Serious Emotional Disturbance and Autism

1
Serious Emotional Disturbance and Autism

• Chapter 22

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Introduction

• Many social problems place individuals at risk
  for serious emotional disturbance
• Statistics vary across socioeconomic level,
  ethnic group, cultural background, family
  structure, and neighborhood
• Behavior is caused by a multitude of factors

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Prevalence of Serious Emotional Disorder

• Varies widely because of differing definitions
  and criteria
• 2 to 22 of school population
• Higher rate in boys
• 7 to 8 require special education services

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Prevalence of Serious Emotional Disorder

• Associated concerns
• Suicide
• Delinquency
• Developmental disabilities
• Dual diagnosis
• Violence and abuse

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Definitions of Serious Emotional Disturbance

• Federal Law Terminology
• Determines eligibility for special education
  services
• CEC Terminology
• Behavior disorders

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Definitions of Serious Emotional Disturbance

• APA Terminology - DSM-IV-TR
• Definitive source of knowledge about mental
  disorders
• Terminology
• Diagnostic features
• Prevalence
• Course

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Classic DSM Mental Disorders

• Substance-related disorders
• Schizophrenia and other psychotic disorders
• Mood disorders
• Anxiety disorders
• Dementia
• Eating disorders

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Substance-Related Disorders

• Abuse or dependence on substance
• Results in behavioral changes that negatively
  affect various aspects of life
• Legal or illegal
• Prescribed or open market
• Toxic substances
• Inability to reduce or stop use and episodes of
  overuse

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Schizophrenia

• A psychotic disturbance that lasts for at least 6
  months and includes at least 1 month of two or
  more of the following
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms

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Other Psychotic Disorders

• Manifestation of delusions, hallucinations or
  serious symptoms that grossly interfere with
  daily life, but do not meet the criteria for
  Schizophrenia or other mental disorders
• Managed by daily medication
• Acute episodes during active phase
• Tardive dyskinesia - motor abnormality

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Mood Disorders

• Unipolar - usually episodes of extreme depression
• Bipolar - mood shifts from mania to depression
  and vice versa
• Associated with ADHD in children
• Persons may deny they have a problem and refuse
  to take medication

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Anxiety Disorders

• Conditions of excessive worry and unease
• Treated with medication and counseling
• Panic attacks
• Panic disorder
• Phobias
• Obsessive-compulsive disorders

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Dementia

• Multiple cognitive deficits that are a
  significant change from previous level of
  functioning
• Attributed to medical condition, aging, and/or a
  substance
• Alzheimers disease
• Head trauma
• Parkinsons disease
• HIV
• Long-term substance abuse

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Eating Disorders

• A gross disturbance in eating behavior
• Generally manifests in adolescence
• Anorexia nervosa
• - Amenorrhea
• Bulimia
• Recurrent episodes of binge eating

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Impact of Adult Mental Disorders on Children

• Change in child-rearing
• Change in emotional climate at home
• Creates anxiety in children
• Genetic predisposition

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DSM Disorders in Children and Adolescents

• Conduct disorder
• Oppositional defiant disorder
• Tic disorders and Tourettes disorder

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Conduct Disorder

• Pattern of persistent and repetitive behaviors
  that violate the basic rights of others and/or
  major age-appropriate societal norms or rules
• Aggressive conduct
• Destruction of property
• Deceitfulness
• Serious violations of major rules

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Oppositional Defiant Disorder

• Recurrent pattern of hostile and disobedient
  behavior toward authority figures
• Various behaviors such as losing ones temper,
  arguing with adults, deliberately annoying
  others, blaming others, etc.
• Disruptive behaviors tend to be less serious than
  in conduct disorder

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Tic Disorders and Tourettes Disorder

• Tics - uncontrollable motor movement or
  vocalization
• Variety of different tics
• Tourettes - genetic tic disorder
• May have associated mental disorders
• Tics diminish while engaging in rhythmic
  activities
• Average or better intelligence

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Stereotypic Movement Disorders

• Repetitive, seemingly driven, nonfunctional motor
  behaviors that interfere with normal activities
  or result in self-inflicted injury
• Coexist with other conditions
• Self-injurious behaviors associated with severe
  mental retardation
• Major problem is social acceptance

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Treatment of Serious Emotional Disturbance

• Medication
• Psychotherapy and/or counseling
• Cooperative home-school-community intervention
  programs
• During acute phases the individual may not be
  attending school

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Medication (Drug Therapy or Pharmacotherapy)

• Four categories of drugs commonly used
• Understanding of side effects and support of
  individuals
• Bipolar drugs - high risk of serious side effects
• Exercise may alter effects of medication

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Psychotherapy and Counseling

• Psychotherapy - combined use of drugs and other
  helping techniques
• Dance therapy is one form
• Counseling - interactive verbal communication by
  individual trained in counseling
• Peer counseling, small-group sharing, and support
  networks may be beneficial

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Cooperative Home-School-Community Programs

• Challenges in providing support
• Assessing problem behaviors
• Incorporating structure in routine
• Enhancing communication
• Expanding relationships
• Increasing choice-making
• Reducing stress

