Lect 1-2 - Characteristics

7/29/2019 Lect 1-2 - Characteristics

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Lecture 2

Characteristics of Emotional

and Behavior Disorders



Outline

• Prevalence of EBD

• EBD in early childhood

• Types and characteristics of EBD

i. Internalizing conditions

ii. Externalizing conditions



• Difficult to estimate the prevalence and the number of students with EBD due to the subjective andvague of federal definition

• WHO estimated that neuropsychiatric disorders willrise by over 50% internationally by 2020

• Some experts: estimates 16%-22%

• 2000-2001: number of students bet ages 6 and 21years who received sps ed services under IDEAdue to having EBD was <1% (.72%)

• Big difference ….it means thousands of students

with EBD are not receiving sps ed services

Factors That Affect the Prevalence

of EBD



1. Gender Boys more often identified as having EBD than girls

European American (E-A) male – 4X > E-A girls

Hispanic males -- 3X > girls

African American -- 6X > E-A girls

Boys > girls having externalizing problems and displayconduct problems, immaturity, antisocial behavior, andaggressive behaviors

Girls > boys having internalizing problems and displaydepression and social withdrawal

Girls < boys causing disruptions in the classroom

Because teachers see boys’ behavioral problems as moredisturbing, boys are more often identified as having EBD


of EBD



2. Culturally and linguistically diversity

Some culturally and linguistically diverse students

are disproportionately identified (overidentified)

as having EBD

Federal government data indicate that African

American students historically have been

overrepresented in many of the disability

categories (2X than other racial groups such as

Hispanics, American Indians, Alaskan Native,

Asian or Pacific Islanders)


of EBD



Classic study of Quay, Morse, and Cutler (1966)

established 3 factors, supported by Conners,

1970; Kaufman, Swan, & Wood, 1979; Quay,

1966Quay (1972, 1975) has identified a cluster of

behaviors associated with socialized delinquency

or juvenile delinquency

Federal regulations excludes “sociallymaladjusted” – unless it is determined that they

are seriously emotionally disturbed (Federal

Register, 1977)

Factors of Disordered Behavior (Coleman, 1986)



What are the factors that

affect the prevalence of

EBD?

Discuss



Factors affecting disproportionate

representation of EBD

• Teacher bias

• Lack of effective prereferral intervantions

• Use of inapropriate and/or inequitableassessment procedures

• Assignment of certain students to low-ability groups/tracking

• Teacher expectations



Factors affecting disproportionate

representation of EBD

• Poverty is associated with higher identificationrates of EBD – poor health, poor education, poor social outcome

• Minority status – many minorities are more likelythan European Americans to be identified ashaving mental retardation or learning disabilities

• Minority status – African Americans are morelikely to be identified as having EBD



• There is a relationship between children whodevelop EBD and their environment

• Environment – domestic violence, parental drug

and alcohol abuse – children demonstrate severeand chronic behavior problems by the time theyare of school age and they seldom receive earlyintervention

• Without a clearly defined operational definition, itis difficult to determine whether a particular behavior is within the parameters of developmental norms or the result of an EBD

EBD in Early Childhood



• From birth – 5 years, a child’s behavior isinfluenced by temperament and parentalinteraction, and early behavior may not be

predictive of later behavior

• Because young children are not in school, itis difficult to ascertain whether their behaviors have persisted over a long periodof time or whether they are displayingbehaviors that affect academic performance




• Coordination and collaboration between servicesis limited or nonexistent – it means identificationprocess for children with EBD does not begin untilafter they enter school

• Many educators, pediatricians, and other practitioners are reluctant to identify youngchildren with EBD because they are unsure thatthe child has disorder or they having schoolproblems (due to learning problems)

• Students with EBD are typically identified later inlife – they seldom receive early intervention whenit could have had a substantive impact




Identification and Intervention

• Early identification and prevention is crucial inserving young children who are at risk of EBD

• Screening in preschool or daycare setting

• Intervention program should include severaldifferent strategies

• Components of intervention include social skillsinstruction, parent training, and related skillbuilding




What are the factors that

hinder the identification of young children displaying

EBD?

