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Understanding Students with Emotional or Behavioral Disorders

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Title: Understanding Students with Emotional or Behavioral Disorders


1
Understanding Students with Emotional or
Behavioral Disorders
  • Presented by
  • Amber Melton

2
Defining EMD
  • Inability to learn (cannot be explained by
    intellectual, sensory, or health factors)
  • Inability to develop or maintain interpersonal
    relationships
  • Inappropriate types of behaviors or feelings
  • Pervasive mood of unhappiness or depression
  • Physical symptoms or fears associated with
    personal or school problems

3
Diagnostic Informationin Childrens Mental Health
  • DSM-IV is the accepted guide to psychiatric
    diagnosis
  • Many disorders show similar symptoms
  • Some tend to occur together in the same child
  • It may take years to reach an accurate diagnosis
    as symptoms change with time and development

4
Educational Classifications
  • Most children with a diagnosable mental health
    disorder will need special education assistance
  • Usual classifications will be EMD (Emotional
    Disorders) or OHI (Other Health Impairment)
  • Classification does NOT dictate classroom
    placement many of these students succeed in a
    regular education classroom

5
EMD
  • Responses must adversely effect educational or
    developmental performance and be seen in at least
    three settings including two educational settings
    (for instance - classroom and lunchroom)
  • Behaviors seen must be significantly different
    from appropriate age, cultural or ethnic norms
    and must not be primarily the result of
    intellectual, sensory, or acute or chronic health
    conditions

6
Characteristics
  • Internalizing
  • Externalizing
  • Cognitive
  • Academic

7
Internalizing Disorders
  • Anxiety - Withdrawal
  • Separation anxiety disorder
  • Generalized anxiety
  • Phobias
  • OCD
  • Panic disorder
  • Anorexia, bulimia
  • Depression
  • Post-traumatic stress disorder

8
Anxiety Disorders
  • Fear of separation
  • School avoidance
  • Fear of new situations
  • Drug or alcohol abuse
  • See also OCD, PTSD
  • Frequent absences
  • Isolating behaviors
  • Many physical complaints
  • Excessive worry
  • Frequent bouts of tears
  • Frustration

9
Depression
  • Continuing sadness
  • Hopelessness, self-deprecating remarks
  • School avoidance
  • Changed eating or sleeping patterns
  • Frequent physical complaints
  • Isolation, nonparticipation
  • Affects thoughts, feelings, behavior,
    relationships, physical health
  • Irritability
  • In early childhood, may appear as irritability,
    defiance, restlessness, or clinging

10
Internalizing Behavior
  • Psychotic behavior
  • hallucinations
  • delusions
  • schizophrenia
  • schizotypal (personality disorder)

11
Schizophrenia
  • Withdrawn, lack motivation
  • Vivid and bizarre thoughts or speech
  • Confusion between fantasy and reality
  • Hallucinations (visual) or delusions (auditory)
  • Severe fearfulness
  • Odd, regressive behavior
  • Disorganized speech
  • Commonly appears in late teens or early adulthood
  • May come on gradually may appear in teens with
    other mental health diagnoses.
  • Early diagnosis and treatment is imperative
    50 percent or more may attempt suicide

12
External Disorders
  • Socialized Aggressive CD
  • Socialized delinquency
  • gang involvement
  • truancy
  • looks up to other rule violators
  • aware of behavioral expectations covert attempts
  • Undersocialized Aggressive CD
  • CD
  • Attention Problems - Immaturity
  • Motor Excess
  • unaware of behavioral expectations

13
Oppositional Defiant Disorder
  • Frequent angry outbursts
  • Noncompliant and argumentative
  • Easily annoyed
  • Rejects praise, may sabotage activity that was
    praised
  • Deliberately annoys, provokes others
  • Above average level of anger, blaming, hostile,
    or vindictive behavior
  • May be a reaction to frustration, depression,
    inconsistent structure, or constant failure due
    to undiagnosed ADHD, learning disabilities, etc.

14
Conduct Disorder
  • Problem must be persistent, not a reaction to
    stress, crisis, cultural, or social life context
  • Co-occurs with ADHD, learning disabilities,
    depression
  • See also Oppositional Defiant Disorder
  • Serious, repetitive, and persistent misbehavior
  • Aggression toward people or animals
  • Property destruction
  • Deceitfulness, theft
  • Three or more incidents in last year one during
    last six months

15
Reactive Attachment Disorder
  • Destructive, self-injurious
  • Absence of guilt or remorse
  • Extreme defiance, provokes power struggles,
    manipulative
  • Mood swings, rages
  • Inappropriately demanding or clinging
  • Disturbed and developmentally inappropriate
    social relatedness in most contexts
  • Begins before age five, usually after a period
    of grossly inadequate care or multiple caretaker
    changes

16
Bipolar Disorder
  • Anxiety, defiance may be seen
  • Strong craving for carbohydrates
  • Impaired judgment, impulsivity
  • Delusions, grandiosity, possibly hallucinations
  • High risk for suicide and accidents
  • Frequent, intense shifts in mood, energy,
    motivation
  • Shifts in children are very fast and
    unpredictable
  • Mania phase may appear as intense irritability
    or rages

17
Obsessive-Compulsive Disorder
  • Difficulty finishing work on time due to
    perfectionism or ritual rewriting, erasing, etc.
  • Counting rituals, rearranging objects
  • Poor concentration
  • School avoidance
  • Anxiety or depression
  • Intrusive, repeated thoughts
  • Senseless repeated actions or rituals
  • Frequently co-occurs with substance abuse, ADHD,
    eating disorders, Tourette Syndrome, other
    anxiety disorders

