Transcript Understanding Students with Emotional or Behavioral Disorders

Understanding
Students with
Emotional or
Behavioral Disorders
Presented by:
Amber Melton
Defining EMD
O Inability to learn (cannot be explained by
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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
O DSM-IV is the accepted guide to psychiatric
diagnosis
O Many disorders show similar symptoms
O Some tend to occur together in the same
child
O It may take years to reach an accurate
diagnosis as symptoms change with time
and development
Educational Classifications
O Most children with a diagnosable
mental health disorder will need
special education assistance
O Usual classifications will be EMD
(Emotional Disorders) or OHI (Other
Health Impairment)
O Classification does NOT dictate
classroom placement; many of these
students succeed in a regular
education classroom
EMD
O 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)
O 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
O Internalizing
O Externalizing
O Cognitive
O Academic
Internalizing Disorders
O Anxiety - Withdrawal
O Separation anxiety disorder
O Generalized anxiety
O Phobias
O OCD
O Panic disorder
O Anorexia, bulimia
O Depression
O Post-traumatic stress disorder
Anxiety Disorders
O Frequent absences
O Fear of separation
O Isolating behaviors
O School avoidance
O Many physical
O Fear of new
O Excessive worry
O Drug or alcohol
complaints
O Frequent bouts of
tears
O Frustration
situations
abuse
O See also: OCD, PTSD
Depression
O Affects thoughts,
feelings, behavior,
relationships,
physical health
O Irritability
O In early childhood,
may appear as
irritability, defiance,
restlessness, or
clinging
O Continuing sadness
O Hopelessness, selfO
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deprecating remarks
School avoidance
Changed eating or
sleeping patterns
Frequent physical
complaints
Isolation,
nonparticipation
Internalizing Behavior
O Psychotic behavior
O hallucinations
O delusions
O schizophrenia
O schizotypal (personality disorder)
Schizophrenia
O Commonly appears in
late teens or early
adulthood
O May come on
gradually; may appear
in teens with other
mental health
diagnoses.
O Early diagnosis and
treatment is
imperative; 50
percent or more may
attempt suicide
O Withdrawn, lack
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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
O Undersocialized
Aggressive CD
O CD
O Socialized Aggressive
CD
O Socialized
delinquency
O Attention Problems -
Immaturity
O Motor Excess
O unaware of
behavioral
expectations
O gang involvement
O truancy
O “looks up to other
rule violators
O aware of
behavioral
expectations;
covert attempts
Oppositional Defiant Disorder
O Above average level of
anger, blaming, hostile,
or vindictive behavior
O May be a reaction to
frustration, depression,
inconsistent structure,
or constant failure due
to undiagnosed ADHD,
learning disabilities,
etc.
O Frequent angry
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outbursts
Noncompliant and
argumentative
Easily annoyed
Rejects praise, may
sabotage activity
that was praised
Deliberately annoys,
provokes others
Conduct Disorder
O Serious, repetitive,
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and persistent
misbehavior
Aggression toward
people or animals
Property destruction
Deceitfulness, theft
Three or more
incidents in last year;
one during last six
months
O Problem must be
persistent, not a
reaction to stress,
crisis, cultural, or
social life context
O Co-occurs with ADHD,
learning disabilities,
depression
O See also: Oppositional
Defiant Disorder
Reactive Attachment Disorder
O Disturbed and
developmentally
inappropriate social
relatedness in most
contexts
O Begins before age
five, usually after a
period of grossly
inadequate care or
multiple caretaker
changes
O Destructive, selfO
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injurious
Absence of guilt or
remorse
Extreme defiance,
provokes power
struggles, manipulative
Mood swings, rages
Inappropriately
demanding or clinging
Bipolar Disorder
O Frequent, intense
shifts in mood,
energy, motivation
O Shifts in children are
very fast and
unpredictable
O “Mania” phase may
appear as intense
irritability or rages
O Anxiety, defiance
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may be seen
Strong craving for
carbohydrates
Impaired judgment,
impulsivity
Delusions,
grandiosity, possibly
hallucinations
High risk for suicide
and accidents
Obsessive-Compulsive
Disorder
O Intrusive, repeated
thoughts
O Senseless repeated
actions or rituals
O Frequently co-occurs
with substance
abuse, ADHD, eating
disorders, Tourette
Syndrome, other
anxiety disorders
O Difficulty finishing work
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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
O Affects children who
are involved in or
witness a traumatic
event
O A concern with
refugee populations
O Intense fear and
helplessness
predominate at
event and during
flashbacks
O Flashbacks,
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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
O Anorexia, Bulimia
O Now at earlier ages,
10-20% boys
O Perfectionists, overachievers, athletes
at highest risk
O High risk for
depression, alcohol,
and drug abuse
O Impaired
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concentration
Withdrawn,
preoccupied, anxious
Depressed or mood
swings
Irritability, lethargy
Fainting spells,
headaches
Cognitive
O Most have IQ in low range
O More than half have learning disabilities
O Relationship between academic and social
behaviors are connected
Academic
O Achieve below grade level in reading,
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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…
O Three million American children meet the clinical
criteria for mood disorders
O 21% of children and adolescents have a
behavioral, emotional, or mental health problem
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
O Some symptoms relate to damage due to injury,
infection, poor nutrition, or exposure to toxins
O Stressful life events, malnutrition, childhood
maltreatment, and aggression may lead to short or longterm symptoms and increase the likelihood of adverse
outcomes
Causes
O Biological
O Genetics
O Environmental
O Stressful living conditions
O Child maltreatment (neglect, physical abuse,
sexual abuse, emotional abuse)
O School factors
What would you do if this was
your student?
