BEHAVIOR DISORDERS IN THE SCHOOL SETTING DAN BLUMHARDT & ROB ALVAREZ

FOR COUNSELING INDIVIDUALS WITH DIVERSE NEEDS PROFESSOR: DR. TINA ANCTIL JULY 19, 2011

OVERVIEW BEHAVIOR DISORDERS DEFINED ! The teen years are lled with overwhelming challenges developmentally and socially. As

such, teens can often be expected to act out in different or extreme ways compared to healthy adults. However, there are times when adolescents display patterns of behavior that go above and beyond the norm for what can be expected of a teenager; resulting in signicant social struggles that impact learning. This is where behavior disorders become relevant to the school setting. ! Behavior disorders are sometimes understood as antisocial behavior patterns that are

identied by uncommon characteristics, and by physical manifestations of psychological problems. It would be considered normal for a student that had a recent problem at home to be aggressive. However, if this same student shows a pattern of behavior over time, the behavior may be the expression of a diagnosable disorder that must be addressed. Thus, adolescents with behavior disorders are clearly distinguished from those who are simply misbehaving in a given situation or time period. Below are a few helpful denitions to further explain what a behavior disorder is: Any of a group of antisocial behavior patterns occurring primarily in children and adolescents, such as overaggressiveness, overactivity, destructiveness, cruelty, truancy, lying, disobedience, perverse sexual activity, criminality, alcoholism, and drug addiction (Mosby's Medical Dictionary, 8th edition) It is further dened as a functional disorder, which is: A physical disorder in which the symptoms have no known or detectable organic basis but are believed to be the result of psychological factors such as emotional conicts or stress (American Heritage Stedmans Medical Dictionary). EDUCATIONAL, PSYCHOSOCIAL, AND POST-SCHOOL IMPLICATIONS!

School counselors can be sure their work with these students is important. Behav-

ior disorders have a significant impact on students in educational pursuits, psychosocial development, and post-school outcomes. !In relation to academic pursuits. students with behavior disorders have poor academic records and high drop out rates (Couting M. & Oswald, D, 1995, Fergusson). In relation to the psychosocial development, students with BD are at risk for juvenile crime, mental health problems, and drug use suggests that early conduct problems are likely to act as one of the most important factors in determining long-term psychosocial outcomes (Horwood D. & Fergusson J., 1998, Fergusson et al. 2005). After school is finished, research shows that these students are at risk of not graduating and being unemployed later as a result. Horwood & Fergusson (1998) wrote: There seems to be little doubt on the basis of the accumulated evidence that reduced life opportunities should be included in the growing list of disadvantageous later outcomes that are associated with early-onset conduct problems. PREVALENCE ! First, it should be noted that behavior disorders are relatively common. The average age

of onset is 11 years of age and 19.1% (see chart below) of all youth meet the criteria for a behavior disorder (apa.org). Of those 19% of students with behavior disorders, more than half (63%) are in the emotionally disturbed category. See chart below:

Second, the prevalence for males is much higher than females. Not only do males ac-

count for two thirds of youth disabilities, but males are an even higher percentage for specic categories such as emotional disturbances (Nock M. et al., 2007; nlts2.org, 2003). ASSESSMENT/DETERMINING ELIGIBILITY ! There are a number of symptoms to look for as patterns to determine if a student needs

to be screened for a behavior disorder. These could include: Harming or threatening themselves, other people or pets Damaging or destroying property Lying or stealing Not doing well in school, skipping school Early smoking, drinking or drug use Early sexual activity Frequent tantrums and arguments Consistent hostility towards authority gures

(Substance Abuse and Mental Health Services Administration) ! ! It is helpful not only to be aware of the behaviors associated with these disorders, but

also the risk factors that can be the cause of them as assess student behavior. Here is a list of known risk factors that may result in the development of a behavioral disorder:

Child abuse Difculty interpreting the actions or intent of others Family history of mental illness or substance abuse Fetal exposure to tobacco or illicit drugs Inconsistent, harsh discipline Lack of supervision Male gender Parental substance abuse Poor social skills Stressful home or school environment

http://www.bettermedicine.com/article/behavioral-disorders

BEHAVIOR DISORDERS IN THE SCHOOL SETTING ! ! In the school setting, school counselors must live with the ambiguity that arises from the

fact that though they have often been trained to view mental health through the lens of the DSM-IV-TR, they are only allowed to use the specic criteria given by the IDEA to determine eligibility. However, the DSM-IV-TR is not irrelevant for a few reasons. First, even though a mental health diagnosis from the DSM-IV-TR is not the criteria used for special education, the symptoms of a mental health diagnosis can play a significant role in an emotional disturbance and may come to light in the process of assessing a student for eligibility. Second, though schools use their own assessments for eligibility under IDEA criteria, many behavior disorders are symptoms of mental health problems. Thus, understanding students from a mental health perspective is still relevant and useful to the assessment process. ! Due to the fact that IDEA is the measuring stick for eligibility, school counselors must

look at the criteria it provides. A student must be adversely affected in their learning and t into one of the categories. The main category a student with a behavior disorder could potentially t into, once environmental factors and the other IDEA disability categories have been ruled out, is the emotional disturbance category. Below is a denition directly from IDEA: Emotional disturbance means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems. (http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,4,i,) ! For purposes of understanding this issue, it will be good to understand a brief history on

the term emotional disturbance. In the 1960s, Eli Bower and his associates came up with criteria for students who are determined to be emtionally handicapped. In the 1970s, this criteria inuenced special education law, which now uses the same criteria for the emotionally disturbed criteria as you see above. Later, wording was added to exclude social maladjustment as a qualication. The idea was to eliminate students who had behavior problems on accord of their own will. However, social maladjustment and emotionally disturbed are so hard to distinguish, it creates plenty of confusion even now (Merrell & Walker, 2004).