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Exercise and Serious Emotional Disturbance

• Reduction of depression, anger, disruptive
  behaviors, and stereotypies
• Intervention guidelines include enjoyable,
  aerobic, noncompetitive, nonthreatening, moderate
  intensity for 20-30 minutes, and used 2 to 3
  times per day
• Utilize music of individuals choice

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Adapting the Public School Program

• May be assigned to separate adapted physical
  education instruction
• Class size no larger than 12 students
• Paraprofessionals assigned to students
• In general classes peer counselors or partners
  should be assigned

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General Guidelines for Conducting Class

• Display appropriate authority
• Explain class goals and routines
• Meet individually with each student
• Keep class rules simple
• Clearly explain consequences
• Involve students in setting consequences
• Demonstrate consistency
• Use visual cues
• Constantly check understanding

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Juveniles Who are Incarcerated

• High incidence of arrests
• Few special education services
• Utilize sport for socialization and transition
• Recreational offerings and facilities vary
• State curriculum guides

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Applied Behavior Analysis (ABA) Principles

• Target specific behaviors
• Observe, chart, and analyze behaviors
• Select and apply specific strategies
• Select and apply appropriate consequences
• Periodically evaluate progress

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Transitions From Activity to Activity in the Gym

• Transitions may be difficult
• Using stations may be contraindicated
• Structure transitions from one part of the lesson
  to the next
• Use more time on each activity
• Specific instructions for formations may be needed

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Ecological Pedagogy and Specific Conditions

• Matching content with student interests and needs
• Provide choices to students
• Utilize small class sizes
• Provide the necessary supports
• Requirements become part of the IEP

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Strategies for Schizophrenia

• Do not respond well to firm discipline
• Seem out of contact with reality
• Criticism can elicit destructive behavior
• Combine friendliness and warmth with consistent
  enforcement of limits
• Physical restraint may be necessary

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Strategies for Anger and Aggression

• Guidelines for schizophrenia apply
• Adult and peer counseling to help identify the
  source of anger and learn to avoid it
• Talking-bench strategy
• Express hostility in socially acceptable ways
• Students taught coping skills

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Strategies for Depression and Withdrawal

• Need to be kept active but often refuse to
  participate
• Display a rough, noncommittal exterior
• Mirror or restate thoughts rather than contradict
• Will follow instructions but may need to be taken
  by the hand to participate

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Strategies for Anxiety, Fear, and Withdrawal

• Should not force participation
• Desensitization - planned progression of
  activities to gradually reduce fear reactions
• Improving situation-specific self-confidence

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Aquatics and Individuals With SED

• Recommended for individuals who demonstrate
  overanxious, aggressive, and hyperactive
  behaviors
• Warm temperatures provide relaxing effect
• Increases in self-image and self-confidence
• Learn social skills and make friends

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Behavior and Disciplinary Placement Change

• Behavioral intervention plan (BIP)
• Functional behavioral assessment - determine the
  function of behavior
• To obtain or maintain something desirable
• To escape from or avoid something undesirable
• Manifestation determination - determine that the
  inappropriate behavior was not caused by the
  students disability

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Pervasive Developmental Disorders or Autism
Spectrum Disorder

• Diagnostic category for severe impairment in
  reciprocal social interaction or communication
  skills and/or the presence of stereotyped
  behavior, interests, and activities
• Autism
• Aspergers disorder
• Retts disorder

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Types of Pervasive Developmental Disorders

• Typical development initially
• Delays or abnormal function become pervasive and
  affect all aspects of life
• Specific diagnosis is difficult
• Autism continuum or spectrum

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Types of Pervasive Developmental Disorders

• Autistic disorder
• Impaired functioning in social interaction,
  language as used in social communication,
  imaginative or social imitative play, and
  repetitive, stereotyped patterns of behavior
• Self-absorption and withdrawal
• Associated with other disabilities and lower IQs
• Intellectual assessment may not be accurate

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Types of Pervasive Developmental Disorders

• Aspergers disorder
• Severe and sustained impairment in social
  interaction, coupled with repetitive, stereotyped
  patterns of behavior, that seriously impacts
  function
• No significant delays in language, cognitive
  function, self-help skills, adaptive behaviors
  (except for social interaction), or curiosity
  about the environment
• Clumsiness

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Types of Pervasive Developmental Disorders

• Retts disorder
• Affects only females
• Severe degenerative condition diagnosed by
  deceleration of head growth, loss of previously
  acquired hand skills, loss of interest in the
  social environment, appearance of stereotyped
  handwringing movements and gait and coordination
  problems, and subsequent development of severe
  impairment in language and psychomotor function

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Incidence of Pervasive Developmental Disorders

• Autism - 15 in 10,000 births
• More common in males than females
• Aspergers - 3 in 10,000 births
• Retts - 1 in 10,000 female births

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Autism and the Federal Law

• Considered emotional disturbance until 1981
• 1990 reclassified as a separate category
• Category encompasses all forms of PDD

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Causes of Autism

• Neurobiological and genetic
• No specific gene - but often affects siblings
• Family history of other disabilities
• Appears to be acquired and linked to childhood
  diseases, metabolic problems, and brain injury
  but the link is not well understood

