CHILDREN WITH EMOTIONAL & BEHAVIORAL DISORDERS

ANGIE SHULTIS * EDU540

MEET BETH

• Beth Thomas, age 6, subject of 1990 HBO documentary “Child of Rage”

• Diagnosed with Reactive Attachment Disorder after suffering early childhood abuse

http://www.youtube.com/watch?v=ME2wmFunCjU

HISTORICAL PERSPECTIVES

• Two Centuries Ago• “Possessed”, “insane” or “retarded”• Institutionalization

• 1800s• Greater awareness of genetic factors• Medical focus• Special ungraded classes, little attention to individual

needs

• Post WWII• Greater awareness of the power of ecological and social

factors• Shift in responsibility for children with exceptionalities,

from medical/mental health communities to educators

WHAT IS EBD?

• Federal Definition of Emotional & Behavioral Disorders:• A condition exhibiting one or more of the following

characteristics over a long period of time and to a marked degree that adversely affects educational performance:• An inability to learn that cannot be explained by intellectual,

sensory or health factors• An inability to build or maintain satisfactory interpersonal

relationships with peers and teachers• Inappropriate types of behavior or feelings under normal

circumstances• A general pervasive mood of unhappiness or depression• A tendency to develop physical symptoms or fears associated

with personal or school problems• The term does not apply to children who are socially maladjusted

unless it is determined that they have an emotional disturbance

WHAT IS EBD?

• Federal Definition of Emotional & Behavioral Disorders:• A condition exhibiting one or more of the following

characteristics over a LONG PERIOD OF TIME and to a marked degree that adversely affects educational performance:• An inability to learn that CANNOT BE EXPLAINED BY INTELLECTUAL,

SENSORY OR HEALTH FACTORS• An inability to build or maintain satisfactory interpersonal

relationships with peers and teachers• Inappropriate types of behavior or feelings UNDER NORMAL

CIRCUMSTANCES• A general pervasive mood of unhappiness or depression• A tendency to develop physical symptoms or fears associated with

personal or school problems• THE TERM DOES NOT APPLY TO CHILDREN WHO ARE SOCIALLY

MALADJUSTED UNLESS IT IS DETERMINED THAT THEY HAVE AN EMOTIONAL DISTURBANCE

WHAT IS EBD?

• What separates children with EBD from their more average peers?• Intensity of their behavior• Long-lasting nature of their behavior

• Other problems with the federal definition• Places all responsibility on the child, none on the

environment, necessitating changes to the child and not the environment

• The term “behavior disorder” implies the child is causing trouble for someone else

• Cultural considerations• “Norms” vary from culture to culture

HOW COMMON IS EBD?

• Number of children judged to have either serious emotional disturbance or behavior disorders: 5-15 %

• Number of children receiving special services for EBD: About 1%

DIAGNOSTIC ISSUES

• Subjective judgments, often left to local personnel

• Lack of clear line separating severe from mild emotional and behavior disorders

• “Diagnostic Fads”• Over-diagnosis and over-treatment of certain disorders• Bipolar Disorder • ADHD• Autism Spectrum Disorders

IMPORTANCE OF INTERVENTION

• Tendency towards longevity• Longitudinal studies suggest that students at moderate

or high risk for behavior and academic problems tend to continue to be at risk for poor school outcomes through middle school

CAUSES OF EBD

• Neurology & Genetics• “The Evil Child” - future behavior is determined at birth?• Widely considered over-simplistic

• Genetics tells us that some children ARE predisposed towards:• Hyperactivity• Attention problems• Impulsiveness

• Interaction Between Genetics & Environment• Data suggests that behavior is a result of integrated

contributions of factors, both internal and external• The influence of child abuse• Physical and psychological mistreatment of children is strongly

predictive of EBD, and requires preventative action such as parent training and support

EXTERNALIZING DISORDERS

• Externalizing disorders are characterized by aggression and “acting out”

Positive Constraints•Academic Success•Positive Peer Relations•Athletic Competence•Supportive Adults•Sufficient Resources

Positive Constraints•Academic Success•Positive Peer Relations•Athletic Competence•Supportive Adults•Sufficient Resources

Negative Constraints•Academic Difficulties•Attention Problems•Peer Rejection•Coercive Family Systems•Poor Parental Monitoring

Negative Constraints•Academic Difficulties•Attention Problems•Peer Rejection•Coercive Family Systems•Poor Parental Monitoring

Correlated Constraints That Affect Aggression

Operate as a brake on aggression Tend to predict aggression

RISK FACTORS – EXTERNALIZING DISORDERS

• Family Risk Factors• Family violence, including

child abuse• Violence against children is a

behavior children are likely to display when old enough to inflict violence

• Many believe a child’s atypical behavior may cause parents to act in a way that is inappropriate, causing a downward spiral

RISK FACTORS – EXTERNALIZING DISORDERS

• School Risk Factors•While one might think EBD students act out as a reaction to failure in school, in EBD children aggressive behavior is typically observable before they enter school

• School Violence & Bullying•Violence is prevalent in schools, though typically to a lesser degree than in the community at large•Children prone to violence can be identified early •Studies suggest 6-9% of children account for more than 50 percent of discipline referrals and nearly all serious offenses•Early discipline problems are predictive of later adjustment problems.