AN IMPORTANT NOTE ABOUT BEHAVIOR DISORDERS & DISCIPLINE ! You may see a student behaving poorly, and think that some good old-fashioned

tough talk or discipline would straighten him or her out. Furthermore, you may view schools as letting poorly behaved students get away with it, or maybe even as reinforcing poor behavior. It is important to remember that schools have a responsibility to first determine why a student is behaving the way he or she is, and it is an important task to determine if a student has a disability before making such judgments. Ultimately, schools can do right by students with disabilities by doing proper assessment. Additionally, this is also an opportunity to address behavior problems that cannot legitimately be explained by a disability. Social maladjustment disorders do not qualify under IDEA, so poor behavior by choice only is not enough to qualify a student for Special Education services.

Socially maladjusted behaviors could include: swearing at staff, throwing objects, deance, violence, physical altercations, truancy, bringing weapons to school, bringing pornography to school, sexual misconduct, sexual harassment, re setting, destruction of property, cutting on self, any illegal activity, threats to harm self or others, suicide talk/attempts, drugs/ alcohol use, bullying, and a general disrespect to everyone. Students with socially maladjusted behaviors are synonymous with the DSM-IV-TRs diagnosis of Conduct Disorder, Intermittent Explosive Disorder, or Oppositional Deant Disorder (ODD). Behavior characteristics of a socially maladjusted student are, planned and manipulative behaviors, no regard for others, guiltless, believe themselves as superior, have entitled thinking, ignore rules, and indifferent to consequences. ! Further information is found in the back under resources that will aid in the assessment

process. Additionally, there is a detailed description & pyramid chart of different levels of behavior to help distinguish between different types of behavior disorders. TREATMENT & INTERVENTIONS ! The word treat literally means to handle with your hands, and treatment means to ap-

ply corrective action to an illness or disorder (www.webster-dictionary.net). The word intervention literally means to come in between (www.webster-dictionary.net). So, interventions are the actions used to try and reduce and/or eliminate problematic behaviors exhibited by a student. An appropriate and applied intervention can bring prompt positive results, sometimes within a few seconds for a student exuding behavioral problems. The counselor and appropriate staff members priority is always addressing and reducing the predominant problem behavior. Always remember to take a holistic approach when providing treatment for a student.

In my 12-years of being a professional counselor, I believe one of the most effective

treatment and intervention tools I have used in working with most students is the strength and value of the (therapeutic and personal) relationship. Simply stated, a positive relationship with a student (as well as staff and parents) builds trust, strength, and self-esteem. When a student knows that he or she is genuinely cared for they will listen to you and value what you have to say, especially during a stressful situation. To accept someone unconditionally allows the opportunity for a person to grow, heal, and develop their own strengths. It provides an environment where a student can have the opportunity and courage to discover themselves, where they have come from, how to relate to others and their environment. In a safe environment a student can discover meaning, direction, and a purpose to learn about self, family, life, love, etc. The school might be the only safe environment a student has, and you might be the only safe person in their life. We can help students learn about who they are, how they feel and what they think when the counselor-student relationship is strong and trustworthy. ! I think another crucial tool is self-assessment. In other words, How well do you know

yourself? How well you know yourself will determine how effective you will manage a situation with yourself, a student, a teacher, or a parent. In psychotherapy, how a patient responds/ reacts to you and how you respond/react to a patient is called transference and countertransference. Your own thoughts and feelings will be communicated, silently or actively. Students perceive the depth of your caring disposition and how sincere your intentions are with them. How you respond/react to a student, teacher, or parent when they treat you a certain way, talk to you a certain way, or behave towards you a certain way all depends on how well you know yourself and how you respond.

Overall, I believe in the premise that a students behavior, either positive or negative, is

simply a form of communicating their internal thoughts and/or feelings, either intentional or unintentional about something or someone instead of using his or her words. Some examples of this are; Kendra may misbehave in math class to avoid math time because it is difcult for her: Rick may act out in class to gain attention from his peers or teacher: Tom bullies another student because he himself was recently bullied. ! As I was writing this paper, I thought of a word picture as one way to describe the work

and situations of a school counselor. Think of yourself as a road repair worker. In the green zone, your boss tells you to go to a certain road and x the minor damages such as potholes and cracks or other minor road problems you observe. You gather some tools and some asphalt and head out to repair the road. In the yellow zone, the repairs needed to the road are more signicant and require more time to repair. It requires you to bring in other workers, warning signs, cones, ags, caution lights, and some heavier equipment. To repair the road in the red zone you need a large repair crew, you need to collaborate with the city, consider changing the direction of the road, use detour signs, or use a temporary detour for trafc. Heavy machinery might be used and the repair process could be long-term in the red zone. GREEN ZONE BEHAVIORS AND TREATMENT/INTERVENTIONS ! If a teacher contacts you about a few concerns he or she has about a student, you could

give the teacher some quick suggestions or meet with the student to have a better understanding of the situation. You might also perform observations. Together with the student and teacher, you can try some interventions that will hopefully stop the behaviors that are affecting the students ability to learn.

