Transcript Understanding Students with Emotional or Behavioral Disorders

Understanding Students with
Emotional or Behavioral
Disorders
Chapter 7
Defining EBD
• Inability to learn (cannot be explained by
intellectual, sensory, or health factors)
• Inability to develop or maintain
interpersonal relationships
• Inappropriate types of behaviors or feelings
• Pervasive mood of unhappiness or depression
• Physical symptoms or fears associated with
personal or school problems
Diagnostic Information
in Children’s Mental Health
• DSM-IV is the accepted guide to
psychiatric diagnosis
• Many disorders show similar symptoms
• Some tend to occur together in the
same child
• It may take years to reach an accurate
diagnosis as symptoms change with
time and development
Educational Classifications
• Most children with a diagnosable mental
health disorder will need special
education assistance
• Usual classifications will be EBD
(Emotional or Behavioral Disorders) or
OHD (Other Health Disorders)
• Classification does NOT dictate classroom
placement; many of these students
succeed in a regular education classroom
Emotional or
Behavioral Disorders
• An established pattern of one or more:
• Withdrawal or anxiety, depression,
problems with mood, or feelings of selfworth defined by behaviors
• Disordered thought processes with unusual
behavior patterns and atypical
communication styles
• Aggression, hyperactivity, or impulsivity
that is developmentally inappropriate
EBD
• Responses must adversely effect educational
or developmental performance and be seen
in at least three settings including two
educational settings (for instance classroom and lunchroom)
• Behaviors seen must be significantly
different from appropriate age, cultural or
ethnic norms; and must not be primarily the
result of intellectual, sensory, or acute or
chronic health conditions
Characteristics
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Internalizing
Externalizing
Cognitive
Academic
Internalizing Disorders
• Anxiety - Withdrawal
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Separation anxiety disorder
Generalized anxiety
Phobias
OCD
Panic disorder
Anorexia, bulimia
Depression
Post-traumatic stress disorder
Anxiety Disorders
• Frequent absences
• Fear of separation
• Isolating behaviors
• School avoidance
• Many physical
complaints
• Fear of new
situations
• Excessive worry
• Frequent bouts of tears
• Drug or alcohol
abuse
• Frustration
• See also: OCD, PTSD
Depression
• Affects thoughts,
feelings, behavior,
relationships, physical
health
• Irritability
• In early childhood, may
appear as irritability,
defiance, restlessness,
or clinging
• Continuing sadness
• Hopelessness, selfdeprecating remarks
• School avoidance
• Changed eating or
sleeping patterns
• Frequent physical
complaints
• Isolation,
nonparticipation
Internalizing Behavior
• Psychotic behavior
• hallucinations
• delusions
• schizophrenia
• schizotypal (personality disorder)
Schizophrenia
• Commonly appears in
late teens or early
adulthood
• May come on gradually;
may appear in teens
with other mental
health diagnoses.
• Early diagnosis and
treatment is
imperative; 50
percent or more may
attempt suicide
• Withdrawn, lack
motivation
• Vivid and bizarre
thoughts or speech
• Confusion between
fantasy and reality
• Hallucinations (visual)
or delusions (auditory)
• Severe fearfulness
• Odd, regressive
behavior
• Disorganized speech
External Disorders
• Undersocialized
Aggressive CD
• CD
• Attention Problems Immaturity
• Motor Excess
• unaware of
behavioral
expectations
• Socialized
Aggressive CD
• Socialized
delinquency
• gang involvement
• truancy
• “looks up to other
rule violators
• aware of
behavioral
expectations;
covert attempts
Oppositional Defiant Disorder
• Above average level of
anger, blaming, hostile,
or vindictive behavior
• May be a reaction to
frustration, depression,
inconsistent structure,
or constant failure due
to undiagnosed ADHD,
learning disabilities,
etc.