18
Post-Traumatic Stress Disorder
  • Flashbacks, nightmares, repetitive play
    re-enactments
  • Emotional distress when reminded of incident(s)
  • Fear of similar places, people, events
  • Easily startled, irritable, hostile
  • Physical symptoms such as headaches, dizziness
  • Affects children who are involved in or witness a
    traumatic event
  • A concern with refugee populations
  • Intense fear and helplessness predominate at
    event and during flashbacks

19
Eating Disorders
  • Impaired concentration
  • Withdrawn, preoccupied, anxious
  • Depressed or mood swings
  • Irritability, lethargy
  • Fainting spells, headaches
  • Anorexia, Bulimia
  • Now at earlier ages, 10-20 boys
  • Perfectionists, over-achievers, athletes at
    highest risk
  • High risk for depression, alcohol, and drug abuse

20
Cognitive
  • Most have IQ in low range
  • More than half have learning disabilities
  • Relationship between academic and social
    behaviors are connected

21
Academic
  • Achieve below grade level in reading, math, and
    written expression
  • Drop out of school at a higher rate than any
    other students
  • Mean achievement level at the 25th percentile
  • More academic problems with externalizing
    behaviors
  • Less likely to attend post-secondary school

22
On Any Given Day
  • Three million American children meet the clinical
    criteria for mood disorders
  • 21 of children and adolescents have a
    behavioral, emotional, or mental health problem

23
Risk Factors
  • Research shows both biological and
    psychosocialfactors influence the development of
    the brain, and
  • brain disorders
  • Many brain disorders cluster in families,
    showing a genetic component or predisposition
  • Some symptoms relate to damage due to injury,
    infection, poor nutrition, or exposure to toxins
  • Stressful life events, malnutrition, childhood
    maltreatment, and aggression may lead to short or
    long-term symptoms and increase the likelihood of
    adverse outcomes

24
Causes
  • Biological
  • Genetics
  • Environmental
  • Stressful living conditions
  • Child maltreatment (neglect, physical abuse,
    sexual abuse, emotional abuse)
  • School factors

25
What would you do if this was your student?
26
This wont work!
27
Or this
28
Not this either!
29
Stages of a Meltdown
  • Anxiety/Starting Out a noticeable change in
    behavior
  • Can be an increase or a decrease
  • Examples

30
Stages of a Meltdown
  • Defensive/Picking Up Steam beginning stage of
    loss of rationality
  • Student may become belligerent
  • Student may challenge authority
  • Examples

31
Stages of a Meltdown
  • Acting-Out/Point of No Return total loss of
    control which results in physical or emotional
    acting out episode
  • Its on!!!!!
  • Flight or fight mechanism is triggered
  • Examples

32
Stages of a Meltdown
  • Tension Reduction/Recovery Period a decrease in
    physical and emotional energy that occurs after
    one has acted out
  • This is your goal
  • Can happen after any stage
  • Examples

33
Your Response
  • Supportive be non-judgemental and empathic to
    attempt to alleviate anxiety
  • Listen
  • Show concern
  • Ask questions
  • Acknowledge the students feelings
  • Understand that students with ASD and EMD
    sometimes do not have automatic sensory
    regulation

34
Your Response
  • Directive an approach to take control of a
    potentially escalating situation
  • Set limits
  • Re-direct
  • Offer choices positive, positive positive,
    negative or negative, positive

35
Your Response
  • Remove the audience
  • Allow the student to vent and just listen
  • Silence is ok
  • Do not attempt to touch the student unless he is
    a threat to himself or others

36
Your Response
  • Once the student has reached tension reduction,
    re-establish communication
  • Reassure the student that your relationship is
    not damaged
  • Allow down time

37
Keys to Verbal Intervention and Setting Limits
  • Simple and clear
  • Reasonable
  • Enforceable
  • Stay calm
  • Be aware of body language
  • Give undivided attention

38
Why the Meltdown?
  • Precipitating Factors internal or external
    causes of acting out behavior over which staff
    have little to no control
  • examples poverty, rejection, bullying
  • Sensory Processing Problems the inability to
    filter external sensations or organize sensory
    messages
  • Sensitivity to light, noise, touch, taste, or
    smell
  • Perfumes, crowded areas, scratchy clothing,
    bright lighting

39
Why the Meltdown?
  • Difficulty with Abstract Thinking inability to
    imagine what is not directly perceived by the
    senses
  • If I cant see it, hear it, or touch it, it must
    not be true!
  • Difficulty with Perspective Taking the
    inability to feel empathy (to feel what others
    feel)
  • Inflexibility inability to accept change or
    alter what is expected

40
What Can You Do?
  • Offer sensory breaks
  • Teach social skills
  • Give specific directions and questions
  • Break tasks into smaller steps
  • Use visual images to teach abstract thoughts
  • Use visual schedules
  • Use timers for transitions
  • Warnings about schedule changes
  • Use video modeling
  • Help peers understand their behavior and ask them
    to be supportive and accepting

41
What can you do?
  • Structure the classroom setting to offer a quiet
    place to work
  • Avoid demanding eye contact
  • Implement the use of a safe person for needed
    breaks
  • Avoid a power struggle
  • Use rewards, punishment is not as successful with
    EMD students
  • Be consistent
  • Be structured
  • Positive reinforcement

42
Questions???
  • Amber Melton
  • Positive Behavior Specialist
  • 901-496-9345
  • amber.melton_at_dcsms.org
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