Examples of green zone Suggested interventions: problem behaviors:

- unwilling to do work/ assignment - talking out of turn - getting out of seat - tardy - complains - lies - cheats - unmotivated - low self-esteem - outwardly selsh - talk with parents - consult with teacher(s) - introduce to counselor - nd and use motivators - use a reward system (reward by minute, hourly, daily, weekly, etc.) - verbal praise - use a positive distraction - choice/preferred activity - rst school work, then play time - earn extra time - games - rst at lunch, rst in line, etc. - sit next to friend - snack/food - positive reports to parents via phone calls - teachers helper - lead class in pledge - class/student helper - helper for other teacher/classroom

! ! If you need more information about a students behavior, you can consult with the stu-

dents other teachers to learn if they are observing the same behaviors and if so, what interventions they are using to help the student. The behavior interventions take place before the schools formal student referral process mentioned further in this section. Again, the green zone behaviors are considered minor, should be collaboratively implemented mostly by the teacher and student, the counselor is seen as a consultant, and the behaviors should only last a few weeks in duration.

YELLOW ZONE BEHAVIORS AND TREATMENT/INTERVENTIONS ! Yellow zone interventions need more time, more people, and stronger interventions.

Students with signicant behaviors might qualify for certain special education eligibilities such as Emotional Disturbance, Autism Spectrum Disorder, Other Health Impaired, or could be considered for a 504 Plan. Some students with unknown or undetected visual, hearing, or neurological disorders may act out behaviorally but know why they are acting the way they are, so it is imperative to practice expedient communication as well as collaboration with teachers to determine if a signicant impairment could be the cause of the behaviors.

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Examples of yellow zone problem behaviors:

- not turning in homework - frustration - anxiety - disruptive - out of chair - talking out - non-compliance - argumentative - impulsive - yelling - deant - unmotivated - depressed - poor academic skills - sensory issues (touch/feel) - physical aggression - inattention - hyperactivity - difculty with handwriting/motor skills - physical difculties - mood swings - eating problems

Suggested interventions:
- talk with parents - consult with teacher(s) - 1x1 with counselor (daily, weekly) - student meets with admin - verbal prompts - 5 min/10-min breaks - talk to male versus female staff - strength assessment - lunch with staff - walk - use humor - problem solving sheet - Functional Behavior Asmnt (FBA) - Behavior Intervention Plan (BIP) - pre-referral to student team - Individual Education Program (IEP) - daily check in/out - attend groups - teach anger/social/behavior skills - emotive/empathy skills - problem solving skills - meet with student 1, 2, 3 x per week - art therapy - positive self-talk - self-esteem work - communication skills - build in breaks - teach school/classroom expectations - change schedule - delayed start/early release - break area in classroom - modify academic time - regular parental contact - reward chart - 5-point scale - positive behavior bucks - pre teach (modeling, role play) - visual cues - visual schedule - transition prompts (5-min warnings) - rst this, then that - verbal prompts - where, what, when, whats next - peer/buddy room - teach friendship skills - choice time (motivations, likes) - teach calming techniques - give attention - home rewards 11 - daily tracking sheets - academic assignment modications - referral to student support team

You can borrow and use other interventions in the other levels as appropriate since the

main goal is what will work with a student. The interventions in all 3 zones are uid and meant to build upon each other as well as be used as needed for any student. RED ZONE BEHAVIORS AND TREATMENT/INTERVENTIONS ! Some of these behaviors could still qualify a student for an ED eligibility or maybe a 504

Plan, but the more socially maladjusted, severe, and deant the behaviors, the more the student may not be eligible for special education.

Examples of red zone problem behaviors:

- swearing at staff - throwing objects - deance - chair/desk moving, throwing - physical altercations/ violence - truancy - weapons - pornography - drugs/alcohol - inappropriate sexual touching - sexual harassment - re setting - destruction of property - cutting on self - gang activity/ involvement - illegal activity - homicidal - suicidal ideation/ gestures/attempt

Suggested interventions:
- room clear - administration involvement/consult - consult w experts - school psychologist - threat assessment - sexual incident assessment - suicide assessment - delayed start/early release - safety plan - Behavior Intervention Plan - supervision plan - parent contact - student resource ofcer (SRO) - local police - Child Protective Services (CPS) - Child Abuse/neglect report - consult with gang prevention - Alternative Education Program - alternative placement - local/county mental health/programs - other local youth resources - Wrap-around Services - tutor - online school - 504

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AUTISM SPECTRUM DISORDER ! Please refer to the class presentation on Autism Spectrum Disorder (ASD) for more in-

formation. Here are just a few behavior symptoms and interventions that a student may demonstrate who has ASD:

Autism symptoms/ behavior examples - impaired social interaction - fail to respond to their names - often avoid eye contact with other people - difculty interpreting social cues - lack empathy - engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging - start speaking later than other children - may refer to themselves by name instead of I or me - dont know how to play interactively with other children (http://www.ninds.nih. gov/disorders/ autism/detail_autism).