• Frequent angry
outbursts
• Noncompliant and
argumentative
• Easily annoyed
• Rejects praise, may
sabotage activity that
was praised
• Deliberately annoys,
provokes others
Conduct Disorder
• Serious, repetitive, and
persistent misbehavior
• Aggression toward
people or animals
• Property destruction
• Deceitfulness, theft
• Three or more
incidents in last year;
one during last six
months
• Problem must be
persistent, not a
reaction to stress,
crisis, cultural, or
social life context
• Co-occurs with ADHD,
learning disabilities,
depression
• See also: Oppositional
Defiant Disorder
Reactive Attachment
Disorder
• Disturbed and
developmentally
inappropriate social
relatedness in most
contexts
• Begins before age five,
usually after a period
of grossly inadequate
care or multiple
caretaker changes
• Destructive, selfinjurious
• Absence of guilt or
remorse
• Extreme defiance,
provokes power
struggles, manipulative
• Mood swings, rages
• Inappropriately
demanding or clinging
Bipolar Disorder
• Frequent, intense shifts
in mood, energy,
motivation
• Shifts in children are
very fast and
unpredictable
• “Mania” phase may
appear as intense
irritability or rages
• Anxiety, defiance may
be seen
• Strong craving for
carbohydrates
• Impaired judgment,
impulsivity
• Delusions, grandiosity,
possibly hallucinations
• High risk for suicide
and accidents
Obsessive-Compulsive
Disorder
• Intrusive, repeated
thoughts
• Senseless repeated
actions or rituals
• Frequently co-occurs
with substance abuse,
ADHD, eating disorders,
Tourette Syndrome,
other anxiety disorders
• Difficulty finishing work
on time due to
perfectionism or ritual
rewriting, erasing, etc.
• Counting rituals,
rearranging objects
• Poor concentration
• School avoidance
• Anxiety or depression
Post-Traumatic Stress
Disorder
• Affects children who
are involved in or
witness a traumatic
event
• A concern with refugee
populations
• Intense fear and
helplessness
predominate at event
and during flashbacks
• Flashbacks,
nightmares, repetitive
play re-enactments
• Emotional distress
when reminded of
incident(s)
• Fear of similar places,
people, events
• Easily startled,
irritable, hostile
• Physical symptoms such
as headaches, dizziness
Eating Disorders
• Anorexia, Bulimia
• Now at earlier ages,
10-20% boys
• Perfectionists, overachievers, athletes at
highest risk
• High risk for
depression, alcohol,
and drug abuse
• Impaired concentration
• Withdrawn,
preoccupied, anxious
• Depressed or mood
swings
• Irritability, lethargy
• Fainting spells,
headaches
Cognitive
• Most have IQ in low range
• More than half have learning
disabilities
• Relationship between academic and
social behaviors are connected
Academic
• Achieve below grade level in reading, math,
and written expression
• Drop out of school at a higher rate than any
other students
• Mean achievement level at the 25th
percentile
• More academic problems with externalizing
behaviors
• Less likely to attend post-secondary school
On Any Given Day…
• Three million American children meet the
clinical criteria for mood disorders
• 21% of children and adolescents have a
behavioral, emotional, or mental health
problem
• One out of every 20 Minnesota children is
identified with Severe Emotional Disturbance
• Suicide is the second leading cause of death
for ages 15-34 in Minnesota. The overall
suicide rate is double the homicide rate in
the state
Risk Factors
Research shows both biological and psychosocial
factors influence the development of the brain, and
brain disorders
Many brain disorders cluster in families, showing a
genetic component or predisposition
• Some symptoms relate to damage due to injury,
infection, poor nutrition, or exposure to toxins
• Stressful life events, malnutrition, childhood
maltreatment, and aggression may lead to short or
long-term symptoms and increase the likelihood of
adverse outcomes
Causes
• Biological
• Genetics
• Environmental
• Stressful living conditions
• Child maltreatment
• School factors
Stressful Living Conditions
• 38% youth with EBD come from households
with annual income under $12,000
• 32% come from households with income
$12,000 - $24,999
• 44% single parent households
• 1/2 to 3/4 children in foster care have EBD
• Homeless children experience EBD 3 to 4
times more frequently
Child Maltreatment
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Neglect
Physical abuse
Sexual abuse
Emotional abuse
School Factors
• Students do not receive research-based
interventions in reading
• 2/3 of teachers are not certified in EBD
• Teachers working with students with
EBD experience burnout and job stress
more than other teachers
Nondiscriminatory
Evaluation (see pg.166)
Observation
Screening
Prereferral
Referral
Nondiscriminatory evaluation
procedures
• Determination
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Interventions/Techniques
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Positive Reinforcement
Response Cost
Proximity Control
Attention to Compliance
Ignoring
Group Consequences
Self Management
Contracts
Service Learning
Group Activity
• Get into your group
• Read Partnership Tips - Box 7-4 pg. 173
• Answer the 3 questions at the end
Wraparound Supports
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Family driven
Collaborative
Individualized
Culturally competent
Community and strength-based
Involves community, school, family,
mental health, and other services