Understanding Students with Emotional or Behavioral Disorders

1. Understanding Students with Emotional or Behavioral Disorders Chapter 7

2. 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

3. Diagnostic Informationin 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

4. 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

5. Emotional or Behavioral Disorders • An established pattern of one or more: • Withdrawal or anxiety, depression, problems with mood, or feelings of self-worth defined by behaviors • Disordered thought processes with unusual behavior patterns and atypical communication styles • Aggression, hyperactivity, or impulsivity that is developmentally inappropriate

6. 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

7. Characteristics • Internalizing • Externalizing • Cognitive • Academic

8. Internalizing Disorders • Anxiety - Withdrawal • Separation anxiety disorder • Generalized anxiety • Phobias • OCD • Panic disorder • Anorexia, bulimia • Depression • Post-traumatic stress disorder

9. Frequent absences Isolating behaviors Many physical complaints Excessive worry Frequent bouts of tears Frustration Fear of separation School avoidance Fear of new situations Drug or alcohol abuse See also: OCD, PTSD Anxiety Disorders

10. Affects thoughts, feelings, behavior, relationships, physical health Irritability In early childhood, may appear as irritability, defiance, restlessness, or clinging Continuing sadness Hopelessness, self-deprecating remarks School avoidance Changed eating or sleeping patterns Frequent physical complaints Isolation, nonparticipation Depression

11. Internalizing Behavior • Psychotic behavior • hallucinations • delusions • schizophrenia • schizotypal (personality disorder)

12. 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 Schizophrenia

13. 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 External Disorders

14. 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 Oppositional Defiant Disorder

15. 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 Conduct Disorder

16. 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, self-injurious Absence of guilt or remorse Extreme defiance, provokes power struggles, manipulative Mood swings, rages Inappropriately demanding or clinging Reactive Attachment Disorder

17. 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 Bipolar Disorder

18. 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 Obsessive-Compulsive Disorder

19. 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 Post-Traumatic Stress Disorder

20. Anorexia, Bulimia Now at earlier ages, 10-20% boys Perfectionists, over-achievers, 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 Eating Disorders

21. Cognitive • Most have IQ in low range • More than half have learning disabilities • Relationship between academic and social behaviors are connected

22. 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

23. 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

24. Risk Factors Research shows both biological and psychosocialfactors 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

25. Causes • Biological • Genetics • Environmental • Stressful living conditions • Child maltreatment • School factors

26. 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

27. Child Maltreatment • Neglect • Physical abuse • Sexual abuse • Emotional abuse

28. 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

29. Nondiscriminatory Evaluation (see pg.166) • Observation • Screening • Prereferral • Referral • Nondiscriminatory evaluation procedures • Determination

30. Interventions/Techniques • Positive Reinforcement • Response Cost • Proximity Control • Attention to Compliance • Ignoring • Group Consequences • Self Management • Contracts • Service Learning

31. Group Activity • Get into your group • Read Partnership Tips - Box 7-4 pg. 173 • Answer the 3 questions at the end

32. Wraparound Supports • Family driven • Collaborative • Individualized • Culturally competent • Community and strength-based • Involves community, school, family, mental health, and other services