Suggested Interventions - referral to special education services - visual pictures - visual schedule - visual activities - social stories - rst this, then that - token rewards - sensory integration - timer - Autism curriculum

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OTHER SCHOOL-BASED INTERVENTIONS ! If the interventions in the green zone are not helping the student and the behavior prob-

lems persist, a referral to the schools student intervention team is the next step. This multidisciplinary team has been referred to as the student intervention team (SIT), student services team (SST), student behavior team (SBT) as well as other titles. The team usually consists of an administrator, counselor, teacher, behavior specialist, and a special education teacher. The team process can vary from school-to-school, but its main function is to determine the next steps that the school, student, and/or parent will perform to help the student be more successful. The process usually starts by the teacher or counselor contacting the parents again (already took place in the green zone) to inform them that their child is being referred to the Team to learn how to collaborate and create interventions to best support their child. Then the teacher (or counselor) completes the team referral student packet which should include current concerns, interventions already tried, and behavior checklists for the students other teachers. Then another team member, usually the counselor completes a le review (current academic scores, discipline, attendance, academic history, etc.), completes classroom observations across different environments if needed, consults with parent(s) as needed, and gathers other pertinent information. ! At the next scheduled Student Intervention Team, the student packet is presented and

reviewed by the team. If the team knows the student well, the team may recommend and proceed with acquiring written informed consent (permission) from the guardian for special education evaluations (Autism, ED, OHI, etc.). Otherwise, the team may suggest other interventions for the teacher to use to reduce the problem behaviors and show the students response to interventions (RTI) at the next scheduled meeting. After acquiring written informed consent from the

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guardian, the assessment process (60 school days to complete) is managed by the special education teacher, also titled case manager. If the student meets the educational criteria for a special education eligibility, an IEP is developed and implemented in the classroom within 30 calendar days, and case managed by the special education teacher. If the student is not found eligible for a disability, the team may consider a 504 Plan or other appropriate behavior/academic interventions for the student. THE FUNCTIONAL BEHAVIOR ASSESSMENT (FBA) ! The Functional Behavior Assessment (FBA) is a process that guides a team to help de-

termine the function of the inappropriate behavior - in other words, why the student is doing what (s)he is doing. Per the syllabus please refer to the in-class lecture/section for more information on FBAs. Typically, behavior intervention plans (BIP) are created following the FBA. Please refer to the next Level 3 section for more information on BIPs. INDIVIDUAL EDUCATION PROGRAMS ! Per the syllabus, please refer to the in-class session for more information on IEPs.

CRISIS/DE-ESCALATION INTERVENTION ! Based on the work of David Mandt and his son Kevin, The Mandt System (1975) is an

international training program originally designed for people with disabilities in residential facilities that now has numerous agencies including schools investing in to train staff personnel on how to work with people/students who have difculty managing their own behaviors including aggression and uncooperative behaviors. The Mandt System programs focus is to reduce violence and increase safety through positive behavior supports (http://www.mandtsystem.com/ company/history.ms). Here is Mandts crisis cycle and how school staff (i.e., counselors) should respond:

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Phases of Student Crisis

Staff Response

Phase 1: Trigger/ Remove trigger/stimulant Stimulus - what is causing the student to act out? Phase 2: Escalation Give student choices with limits the student is becoming more angry or shut down Phase 3: Crisis the Least amount of interaction with student; evestudent could be yelling, ryones safety is the goal defiant, belligerent, or hiding under a desk, running away Phase 4: De-escalation/ Structured place and time for student to cool Recovery off Phase 5: Stabilization Phase 6: Post Crisis Phase 7: Student is stable Active listening Observe and support student Process and Prevention

Http://www.mandtsystem.com/crisiscycle.ms). ! When a students behavior is escalating, give the student a few reasonable choices. It is

more important to de-escalate the situation as soon as possible rather than get into a power struggle. The goal with the student is to identify the triggers and prevent the student from reaching phase 3 if possible. A few things to remember when working with a student in crisis/ escalation: ! ! ! ! ! ! ! ! Assess a students emotional state. If the student is visibly upset, use few words if any. Give a student an average of 15-minutes or more to calm down. Stay positive and talk about what a student is doing right. Let the student tell his story. Acknowledge the students feelings (active listening). Ask the student, Are you ready to(make a positive choice) Ask questions like, How can I help you? What are you willing to do? What do you want? How does this (a choice/solution) sound? ! Be aware of your proximity to the student and how it impacts a student. ! Cross-talk with another staff (communicate desired behaviors).
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 ! Use distraction techniques. ! Use humor only when appropriate and if you know the student well. THE BEHAVIOR INTERVENTION/SUPPORT PLAN (BIP) ! The Behavior Support Plan is a detailed, strategic plan to hopefully prevent the problem

behavior(s) as identied on the FBA from re-occurring. It explains the positive interventions and expectations that the student and staff will agree to use and implement for the student to be more successful in any school setting. In other words, the plan is to make the students problem behavior(s) irrelevant, inefcient and ineffective. The BIP can address one or more behavior problems depending on the severity and complexity of the plan as determined by the team. Again the counselor/ case manager should schedule a meeting to review the BIP with students and staff as well as parents. The BIP should include the following categories/strategies: 1. ! Modications to the environment (different chair/desk, designated safe/break area, buddy room, etc.) 2. ! Modications to trigger/antecedent (teacher will not call on student, teacher will use a signal or code word to cue student 3. ! Teach the alternative/appropriate behavior (instead of yelling, you can use a regular voice, stay seated, use your break area) 4. ! Teach the desired behavior (please raise your hand if you know the answer, walk from the classroom to the bathroom) 5. ! Strategies to reinforce appropriate, alternative and desired behavior (verbal praise, student will earn computer time, recess time, snack time, eagle buck for the school store, reward at home) 6. ! Consequences if student engages in problem behavior 7. ! Safety procedures if needed (back pack search, locker search, change classes to avoid student contact) 8. ! Start date and review plan date 9. ! Who will do what - assign student and staff to all listed strategies 10.! Plan for notifying appropriate staff, substitutes, administrator, etc. 11.! How will the plan be being implemented? (What information will be collected, by whom, how summarized, and when reviewed?)