This won’t work!
Or this…
Not this either!
Stages of a Meltdown
O Anxiety/Starting Out – a noticeable
change in behavior
O Can be an increase or a decrease
O Examples:
Stages of a Meltdown
O Defensive/Picking Up Steam – beginning
stage of loss of rationality
O Student may become belligerent
O Student may challenge authority
O Examples
Stages of a Meltdown
O Acting-Out/Point of No Return – total loss of
control which results in physical or
emotional acting out episode
O It’s on!!!!!
O Flight or fight mechanism is triggered
O Examples
Stages of a Meltdown
O Tension Reduction/Recovery Period – a
decrease in physical and emotional energy
that occurs after one has acted out
O This is your goal
O Can happen after any stage
O Examples
Your Response
O Supportive – be non-judgemental and
empathic to attempt to alleviate anxiety
O Listen
O Show concern
O Ask questions
O Acknowledge the student’s feelings
O Understand that students with ASD and EMD
sometimes do not have automatic sensory
regulation
Your Response
O Directive – an approach to take control of a potentially
escalating situation
O Set limits
O Re-direct
O Offer choices – positive, positive; positive, negative; or
negative, positive
Your Response
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Remove the audience
Allow the student to vent and just listen
Silence is ok
Do not attempt to touch the student unless he is a
threat to himself or others
Your Response
O Once the student has reached tension
reduction, re-establish communication
O Reassure the student that your relationship
is not damaged
O Allow “down” time
Keys to Verbal Intervention
and Setting Limits
O Simple and clear
O Reasonable
O Enforceable
OStay calm
O Be aware of body language
O Give undivided attention
Why the Meltdown?
O Precipitating Factors – internal or external causes of
acting out behavior over which staff have little to no
control
O examples: poverty, rejection, bullying
O Sensory Processing Problems– the inability to filter
external sensations or organize sensory messages
O Sensitivity to light, noise, touch, taste, or smell
O Perfumes, crowded areas, scratchy clothing, bright lighting
Why the Meltdown?
O Difficulty with Abstract Thinking – inability to
imagine what is not directly perceived by the
senses
O If I can’t see it, hear it, or touch it, it must not be
true!
O Difficulty with Perspective Taking – the inability
to feel empathy (to feel what others feel)
O Inflexibility – inability to accept change or alter
what is expected
What Can You Do?
O Offer sensory breaks
O Teach social skills
O Give specific directions
and questions
O Break tasks into smaller
steps
O Use visual images to
teach abstract thoughts
O Use visual schedules
O Use timers for
transitions
O Warnings about
schedule changes
O Use video modeling
O Help peers understand
their behavior and ask
them to be supportive
and accepting
What can you do?
O Use rewards,
O Structure the classroom
setting to offer a quiet place
punishment is not as
to work
successful with EMD
O Avoid demanding eye
students
contact
O Be consistent
O Implement the use of a “safe
O Be structured
person” for needed breaks
O Positive reinforcement
O Avoid a power struggle
Questions???
Amber Melton
Positive Behavior Specialist
901-496-9345
[email protected]