Emotional or Behavioral Disorders

Definitions and Characteristics

Important Terms
Emotionally disturbed--term now used in Individuals with Disabilities Education Act (1997) Behaviorally Disordered--term used by Council for Children with Behavioral Disorders, focuses attention on observable aspects of the children

Definitional Problems
Lack of precise definitions of mental health and normal behavior Differences among conceptual models Difficulties in measuring emotions and behavior Relationships between emotional or behavioral disorder and other disabilities Differences in the professionals who diagnose and serve children and youths

Inse rt pict ure H& K p. 285

Emotional disturbance (IDEA)

The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects education performance: an inability to learn which cannot be explained by intellectual, sensory, or health factors an inability to build or maintain satisfactory interpersonal relationships with peers and teachers

Insert picture H&K p. 266

inappropriate types of behavior or feelings under normal circumstances a general pervasive mood of unhappiness or depression or a tendency to develop physical symptoms or fears associated with personal or school problems. The term includes children who are schizophrenic. The term does not include children who are socially maladjusted, unless it is determined that they are seriously emotionally disturbed.

Prevalence and Causes

Prevalence
Government estimates Problems with estimates

Causes
Biological disorders and diseases Pathological family relationships Undesirable experiences at school Negative cultural influences

Definition of Emotional Disturbance

Severe Behavior Handicapped

Five Characteristics One or more of these five characteristics must be exhibited by the child.
1 23 45

Severe Behavior Handicapped

An inability to learn, which cannot be explained by intellectual, sensory or health factors

or

An inability to build or maintain satisfactory interpersonal relationships with peers and teachers

or

Inappropriate types of behavior or feelings under normal circumstances

or

A general pervasive mood of unhappiness or depression

or

A tendency to develop physical symptoms or fears associated with personal or school problems

Three Qualifiers
All three of these qualifiers must exist for any of the five characteristics which are exhibited.

Over a long period of time To a marked degree Adversely affects educational performance

Transitory Situations
The time qualifier precludes situational problems which may be understandable or expected given the nature of particular circumstances. A death in the family, divorce, abuse, new school, family financial crisis, or physical illness of the student or a relative would be situational, and the resulting behavior changes are often transitory. An ED evaluation and placement would be inappropriate if based on situational behavior changes even though the other aspects of the definition apply.

Nontransitory Situations
If change is significant, documentation should demonstrate the history of the transition in behavior and its effect on the individual. Any circumstances, however, may lead to behavioral changes which are not transitory and do not return to the state which existed prior to the precipitating event. Providing other aspects of the definition apply appropriately, the student might then be eligible for ED placement.

Chronological Age

Long period of time must also be considered in relation to the chronological age of the student. Less than a year for a very young child might be considered a long period of time, while that same amount of time for a teenager might be insufficient.

Marked degree

In determining marked degree, the following key questions should be answered: Is the behavior in question considered significant by more than one observer? What are the rate, frequency, intensity, and duration of occurrence? In which settings does the behavior occur? Are there noticeable or predictable patterns to the behavior? How is the behavior affecting others? Is the behavior identified as a concern by norm-referenced behavior measures?

Test Data
Evaluative information from psychological tests may help to substantiate marked degree, but should not be used as the primary source of information. For example, an observable event (providing adverse affect on education has been determined), such as a suicide threat or gesture, should be evaluated by a psychologist using appropriate instruments, interviews, and observations. On the other hand, results from personality measures, which are not substantiated by any observable events, should be regarded with extreme caution.

Adversely affects educational performance

Causal Relationships
The definition of ED requires that determination of eligibility for placement be based on evidence that the students educational performance is adversely affected. There must be a demonstrable, causal relationship between the students behavior and decreased educational performance.

To determine whether educational performance is adversely affected, the following key questions should be considered:

1.

Is the students educational performance within a reasonable range of chronological age and ability level?

2.

If the student is performing below reasonable academic expectations, does the search for the cause of this performance point strongly to emotional or behavioral problems?

3.

Do the students emotional or behavioral problems appear to be affecting educational performance to a greater degree than similar problems are affecting the performance of peers?

4.