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12.! How will we know if the plan is being successful? (What student outcomes will be monitored, by whom, how summarized, and when reviewed?) BEHAVIOR TREATMENT AND INTERVENTIONS SUMMARY ! In summary, here are some things to remember when working with students and creat-

ing and developing interventions; ! Always acquire as much help as possible from others to best determine the problem behaviors and how to best serve the student. ! Always consult with your team before making major decisions. ! Keep the student informed as well as the staff (as appropriate) and parent. ! Learn about other resources in your district (Family Support Team, Rotary Club, Operation School Bell, etc.). ! Consult with a Behavior Specialist who can perform FBAs and create BIPs. ! Respect the student by talking in private whenever possible; never embarrass a student especially in front of their peers. ! Remember to focus on one or two of the most signicant behaviors and not become overwhelmed with the other behaviors. ! Trust your instincts, especially if you know a student fairly well. ! Be the students advocate, respect them and show them by your actions that they are valued as a human being. ! Always communicate to a student why you are thinking the way you are; bring them along in your cognitive process of problem solving. ! Be honest with a student. ! Always remember to nd and build on a students strengths. CLASSROOM GUIDANCE LESSON OVERVIEW WITH ONE EXAMPLE ! ! One of many school approved guidance curriculums that the Salem Keizer School District uses is Steps to Respect: A Bullying Prevention Program created by the Committee for Children. The research-based Steps to Respect curriculum teaches elementary students to recognize, refuse, and report bullying, be assertive, and build friendships. The lessons are focused on reducing bullying and improving school climate. Steps to Respect lessons can help kids feel safe and supported by the adults around them, so they can build stronger bonds to school and

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focus on academic achievement (http://www.cfchildren.org/ programs/). It also has schoolwide policies and training which is similar to Positive Behavior Intervention Supports. Typically, a school counselor could teach this in a classroom, or meet with students in a small-group setting. Here is an example of a guidance lesson: L E V E L 1 Steps to Respect Curriculum ! ! ! Lesson 8 2001, 2005 Committee for Children ! ! ! ! ! ! ! ! ! ! ! ! ! ! Page 163 Lesson 8, Part 1 Students who Witness Bullying Grades 3 to 5

! !

! !

You will need: Newspaper or other attention-grabbing prop Transparency 1: Photo D, page 171

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LESSON OUTLINE 1. Grab students attention (1-min).

LESSON SCRIPT AND INSTRUCTIONS Wad up some newspaper, walk to the center of the classroom, and throw the newspaper ball into the wastebasket or onto your desk. Who saw what I did with the newspaper? Who heard, but didnt see, what I did? Who knew that something was happening but didnt pay much attention? Who didnt notice that I did anything with the newspaper? Did people in another class know what I did with the newspaper? Who can describe exactly what I did with the newspaper? All of the people who knew what happened with the newspaper were witnesses. Todays lesson is about people who witness bullying happening to others. Raise your hand if youve ever seen a bullying situation. How did you feel when you watched it? (Sad, upset, worried, angry, mad, scared.) Write student responses on the board. People who see a bullying situation are called bystanders. In the Steps to Respect program, the definition of bystander is anyone who knows that bullying is happening.

2. Ask these questions (5-mins).

3. Discuss childrens experiences witnessing bullying situations (5-mins).

Identify the characters, and then read the following scenario. At each recess, Tara runs up behind Nathan and pushes him down. Then she calls him names, laughs, and runs off. This bullying always happens in front of other people. Its been going on for three days. How many bystanders are witnessing this bullying situation? Which ones know that Nathan is being bullied? How can you tell? How do you think Nathan feels about Tara pushing him down in front of others?

4. Show Transparency 1 (5-mins).

Are the bystanders making the situation better or worse? How? How do you think these bystanders feel? (Scared, angry, worried, confused, amused, etc.) How would you feel if you were a bystander in this situation? Children who bully use power unfairly. When they get other children to gang up on someone, its unfair because its a bunch of people against one. Often, there are several bystanders watching a bullying situation. These bystanders also have power. How they use that power can either help stop bullying or make it worse. Theres a saying that goes: If youre not part of the solution, youre part of the problem. Lets think for a moment about what that means. What happens when bystanders just watch bullying? Why would they be part of the problem? (A bystander might laugh at or embarrass a person who is being bullied. Theyre not doing anything to stop the bullying. Theyre not helping the person being bullied. It gives the person bullying more power and encourages him/her to keep doing it. It makes the bullying last longer.) Imagine that you were being excluded and made fun of. Several students were watching without saying anything. What would you think and feel? (Id think that everyone is against me, and that no one will help me. Id feel hurt and lonely.)