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Savantism and Autism

• Ability to perform skills at exceptional levels
  without the benefit of instruction or practice
• Appear at an early age
• Incidence in autism is 10
• Lack understanding of what they are doing

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Illustrative People with Autism

• One-third of people with autism live and work
  fairly independently by adulthood while the rest
  remain severely disabled
• Dr. Temple Grandin - associate professor
• Raun Kaufman - graduate of Brown University

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Intervention Programs

• Kaufmans parents established a training center
  for parents of children with autism
• Emphasizes a psychotherapy approach
• Acceptance and imitation of behaviors until the
  child gives them up or replaces them
• Presence of an adult 24-hours per day

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Intervention Programs

• Ivar Lovaas
• Behavior management curriculum
• Used in many public schools
• Follows classic behavior management principles
• Emphasizes direct compliance

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Intervention Programs

• TEACCH
• Uses a cognitive approach that manages behavior
  by addressing it indirectly
• Visual approach based on the skills, interests,
  and needs of individuals
• Key areas of instruction are functional skills,
  communication, and social and leisure skills that
  will enhance community integration

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Intervention Programs

• REACCH
• Therapeutic riding program
• Follow same schedule at the stable as at school
• Improvement in most areas of sensory processing
  and their reactions to the environment around
  them after riding

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Intervention Programs

• Daily Life Therapy
• Provide individuals with a systematic education
  through meaningful and real life experiences
  within a controlled environment
• Develop ability to be close to peers, physically,
  emotionally, socially, and intellectually to
  achieve social independence and dignity

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Parent Involvement Programs

• Need for comprehensive, structured programming
  across all environments all 52 weeks of the year
• Services now written into the IEP or IFSP
• In-home training
• Parent training
• Extended, school day, year-round services

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Motor Clumsiness and Generalization Problems in
Autism

• Motor clumsiness is typical with autism
• Motor clumsiness and motor incoordination
• Assessment may be misleading
• Unresponsive to test directions
• Can actually perform better than scores indicate
• Perform assessment in informal settings
• Focus goals on functional motor competence

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Autistic Behaviors and Pedagogy

• Social interaction and social learning
  impairments
• Language and speech impairments
• Difficulty thinking in words and responding
  appropriately
• Motor planning and executive control problems
• Unusual responses to sensory input, including
  stimming
• Pathological resistance to change
• Stimulus overselectivity and attention problems

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Social Interaction and Social Learning Impairments

• Learning appropriate nonverbal social behaviors
• Seldom learn through imitation and listening to
  instructions or advice
• Functionally deaf
• Tactile defensiveness
• Insistence on eye contact
• Wanders aimlessly in the gym
• Emphasis on personally meaningful reinforcers
• Partners or buddies need special training

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Language and Speech Impairments

• About 50 learn to talk and use language more or
  less appropriately
• Use stereotyped and repetitive phrases
• Pronominal reversal - avoidance of I
• Utilize behavior management plan
• Speech used to talk to self not others
• Social interaction impairment affects ability to
  initiate and sustain meaningful conversations

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Difficulty Thinking in Words and Responding
Appropriately

• Difficulty processing auditory input
• Visual thinkers
• Pictures are first language and words are second
  language
• Utilize visualization skills as strengths to help
  master content
• Demonstrations more helpful than verbal directions

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Motor Planning and Executive Control Problems

• Motor planning, sequencing, and other aspects of
  executive control are weak
• Verbal working memory is limited
• Utilize memory games
• Imitation should progress from single movement to
  increasingly longer sequences
• Self-talk, verbal rehearsal, and visualization
  activities should be used

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Unusual Responses to Sensory Input, Including
Stimming

• Unaware of stimuli or exaggerated responses are
  typical
• Some sound stimuli may be painful
• Visual stimuli may result in stimming
• Organization and synthesis of excessive visual
  input
• Tactile defensive

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Pathological Resistance to Change

• Emotional outbursts may occur
• Utilize a hierarchy of prompts and reinforcements
• Physical guidance - if not tactile defensive
• Verbal/visual and verbal/physical teaching models
  can also be beneficial
• Transitions may be contraindicated

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Stimulus Overselectivity and Attention Problems

• Abnormally limited attentional scope
• Inability to select relevant cues
• Cues matched to a students specific assessed
  needs
• Extrastimulus prompts
• Within-stimulus prompts

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Summary of Teaching Suggestions

• Teach to the preferred modality and learning
  styles
• Minimize unnecessary external stimuli
• Limit the amount of relevant stimuli presented at
  one time
• Limit the use of prompts (some disagreement)
• Teach in a community-based gamelike environment
  to facilitate generalization
• Avoid change in routines
• Provide a variety of activities that focus on the
  same goals

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Special Olympics and Community Sports

• Individuals with IQs under 70 can benefit from
  programming similar to that for mental
  retardation including Special Olympics
• Preoccupation with sameness is a strength in
  fitness and sport training
• Models of schedule adherence and hard work
• Programs support transition to independent use of
  community sport and fitness facilities