To what extent is the student receiving passing grades? Has there been regular growth in academic achievement? Has the student been held back any grade levels?

5.

Is the student absent frequently? If yes, how have grades been affected?

Academic achievement must be documented, but other aspects of education may be considered. A significant degree of subjectivity will be used in this area, but two guiding principles might be:

1. Observable evidence indicates that the student has impaired performance across the educational setting.

2. Documentation shows clearly that the academic portion of the students education is adversely affected.

Assessment
Observations Checklists Reports Interviews
Insert picture H&K p. 280

Behavioral Problems

Behavioral Indications of Potential Problems

I. II. III. IV. V. VI. VII. VIII. IX. Indications of low self-concept Disturbed relations with peers Inappropriate relationships to teachers, parents, and other authority figures Other signs of social-emotional problems Deficits in speech and language Disordered temporal relationships Difficulties in auditory and visual perception Poor quantitative reasoning and computational skill Deficits in basic motor skills

Indicators of Social Disabilities

Poor social perception Lack of judgment Lack of sensitivity to others Difficulty making friends Problems establishing family relationships Social problems in school Social disabilities of adolescents and adults

Environment
TEACHER CONTROLLED SCHOOL CONTROLLED Atmosphere

Atmosphere
Structure Student Behavior

Structure
Student Behavior

Learning Centers
Movement Other Faculty And Staff instruction

Hyperactivity
Hyperactivity is not defined simply by a high rate of activity; it is a high rate of inappropriate behavior of various kinds that the youngster cannot control at will.

Hyperactivity

Closely related to hyperactivity are distractibility (attention problems) and impulsivity (acting without thinking). We see many of the hyperactive childs characteristics in normally developing young children, whereas the hyperactive child exhibits developmentally deviant behavior.

Hyperactivity

Brain damage is the favorite causal explanation for hyperactivity, but there is little evidence to confirm brain injury as the cause in most cases. Hyperactivity may be genetically organized in many cases, but no one knows how this genetic factor works. There is little evidence for any other possible biological cause, such as allergies, toxins, or deficits in neurochemicals. Social learning is a plausible causal factor, but does not explain most cases fully. Because we understand so little about the causes of hyperactivity, secondary prevention is the only feasible approach.

Hyperactivity

Assessment of hyperactivity requires obtaining multiple perspectives on the youngsters behavior and its contexts. Rating scales are useful for screening and initial evaluation, but assessment for educational programming and evaluation of progress demands direct observation. Adequate assessment of attention calls for measuring the students attention in relation to specific tasks in specific contexts. One might assess impulsivity by adapting laboratory instruments and by direct observation.

Causal Factors
Biological Factors
Family Factors School Factors Cultural Factors

Biological Factors
Genetics Brain Damage Brain Dysfunction Malnutrition Temperament Physical Illness

Biological Factors

Genetics
Genetic factors have been suggested as the causes of nearly every type of disorder. Genetics are known to be involved in causing schizophrenia, but little is known about how the gene system that causes the disorder works. The fact that a disorder has a genetic cause does not mean that the disorder is untreatable.

Biological Factors

Brain Damage & Dysfunction

Brain damage or dysfunction has been suggested as a cause of nearly every type of emotional or behavioral disorder. Traumatic brain injury involves known damage to the brain and may cause a wide variety of emotional and behavioral problems. Autism is now recognized as a biological disorder, although neither the exact nature nor the reason for the brain dysfunction are known.

Family Factors
Parental behavior is significant in affecting childrens school performance and conduct Parental discipline is a significant factor in behavioral development
Discipline that is authoritative characterized by high levels of responsiveness and demandingness Usually produces the best outcomes

Family Factors

Conflict and Coercion, are known family factors that increase a youngsters risk for developing an emotional or behavioral disorder. Family structure, by itself, appears to contribute relatively little to childrens emotional and behavioral problems. Divorce does not usually produce chronic disorders in children. Children in single parent homes may be at risk, but we do not know precisely why.

School Factors
In our society school failure is tantamount to personal failure. The school environment is not only critically important for social development but is also the factor over which educators have direct control.