5. Discuss these questions (5-mins).

What might the person who is bullying think if people are watching but not saying anything? (Bullying is okay. Everybodys on my side.) 6. Discuss the bystanders role in bullying situations (15-mins). Bystanders who watch give their power away to the person who bullies. They hurt the person who is being bullied. Theyre not helping, and thats how they become part of the bullying problem. An important thing to remember is that bystanders can use their power to help people who are being bullied. Actions that help stop bullying are part of the solution. All of us in this school need to be part of the solution. In this part of the lesson, we learned about bystander power. Next time, you will learn how bystanders can be part of the solution. Remember to use the transfer-of-learning tips for this lesson throughout the week.

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RESOURCES Common Diagnosis Related to Behavior Disorders Assessment Tool for Behavior Disorders: Informal Behavior Checklist Assessment Tool: Student Interview Form (older students) Assessment Tool: Student Interview Form (younger students) Journal Article Regarding Emotional Disturbance & Behavior Disorders PBIS Pyramid of Social Behavior Intervention & Description Websites

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COMMON DIAGNOSIS RELATED TO BEHAVIOR DISORDERS ! Although schools do not use the DSM-IV-TR labels for behavior, the symptoms of some of these labels could result in the types of behavior that do qualify students. Below are some of the common mental health problems related to behavior disorders: ATTENTION DEFICIT / HYPERACTIVITY DISORDER ADHD (Attention-Decit Hyperactivity Disorder) is characterized by inattention, impulsivity, and/or hyperactivity. Here are some important statistics regarding ADHD: 36% of youth with disabilities receiving special education services in secondary school have been diagnosed with ADD/ADHD. ADD/ADHD also is a secondary disability for many youth in other disability categories, including 63% of those with emotional disturbances.

3%-7% of school-aged children have ADHD. Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD. Rates of ADHD diagnosis increased at a greater rate among older teens as compared to
younger children.

The highest rates of parent-reported ADHD diagnosis were noted among children covered by
Medicaid and multiracial children.

Young (2008) esti- mates that up to two-thirds of ADHD chil- dren have one or more coexisting disorders.

Boys predominate by about 3 to 1 among stu- dents with ADHD who receive special education services

Among students with ADHD who receive special education services, 39% of 6- to 13-yearolds and 35% of 13- to 17-year-olds have low social skills, according to parents.

Approximately 40% of students in both age groups do not live in two-parent households, and
about 25% live in households with incomes below the federal poverty level. 1. 2. 3. 4. http://www.nlts2.org/reports/2003_11/nlts2_report_2003_11_ch2.pdf http://www.cdc.gov/ncbddd/adhd/data.html www.nlts2.org/fact_sheets/nlts2_fact_sheet_2004_11.pdf. http://www.stlouischildrens.org/content/greystone_1435.htm Aguiar, A., Eubig, P., Schantz, S. (2010). Attention Decit/Hyperactivity Disorder: A Focused Overview for Childrens Environmental Health Researchers. Environmental Health Perspectives. Vol. 118 Issue 12, p1646-1653, 8p

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CONDUCT DISORDER ! Conduct disorders are long-term behavior problems. These behaviors are on the serious

side, and have serious implications for students who have it. These particular students may be labeled as bad students without a better understanding of the causes for their behavior. Here is some information on conduct disorders: Students with CD may show some of these behaviors: cruelty & aggression to people and animals, bullying, ghts, using a weapon to cause serious harm, theft while assulting, sexual assult, vandalism, arson, lying, truancy, staying out at night, violation of rules. CD causes can include child abuse, drug addiction or alcoholism of parents, family conicts, genetic defects, and poverty. More common for boys than girls Complications can include development of personality disorders as adults, depression, bipolar disorder, suicide, drug, and legal problems. It is estimated that 6 percent of all children have some form of conduct disorder. The earlier a child displays extremely disturbed behavior, the worse the prognosis. In many instances, unrecognized and untreated learning disabilities and cognitive deciencies create deep frustration for a youngster. For some, delinquent behavior, however unlawful or unacceptable, provides them with both the status among peers and the opportunity for some reinforcement that they are unable to nd at school. More and more, child and adolescent psychiatrists and other professionals are recognizing the role played by prior physical, sexual, and emotional abuse in the genesis of certain kinds of aggressive and inappropriate sexual behaviors. Conduct disorder is often associated with attention-decit hyperactivity disorder (ADHD), depression, bipolar disorder, anxiety, post-traumatic stress disorder (PTSD), and substance abuse. Suicidal behavior and self-mutilating behavior are not uncommon with teenagers who have conduct disorder. Girls with a conduct disorder are prone to running away from home and may become involved in prostitution.

