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Emotional or Behavioral Disorders

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Title: Emotional or Behavioral Disorders


1
Emotional or Behavioral Disorders
  • Definitions and Characteristics

2
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

3
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

4
Insert picture HK 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

5
Insert picture HK 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.

6
Prevalence and Causes
  • Prevalence
  • Government estimates
  • Problems with estimates
  • Causes
  • Biological disorders and diseases
  • Pathological family relationships
  • Undesirable experiences at school
  • Negative cultural influences

7
Definition of Emotional Disturbance
8
Severe Behavior Handicapped
Five Characteristics
One or more of these five characteristics must be
exhibited by the child.
1
2
3
4
5
9
Severe Behavior Handicapped
An inability to learn, which cannot be explained
by intellectual, sensory or health factors
or
10
An inability to build or maintain satisfactory
interpersonal relationships with peers and
teachers
or
I hate the world!
11
Inappropriate types of behavior or feelings under
normal circumstances
or
12
A general pervasive mood of unhappiness or
depression
or
13
A tendency to develop physical symptoms or fears
associated with personal or school problems
14
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
15
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.
16
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.
17
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.
18
Marked degree
19
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?

20
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.
21
Adversely affects educational performance
F
22
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.
23
To determine whether educational performance is
adversely affected, the following key questions
should be considered
  • Is the students educational performance within a
    reasonable range of chronological age and ability
    level?
  • 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?

1.
2.
24
  • 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?
  • 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?
  • Is the student absent frequently? If yes, how
    have grades been affected?

3.
4.
5.
25
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.
26
Assessment
  • Observations
  • Checklists
  • Reports
  • Interviews

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36
Behavioral Problems
37
Behavioral Indications of Potential Problems
  1. Indications of low self-concept
  2. Disturbed relations with peers
  3. Inappropriate relationships to teachers, parents,
    and other authority figures
  4. Other signs of social-emotional problems
  5. Deficits in speech and language
  6. Disordered temporal relationships
  7. Difficulties in auditory and visual perception
  8. Poor quantitative reasoning and computational
    skill
  9. Deficits in basic motor skills

38
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

39
Environment
instruction
40
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.

41
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.

42
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.

43
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.

44
Causal Factors
  • Biological Factors
  • Family Factors
  • School Factors
  • Cultural Factors

45
Biological Factors
  • Genetics
  • Brain Damage
  • Brain Dysfunction
  • Malnutrition
  • Temperament
  • Physical Illness

46
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.

47
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.

48
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 authoritativecharacterized by
    high levels of responsiveness and demandingness
  • Usually produces the best outcomes

49
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.

50
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.

51
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.

52
Cultural Factors
  • The mass media
  • Peer groups
  • Ethnicity
  • Social class and poverty

53
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.

54
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.

55
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.

56
Autism
  • These symptoms fall under three broad headings
  • Social
  • Communication
  • Behavior
  • The symptoms may range from mild to severe.

57
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.

58
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.

59
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

60
Definition
Conduct Disorder
  • Repetitive, persistent pattern of behavior
    violating basic rights of others or
    age-appropriate 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.

61
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.

62
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.

63
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.

64
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.

65
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

66
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.

67
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.

68
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.

69
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).

70
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)

71
Schizophrenia
  • Schizophrenia is a complex, multifaceted
    disorder (or group of disorders), which has
    escaped precise definition after almost a century
    of study.

72
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)

73
SELF-INJURIOUS BEHAVIOR
  • Some youngsters injure themselves repeatedly and
    deliberately in the most brutal fashion. We find
    this kind of self-injurious 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.

74
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.

75
Depression in Children and Adolescents
76
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

77
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

78
Indicators of Suicidal Risk
79
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 break-up, etc.)

80
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.

81
Suicide Prevention
82
Prevention
  • Eisenberg outlined 3 major prevention measures
  • Limited access to devices often used in impulsive
    self-destruction (as though enacting effective
    gun control)
  • Limiting the publicity given to suicides because
    extensive publicity is almost always followed by
    a sharp increase in suicidal acts
  • Improving early detection of depression in
    children and youth

83
Internalizing Behaviors
84
Anxiety and Related Disorders
  • Obsessive Compulsive Disorder (OCD)
  • Post-traumatic Stress Disorder
  • Eating Disorders

85
Anxiety and Related Disorders
  • Characterized by distress, tension, or
    uneasiness that goes with fears and worries

86
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 lifeOCD

87
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)

88
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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