School Factors

As a group, students with emotional or behavioral disorders score below average on intelligence tests and are academic underachievers. Many of them lack specific social skills. Disordered behavior and underachievement appear to influence each other reciprocally. Academic failure and low intelligence, when combined with antisocial behavior or conduct disorder, portend social adjustment problems in adulthood.

Cultural Factors
The mass media Peer groups

Ethnicity Social class and poverty

Cultural Factors

Individuals are influenced by the standards and values of the larger cultures in which they live and work. Conflicts among cultures can contribute to youngsters stress and to their problem behavior. Not only conflicts among different cultures but mixed messages from the same culture can be a negative influence on behavior. Cultures sometimes both encourage and punish certain types of behavior.

Pervasive Developmental Disorder

Distortion of or lag in all or most areas of development, as in autism, Retts disorder, Aspergers disorder, and childhood disintegrative disorder.

AUTISM
The symptoms of autism are first observed during the childs first 3 years: autism is distinguished by its early onset. The primary definition of autism is detailed in the extensive criteria listed in the DSM IV (APA, 1994). However, Harris (1995a) summarizes the essential features: Although the subtle details of the diagnosis continue to be debated, the basic symptoms of autism remain consistent.

Autism

These symptoms fall under three broad headings:

Social Communication Behavior
The symptoms may range from mild to severe.

Autism

Children with autism differ greatly in their specific abilities and disabilities: autism is something one may have in degrees, just as people may have varying degrees of conduct disorder, cerebral palsy, mental retardation or any other special ability or disabling condition.

Autistic Disorder
A pervasive developmental disorder with onset before age three in which there is qualitative impairment of social interaction and communication and restricted, repetitive, stereotyped patterns of behavior, interests, and activities.

Conduct Disorder
Characterized by persistent antisocial behavior that seriously impairs the youngsters functioning in everyday life or results in adults concluding that the youngster in unmanageable.
4 10% of the population

Conduct Disorder

Definition
Repetitive, persistent pattern of behavior violating basic rights of others or ageappropriate social norms or rules, including aggression toward people and animals, destruction of property, deceitfulness or theft, and serious violation of family or school rules. Onset may be in childhood or adolescence, and severity may range from mild to severe.

Conduct Disorder Subtypes

Overt aggressive (undersocialized) Covert antisocial (socialized) untrustworthiness and manipulation of others, running away, and concealment of one's actions Versatile (socialized and undersocialized)
We distinguish youngsters with conduct disorder from those who are developing normally by their higher rates of noxious behaviors and by the persistence of such conduct beyond the age at which most children have adopted less aggressive behavior.

Juvenile Delinquency
Juvenile delinquency is a legal term that indicates violation of the law by an individual who is not yet an adult. Acts that are illegal only if committed by a minor are status offenses; index crimes are illegal regardless of the individuals age. The vast majority of youngsters commit delinquent acts; a small percentage are apprehended. About 20 percent of all children and youth are at some time officially delinquent, and about three percent are adjudicated each year.

Juvenile Delinquency

Self-reported delinquent behavior is not related to social class, but official delinquency appears more often among lower social classes and minorities. Juveniles who are apprehended and adjudicated tend to be those who commit the greatest number of serious delinquent acts and are most logically considered behaviorally disordered.

Juvenile Delinquency

Males commit more serious crimes against persons and property than females, but the juvenile justice system tends to deal more harshly with females than with males.

Sexual Problems
Promiscuous sexual conduct Early sexual intercourse and teenage pregnancy Exhibitionism Sadomasochism Incest Prostitution Fetishism Sexual relations involving children

Intense, excessive and inappropriate masturbation Paraphilia- bizarre/perverted sexual behavior

Substance Abuse
A substance is abused when it is deliberately used to induce physiological or psychological effects (or both) for other than therapeutic purposes and when its use contributes to greater health risks, disruption of psychological functioning, adverse social consequences, or some combination of these. The most serious substance abuse problems involve alcohol and tobacco.

Intervention
The most useful approaches to date are medication (stimulant drugs), behavior modification, and cognitive strategy training. The right dosage of the right drug tends to reduce hyperactive behavior, but the effects on academic performance may not be significant.