Discuss



Internalizing conditions• Depression

• Anxiety disorders

• Separation anxiety disorder

• Generalized anxiety disorder

• Specific phobias

• Social anxiety disorder

• School refusal

• Obsessive-compulsive

disorder • Posttraumatic stress

disorder

• Panic disorder

• Eating disorders

Types and characteristics of EBD

Externalizingconditions

• Conduct disorder

• ADHD• Suicide

• Childhood-onset

schizophrenia



• Categorized as mood disorder in the Diagnosticand Statistical Manual of Mental Disorders(DSM-IV-TR)

• Interferes with the ability to work, study, sleep,eat, and enjoy once pleasurable activities

• Depression generally occurs several times

• Behaviors differ from one developmental stageto another, which makes it difficult to determine whether a child is going through a phase or suffering from depression

Internalizing condition: depression



• A young child suffering from depression maypretend to feel sick or refuse to go to school; older children may be irritable or angry and havebehavioral problems at school

• Adolescent depression may affect interpersonalrelationships and academic performance and maylead to suicide

• High rates of childhood depression may beassociated with being the recipient of abuse,teasing, or bullying; having a parent with mentalillness; having a genetic predisposition to

depression; and having other health problems




• Persistent sad, anxious, or “empty” mood • Feelings of hopelessness

• Feelings of guilt, worthlessness, helplessness

• Losing interest in play, friends, and schoolwork, or

loss of interest in activities that were once enjoyed• Loss of energy or fatigue

• Loss of concentration

• Insomnia or oversleeping• Change in appetite; weight loss or overeating and

weight gain

• Thoughts of death or suicide; suicide attempts

• Restlessness, irritability, anger

Symptoms of depression



• Major depression may include emotional,cognitive, motivational, and physical symptoms


A child with emotional

symptoms may have

feelings of:

-- worthlessness

-- hopelessness

-- guilt-- feel rejected by peers

-- act sad or lonely

-- nothing in life is going

right

A child with cognitive

symptoms may:

-- unable to concentrate on

academics

-- feel that they are unable to

do anything right-- avoid tasks and social

interactions

-- not motivated

-- have suicidal ideation




Physical symptoms:-- a change in appetite or

weight

-- insomnia

-- too much sleep

-- related conditions include

eating disorders,

substance abuse, anxiety

disorders, and juvenile

delinquency

Dysthymia:

-- a less severe form of

depression

-- symptoms are not as

severe as those major

depression

-- not diagnosed and do not

receive the neededintervention

-- poor school performance,

social withdrawal, shyness,

irritability, sleep irregularities




Bipolar disorder :

-- a separate category from depression

-- once known as manic-depressiveillness

-- begins in late adolescence

-- child: extreme mood swings

-- can be treated with medication



• Anxiety disorder -- excessive fear, worry, and

uneasiness that prevent an individual from

functioning in daily life

• Types of anxiety disorders – separation anxiety

disorder, generalized anxiety disorder, specific

phobias, social anxiety disorder, obsessive-

compulsive disorder, posttraumatic stressdisorder, panic disorder, and eating disorders

Internalizing condition: anxiety disorder



• Separation anxiety disorder – occur before the

age of 6 years

• Separation from home or from those to whom the

child is attached• The child may refuse to go to school, refuse to

sleep alone, refuse to leave the house

• Treatment – systematic desensitization (step-by-step separation), modeling, shaping (gradual

steps to eliminate the anxiety)

Internalizing condition: separation anxiety disorder



• Generalized anxiety disorder/GAD – excessiveanxiety and worry that is not caused by any recentevents or activities

• Worries are accompanied by physical symptoms esp fatigue, headaches, muscle tension, muscleaches, difficulty with concentration, irritability,

sleeping difficulties

• Children and adolescents with GAD often worryabout their school performance or competence in

sporting events

Internalizing condition: generalized anxiety disorder



• Specific phobias – intense fear of objects or

situations that pose little or no threat to the person

• Actively avoiding the objects or situations above

• Fear of -- closed-in places such as elevators and

crowded malls, heights (acrophobia), spiders(arachnophobia), water (hydrophobia), blood

(hemophobia), flying (aviophobia)

Internalizing condition: specific disorder



• Social anxiety disorder – persistent and excessivefear of social situations, interpersonal scrutiny, theassociated potential for embarrassment or humiliation

• Children may appear extremely timid and cling tofamiliar persons; may cry or throw tantrums

• Adolescents – poor relationships, rejected by peers,

have fewer quality friendships, have higher rates of peer victimization

• Students – shy, quiet, withdrawn when meeting

mew people or in unfamiliar social settings

Internalizing condition: social anxiety disorder



• School refusal – attempts by a child or adolescentto miss school

• May result from emotional disorder such as

generalized anxiety disorder, separation anxiety,or depression, or school or family factors

• Fear of school environment due to tests, public

bathrooms, teachers (lack of support or criticism),difficulties with peers (bullying, gang activities),attention-seeking behaviors (crying, difficultiessleeping)