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 The behavior interferes with performance at school or work, so that individuals with this disorder rarely perform at the level predicted by their IQ or age. Conduct disorders are among the most frequently diagnosed childhood disorders in outpatient and inpatient mental health facilities. These include slowed development of gross motor coordination (required for throwing a ball or skipping), ne motor skills (handwriting, card playing), and impaired short-term memory, It is not uncommon for children with these kinds of problems to show poor judgment and to have trouble controlling their actions. They have difculty modulating their behaviors, feelings and even their biological rhythms of sleep and appetite. Many teenagers with conduct disorders have learning problems, especially in the area of verbal skills. Since many come from homes in which actions speak louder than words, however, lack of parental stimulation and modeling may account for these weaker verbal skills. Difculties in reading and language contribute to academic difculties, especially in the higher grades when understanding and using the written word is a crucial skill. Language decits may also contribute to an inability to articulate feelings and attitudes, so a teenager might resort to physical expression out of frustration. In many instances, unrecognized and untreated learning disabilities and cognitive deciencies create deep frustration for a youngster. Thus, the entire school experience gets ltered through defeat and humiliation. Recently, there seems to be a signicant increase in such non-agressive aspects of conduct disorders as running away, truancy, and substance abuse. 1. 2. 3. 4. http://www.aacap.org/galleries/FactsForFamilies/33_conduct_disorder.pdf http://www.nlm.nih.gov/medlineplus/ency/article/000919.htm http://www.aacap.org/cs/root/publication_store/your_adolescent_conduct_disorders http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html

OPPOSITIONAL DEFIANT DISORDER Oppositional Deant Disorder is sort of Conduct Disorder LITE because when a student is assessed for, but does not meet criteria for CD, they may be diagnosed with ODD. It sounds similar, but does not have the same extremes of CD. Here are some facts about it: Prevalence is higher for males.
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 Before puberty, the condition is more common in boys, but after puberty the rates in both genders are equal. It is diagnosed when a child displays a persistent or consistent pattern of deance, disobedience, and hostility toward various authority gures including parents, teachers, and other adults. Children with ODD may repeatedly lose their temper, argue with adults, deliberately refuse to comply with requests or rules of adults, blame others for their own mistakes, and be repeatedly angry and resentful. characterized by such problem behaviors as persistent ghting and arguing, being touchy or easily annoyed, and deliberately annoying or being spiteful or vindictive to other people. Stubbornness and testing of limits are common. These behaviors cause signicant difculties with family and friends and at school or work Marital discord, disrupted child care with a succession of different caregivers, and inconsistent, unsupervised child-rearing may contribute to the condition. In different studies, estimates of the prevalence of ODD have ranged from 1 to 6 percent. 1. http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html 2. Journal Of Child Psychology And Psychiatry, And Allied Disciplines [J Child Psychol Psychiatry] 2007 Jul; Vol. 48 (7), pp. 703-13.

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INFORMAL BEHAVIOR CHECKLIST (IBC) Willamette Education School District Student's Name: ________________________ Grade: ____ Date: ____________ Teacher Completing This Form: ________________________ Behav Spec: Rob Alvarez, MMFT, SSL *Please return to ______________________ by: _______________ Please rate the students overall behavior since the last rating period (or last 3 months) until now. Compare the students behavior to other students in the class. Under the Rating column, circle the number which best describes the frequency of behaviors. This information may be shared with the student.
! BEHAVIORS RATING 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 ! COMMENTS 1. ! Is absent, cuts class, tardy, late for activities 2. ! Is accident prone; inicts self-injury 3. ! Is aggressive (physically, verbally) 4. ! Has anger outbursts, tantrums 5 ! Is anxious, oversensitive, cries, has physical complaints 6. ! Displays poor personal appearance, hygiene 7. ! Argues, talks back 8. ! Assignments/homework - fails to complete on time, with accuracy 9. ! Displays bizarre behavior (describe in comment area) 10. ! Blames, doesn't take responsibility for actions 11.! Criticizes, complains 12. ! Dees authority, is uncooperative 13. ! Depends excessively on others 14. ! Is destructive, misuses materials 15. ! Directions/rules (classroom, playground, bus) - fails to follow 16. ! Disrupts (noises, actions) 17. ! Expresses feelings of being picked on, others are out to get him/her 18. ! Lacks emotional expression 19. ! Is impulsive

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

1 2 3 4 5 1 2 3 4 5

1 2 3 4 5 1 2 3 4 5

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20. ! Is inattentive 21. ! Is inexible, is rigid, resists change 22. ! Interacts inappropriately with peers 23. ! Makes irrelevant comments ("off-the-wall" remarks) 24. ! Lies, denies, misrepresents 25. ! Lacks motivation 26. ! Is out of seat, out of place, overactive 27. ! Fails to participate in activities 28. ! Perseverates (repeats behavior/ideas over and over) 29. ! Lacks responsibility for materials, belongings 30. ! Is slow to respond; is lethargic 31. ! Steals, cheats 32. ! Talks out, calls out 33. ! Withdraws, isolates self Other:

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

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WEBSITES: http://www.smhp.psych.ucla.edu/pdfdocs/quicktraining/behaviorproblems.pdf http://smhp.psych.ucla.edu/ http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html http://www.aacap.org/cs/root/publication_store/your_adolescent_conduct_disorders

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To help further explain this, lets look at the Positive Behavior Interventions and Support (PBIS) model pyramid as a visual aid. PBIS uses three zones to help group students with behaviors: 1) the green zone, 2) yellow zone, and 3) the red zone - just like a traffic light. According to the PBIS model, the green zone describes approximately 80% of the
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schools student population (general education) with behaviors that would probably not need special education services. Some Green zone behaviors, also referred to as environmental behaviors, could be caused by: too much noise, too bright, too dark, seating in classroom, difficulty understanding the teacher, students stress of academic subject, other stressors, grief and loss, peer drama, physical discomfort, hunger, fatigue, bullying and/or harassment, etc. What typically separates green zone/ environmental behaviors from the yellow and red zone behaviors are the students can overcome these behavior problems with minimal interventions by working with the teacher or the counselor, and are short-term in duration. The yellow zone, which describes approximately 15% of the schools student population, might have behaviors that cause academic impairment and a lack of progress, in other words, at-risk students. Some examples are: argumentative, anxiousness, talking out, inattention, impaired social interaction, sensory issues, and motor skill difficulty to name a few. These students would benefit from special education consideration and assessment. The red zone is considered to be the remaining 5% of the student population. These students have high-risk behaviors and need specialized individual services and interventions. Students with high risk behaviors might include but not limited too: cutting on self, swearing at staff, throwing objects, violence, and illegal activity. The at-risk and high-risk student behaviors will be further defined in the Treatment and Interventions section of this paper.