RISK FACTORS – EXTERNALIZING DISORDERS

• Cultural & Ethnic Risk Factors• Prevalence of culturally and linguistically diverse children

who are identified as having social or emotional disturbances.

• Conflict between the values of those in authority and of the child’s culture (honesty vs. loyalty, for example)

• Substance Abuse Risk Factors• Exceptional children may be overrepresented among

those who use drugs and alcohol• Predisposition to substance abuse, due to factors such as

prescribed medication, social isolation, depression, family issues, etc.

INTERNALIZING DISORDERS

• Common characteristics:• Anxious• Withdrawn• Fearful

• Children who suffer from internalizing disorders:• Are usually not disruptive• Have problems with excessive internal control –

aggression is turned inward rather than outward• May be rigid and unable to be spontaneous

INTERNALIZING DISORDERS – RISK FACTORS

• Learned Helplessness• The belief that nothing they do can stop bad things from

happening• Can result in severe deterioration in performance after

failure• Pessimism about self and abilities

• Suicide• Strong feelings of hopelessness can be a predominant

reason for children to think about or attempt suicide• Countered with explicit instruction in positive coping

skills, building sense of self-control

THE INFORMATION PROCESSING MODEL

• EBD – whether exhibiting external or internal aggression – has an impact on all aspects of information processing

• While perceptual abilities may test as normal, how the child perceives stimulus may be altered

• Anxiety and stress can influence all processing mechanisms

• A team approach is required to provide appropriate supports to address externalizing or internalizing disorders and build self-confidence

RTI & EBD

• Preschool Children With EBD

• Critical to identify children with EBD as early as possible, to ensure early intervention• In one study, for preschool children

identified as having an emotional disability, only 69 percent were considered to have the same label by fourth grade

• Even if academic ability is normal, EBD can interfere with academic performance.• Oppositional (or depressive) behaviors must be

“persistent, pervasive” and “severe” to warrant mental health referral

RTI SUPPORT FOR EBD – TIER I

• For students with EBD, Tier I must include:

• A strong core reading program, to address poor academic performance commonly associated with EBD

• A consensus on school rules and classroom performance expectations

• Positive behavior approaches.

RTI SUPPORT FOR EBD – TIER II

• Positive Behavior Supports• Proactively creating a positive environment that makes

misbehavior unnecessary• Creating an environment where personal needs and

interests are being met

• Functional Behavior Assessment (FBA)• Gathering information about a child’s behavior in order to

attempt to identify causes• Identifies antecedent behaviors

RTI SUPPORT FOR EBD – TIER III

• Applied Behavior Analysis (ABA)• Focuses on the antecedents to the behavior and the

consequences following it (the Antecedents-Behavior-Consequence, or “A-B-C” approach)

• Focuses on modifying the antecedent and the consequences to hopefully modify the behavior.

• Residential Care• Despite the tendency towards full

Inclusion, other alternatives are beingInvestigated

• Programs are expensive but under the right circumstances might be beneficial to the student.

TEACHER & PROGRAM STRATEGIES FOR CHILDREN WITH EBD

• Social Skills Training – Developing Social Skills

• Self monitoring • Self instruction training (SIT)• Self evaluation• Self reinforcement

• Two desired outcomes of these methods:• The child gains self-confidence by exerting control

over his or her behaviors• The child can participate in the general education

classroom for the maximum time possible

TEACHER & PROGRAM STRATEGIES FOR CHILDREN WITH EBD

• Teacher & Personnel Preparation• The move to full inclusion requires more teacher

preparation than ever• Rather than expecting to have “super teachers” a team

approach is critical to ensuring teachers are appropriately supported

• The Support Teacher (EBD Specialist)• Understands that even a child with serious behavior

problems is not disturbed all the time• Is a source of, and requires, direct assistance• Should be full-time and trained as a special education

teacher, and should be able to help all children with academic and emotional problems.

TEACHER & PROGRAM STRATEGIES FOR CHILDREN WITH EBD

• The Wraparound Approach• A multi-disciplinary approach makes extensive use of

agencies outside the school program• Can include services for not only the student but the

family as well• Focuses on the strengths of the students

• Peer Tutoring• Peer-assisted learning strategies with a “player” (student

with disabilities) and a “coach” (student prepared to help)• Coaches must be prepared appropriately and requires

considerable planning to be successful

TEACHER & PROGRAM STRATEGIES FOR CHILDREN WITH EBD

• Technical assistance• PBIS (Positive Behavior Interventions & Supports)• Behavior games, social skills games

• Time Out• Takes students away from possibly negative interactions• Allows for a cool-off period

• Assistive Technology• Effective because computers don’t interact emotionally with a

child, does not allow student to resort to emotional manipulation

• Computer-based support in academic achievement can lead to enhancement of self-worth

• Students with hyperactivity or concentration issues can be helped by a computer

THE ROLE OF THE FAMILY

• “Partnering of Experts”• Parents as “experts” on their children, and professionals

are “experts” in their areas, such as special education or mental health.

• Challenges• Cultural diversity sometimes leads to view that parents

need to be trained rather than partnered with• Learned helplessness

BETH: PROGRESS?

• http://www.youtube.com/watch?v=g2-Re_Fl_L4