Intervention Continued

Drug effects are idiosyncratic and require careful monitoring. Behavior modification typically leads to improvement in both hyperactivity and academic performance, but it is not a panacea. Positive reinforcement of on-task behavior is the typical behavior modification approach.

PSYCHOTIC includes childhood schizophrenia but not autism

The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of Schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior).

SCHIZOPHRENIA
Delusions Hallucinations Disorganized Speech (e.g., may frequently get derailed or be incoherent) Grossly Disorganized or Catatonic Behavior Negative Symptoms (e.g., lack of affect, inability to think logically, or inability to make decisions (APA, 1994)

Schizophrenia

Schizophrenia is a complex, multifaceted disorder (or group of disorders), which has escaped precise definition after almost a century of study.

Schizophrenia

Schizophrenia is nearly always treated with antipsychotic drugs (neuroleptics), such as Haldol (haloperidol) or Mellaril (thioridazine), which are designed to reduce hallucinations and other symptoms. Children with schizophrenia show a positive treatment response to some of the same pharmacologic treatments that have demonstrated efficacy with adults with schizophrenia (Asarnow & Asarnow, 1995, p. 595)

SELF-INJURIOUS BEHAVIOR
Some youngsters injure themselves repeatedly and deliberately in the most brutal fashion. We find this kind of selfinjurious behavior (SIB) in some individuals with severe mental retardation, but it is a characteristic often associated with multiple disabilities for example, mental retardation and autism or schizophrenia and another disorder.

Self-Injurious Behavior

Some children and youths with normal intelligence and language skills deliberately injure themselves without the intent of killing themselves. The prevalence of such behavior may be as high as 2 to 3 percent of adolescents. Such behavior is closely associated with depression and thoughts of suicide.

Depression in Children and Adolescents

Symptoms of Depression
Anhedonia inability to experience
pleasure in all or nearly all activities

Depressed mood or general irritability

Disturbance of appetite and significant

weight gain or loss

Disturbance of sleep

Depression

Psychomotor agitation or retardation Loss of energy, feeling or fatigue Feelings of worthlessness, self reproach, excessive or inappropriate guilt, or hopelessness Diminished ability to think or concentrate; indecisiveness Ideas of suicide, suicide threats or attempts, recurrent thoughts of death

Indicators of Suicidal Risk

Indicators of Suicidal Risk

Sudden changes in usual behavior or affect Serious academic, social, or disciplinary problems at school Family or home problems Disturbed or disrupted peer relations (including peer rejection, romantic breakup, etc.)

Indicators of Suicidal Risk

Health problems, such as insomnia, loss of appetite, sudden weight change, etc.

Substance abuse
Giving away possessions or talk of not being present in the future Situational crisis such as death of a family member or close friend, pregnancy or abortion, legal arrest, etc.

Suicide Prevention

Prevention

Eisenberg outlined 3 major prevention measures 1. Limited access to devices often used in impulsive self-destruction (as though enacting effective gun control) 2. Limiting the publicity given to suicides because extensive publicity is almost always followed by a sharp increase in suicidal acts 3. Improving early detection of depression in children and youth

Internalizing Behaviors

Anxiety and Related Disorders

Obsessive Compulsive Disorder (OCD)
Post-traumatic Stress Disorder

Eating Disorders

Anxiety and Related Disorders

Characterized by distress, tension, or

uneasiness that goes with fears and worries

Obsessive Compulsive Disorder (OCD)

Obsessions: Repetitive, persistent, intrusive impulses, images, or thoughts about something, not worries about real life problems Compulsions: Repetitive, stereotyped acts the individual feels he or she must perform to ward off a dreaded event When such things interfere with daily life=OCD

Post-traumatic Stress Disorder

Prolonged, recurrent emotional and behavioral reactions following exposure to an extremely traumatic event involving threatened death or serious injury to oneself or others. The persons response at the time of experiencing the event must include intense fear, helplessness, or horror (children may show disorganized or agitated behavior)

Eating Disorders
Anorexia nervosa Refusal to eat a proper diet Bulimia binge eating and purging Obesity Pica Eating inedible substances Rumination self-induced vomiting, which usually begins in infancy

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