Download Emotional or Behavioral Disorders

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
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• 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
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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 student’s educational performance is
adversely affected. There must be a
demonstrable, causal relationship between the
student’s behavior and decreased educational
performance.
To determine whether educational performance is
adversely affected, the following key questions
should be considered:
1.
Is the student’s 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 student’s 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 student’s education is adversely affected.
Assessment
•
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•
Observations
Checklists
Reports
Interviews
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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
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•
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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
Structure
Student Behavior
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 child’s
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
youngster’s 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 student’s 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
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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 children’s 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 youngster’s risk for
developing an emotional or behavioral
disorder.
• Family structure, by itself, appears to
contribute relatively little to children’s
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, Rett’s disorder,
Asperger’s disorder, and childhood
disintegrative disorder.
AUTISM
• The symptoms of autism are first observed
during the child’s 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
youngster’s 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 individual’s 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 person’s 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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