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SOURCES American Psychological Association. www.apa.org American School Counselor Association. Http://www.schoolcounselor.org/ Attention-Decit / Hyperactivity Disorder (ADHD). Center for Disease Control and Prevention. http://www.cdc.gov/ncbddd/adhd/data.html A Prole of Students with ADHD Who Receive Special Education Services (2004). www.nlts2.org/fact_sheets/nlts2_fact_sheet_2004_11.pdf. Attention-Decit/Hyperactivity Disorder in Adolescents. St. Louis Childrens Hospital. http://www.stlouischildrens.org/content/greystone_1435.htm Aguiar, A., Eubig, P., Schantz, S. (2010). Attention Decit/Hyperactivity Disorder: A Focused Overview for Childrens Environmental Health Researchers. Environmental Health Perspectives. Vol. 118 Issue 12, p1646-1653, 8p American Heritage Stedmans Medical Dictionary. A Quick Training Aid...Behavior Problems At School. UCLA Center. http://www.smhp.psych.ucla.edu/pdfdocs/quicktraining/behaviorproblems.pdf Buron, K. D., Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: ! Autism Asperger Publishing Co. Behavior Disorders. http://www.bettermedicine.com/article/behavioral-disorders Committee for Children. Steps to Respect: A Bullying Prevention Program. (2005). ! http://www.cfchildren.org/programs/. Conduct Disorder. http://www.nlm.nih.gov/medlineplus/ency/article/000919.htm Coutinho, M.; Oswald, D. (1995) Identication and placement of students with serious emotional disturbance. Part I: Correlates. Journal of Emotional & Behavioral Disorders; Oct95, Vol. 3 Issue 4, p224, 6p, 3 Charts, 1 Graph. Deconstructing a Denition: Social Maladjustment Versus Emotional Disturbance. Psychology in the Schools, Vol. 41(8), 2004 2004 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20046 Facts for Families: Conduct Disorder (July 2004). ! http://www.aacap.org/galleries/FactsForFamilies/33_conduct_disorder.pdf
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Fergusson, D.; Horwood, J. (1998). Early Conduct Problems and Later Life Opportunities. Journal of Child Psychology & Psychiatry & Allied Disciplines; Nov98, Vol. 39 Issue 8, p1097, 12p Fergusson, D.: Horwood, J.; Ridder, E. (2005). Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology & Psychiatry; Aug2005, Vol. 46 Issue 8, p837-849, 13p, 3 Charts Labeling Troubled and Troubling Youth: The Name Game (1996). Addressing Barriers to Learning Newsletter, Vol. 1 (3). Mandt, D. (2011). The Mandt Sytem. Http://www.mandtsystem.com/company/history.com McCarney, S.B., Wunderlich, C.K. (2006). Pre-Referral Intervention Manual. 3rd Ed. Columbia, MO: Hawthorne Educational Service, Inc. Mosby's Medical Dictionary, 8th edition National Information Center for Children and Youth with Disabilities. (2011). Individuals ! with Disabilities Education Act, Disability Categories. http://nichcy.org/disability/ ! categories. Nock M.; Kazdin A.; Hirpi E; Kessler R. (2007). Lifetime Prevalence, Correlates, and Persistence of Oppositional Deant Disorder: Results from the National Comorbidity Survery Replication. Journal Of Child Psychology And Psychiatry, And Allied Disciplines [J Child Psychol Psychiatry] 2007 Jul; Vol. 48 (7), pp. 703-13. Oregon Administrative Rules for Special Education, Denitions. (2011). Http://www.ode. ! state.or.us/ofces/slp/spedoars.pdf. Other Mental Disorders in Children and Adolescents. http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html Positive Behavior Interventions and Support. (2011). http://www.pbis.org/. Sprick, R. (2011). Safe and Civil Schools. Http://www.safeandcivilschools.com/. Students Perspectives/Addressing Underlying Motivation to Change (1997). Excerpted from a guidebook from the Center for Mental Health in Schools entitled What Schools Can Do to Welcome and Meet the Needs of All Students, Unit VI, pp 16-17 and Unit VII, pp. 23-28. School Mental Health Project. UCLA Center. http://smhp.psych.ucla.edu/ US Department of Education. http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,4,i,
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Wagner, M. Factors Expected to Relate to Achievements of Youth with Disabilities. http://www.nlts2.org/reports/2003_11/nlts2_report_2003_11_ch2.pdf Your Adolescent - Conduct Disorders. American Academy of Child & Adolescent Phsychiatry. http://www.aacap.org/cs/root/publication_store/your_adolescent_conduct_disorders

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