who ranged in age from 1 year and 8 months up to 21 years. In Study 1, behavior slate conditions for each student were observed across 20 sessions in classroom settings. Data were analyzed according to profile groups that reflected similarities and differences in behavior state conditions. The analyses also included short and long term measures of state stability. Results indicated that these stability measures further differentiated the profile groups. The data also showed that the students were observed to spend an average of 42% of their classroom time in slate conditions that were not judged optimal for learning. In Study 2, developmental, medical, environmental, and student characteristic data were compared statistically for the profile groups identified in Study 1. These results showed some different characteristics and conditions associated with each of the behavior state profiles. Overall results suggested that behavior state conditions have significant implications for the education and treatment of students with the most profound handicaps.

Implications of biobehavioral state measures for the assessment of students with profoundly handicapping conditions are discussed in relation to similar behaviors observed in infants and among persons recovering from severe head trauma. Data are presented showing different profiles in biobehavioral states among students with severe and profound disabilities. These profiles are compared with similar descriptions of physical and psychological functioning described in the head-trauma literature, with a discussion of similar education and intervention problems and the need for more exchange of information between special education and rehabilitation therapy for persons with severe neurological impairments. Additionally, biobehavioral state measures among persons with severe and profound disabilities are offered as a potentially valuable assessment tool with important implications for improved intervention strategies and future research directions.

Behavior states and related developmental and medical variables were observed during all or part of the first 4 years of life for 34 infants identified with severe cognitive and multiple disabilities. Eight infants died before 1 year of age. Extensive data were then collected for an additional group of 8 infants who were observed through the age of 4 years. Findings demonstrated emerging state profiles during this time period that were consistent with those found among older populations observed in previous investigations. Different behavior state profiles at age 4 years were indicated by several developmental skills in the first year of life. These results suggest the need for specific, early interventions with infants whose state patterns are inconsistent with optimal learning and development.

A review is presented of recent research on state behavior among children and youth with profound disabilities. A model depicting interactions of state with endogenous and exogenous variables is presented along with a discussion of the importance of state diversity potential to this analysis and considerations for investigating and understanding state organization patterns in this population. Applications of the model are illustrated through case studies of four students with profound disabilities who display different state patterns. Measurable attributes of state reveal major characteristics that define functionally profound disabilities and have important implications for intervention.

This paper provides a review of several critical issues and directions for research and practice, centred on children with multiple and severe disability, with special attention to the recent study of individual behaviour states as a measure of arousal and involvement. It notes several areas for future research and discusses educational interventions designed to improve the engagement of children, focusing on the central role of early intervention and human ecologies in supporting the achievement of positive educational outcomes for this population.