Internalizing condition: school refusal



• Recurrent and persistent distressful thoughts –

fear of contamination, fear of harming others,

inappropriate impulses such as thoughts of

violence and aggression

• The most common among children –hand

washing (cleaning), making sure that toys are

placed in a certain order (ritual ordering), makingsure everything in right place (straightening)

• Behaviors of children are similar to adults

Internalizing condition: obsessive-compulsive

disorder



• Boys – more likely to develop OCD as children

• Girls – more likely to develop OCD as young

adults

• Treatment – medication and cognitive behavioral

therapy

• Medication – reduce anxiety

• Cognitive behavior therapy – help students

understand and cope with the disorder

Internalizing condition: obsessive-compulsive

disorder

I t li i diti tt ti t



• Traumatic events – real or perceived death, injury,or threat to their physical well-being

• Other events – witnessing a violent act,

experiencing the death of a close relative,experiencing sexual or physical abuse, domestic

violence, community violence

• Other symptoms – repetitive play involving thetraumatic event, nightmares, social detachment,

sleep difficulties, hyper-vigilance

• Ordinary events that remind the child of the

traumatic event can trigger flashbacks

Internalizing condition: posttraumatic stress

disorder (PTSD)



• Three clusters of PTSD symptoms:

1. reexperiencing the traumatic event

2. persistently avoiding anything associated with

the trauma

3. having persistent symptoms of increased

arousal

Internalizing condition: posttraumatic stress

disorder (PTSD)



• children who have a panic disorder have suddenand repeated panic attacks or a period of intense,

overwhelming fear

•may feel his or her heart is pounding and may feel

weak and dizzy

• feel nauseated and afraid that something bad is

going to happen• Many children and adolescents who have panic

disorder attribute them to external stimuli

• Rarely identified in children

Internalizing condition: panic disorder



• Severe disturbance in eating behavior

• Most common eating disorders – anorexia

nervosa and bulimia nervosa

• Anorexia nervosa – refusal to maintain a

minimally normal body weight – results in

severe weight loss

• See themselves as overweight though they

are thin

Internalizing condition: eating disorders



• Excessive exercise and may induce vomiting

or misuse laxatives to control their weight

• Frequently come from over-controlled homes

• Mortality rate – 12x > other females ages 15-

24 years




• Bulimia nervosa – eats an abnormally large

amount of food and then self-induces

vomiting or misuses laxatives to control

weight – weight is usually normal for their age and height

• Aware of abnormal eating habits, thus keep

their behavior secret

• Majority of anorexia nervosa and bulimia

nervosa are females


Externalizing condition: conduct



• Individuals with CD show a repetitive and persistent patternof behavior in which they violate the basic rights or major

age-appropriate societal norms or rules at home ==

antisocial behaviors

• E.g. – fighting, assaulting others, destroying property,stealing, lying, being physically cruel to people or animals

• Affect the school environment – disrupt the classroom,

hindering other students from learning

• Academic underachievers, experience peer rejection

• Prevalence rate for boys is higher than girls

Externalizing condition: conduct

disorder



• Associated with early age of onset• Children with conduct disorder

– tend to show covert behaviors such as lying,

stealing, and truancy

-- inappropriate behaviors increase in intensity and

severity as they get older

-- they are oppositional, aggressive, inattentive,

impulsive-- develop delinquent, antisocial behaviors at the

beginning of adolescence

• At risk for criminal behaviors in adolescence

Externalizing condition: conduct disorder



• Dispositional risk factors: – child temperament

-- neuropsychological deficits and difficulties

-- poor academic performance-- temperament: having easy, slow to warm up, and

difficult temperaments

• Any child with any types of temperaments could

develop emotional and behavior disorders but a

child with a difficult temperament could develop

EBD




• Causes-- social factors – relationship child-family, culture,

socioeconomic status of the environment,

acceptance by peers, the quality of the school setting

-- model the behavior observed in family and friends

-- dysfunctional homes – family risk variables: large

family, a single parent, inadequate parent

involvement and discipline, low education level of a

parent, parental involvement in criminal activity and

substance abuse

-- from family with low socioeconomic status




• Estimated 60%-70% of children with LD andbehavior disorders have ADHD

• symptoms: --

– inattention

-- hyperactivity

-- impulsivity

-- exhibit these symptoms before age 7 years in at

least 2 setting, usually at home and school

• Interfere with the child’s developmentally

appropriate social, academic, or occupational

functioning

Externalizing condition: ADHD



• Three types of ADHD:i. Attention-deficit disorder (ADD) – inattentive,

daydreaming, occupied with internal thoughts,

forgetful

ii. Hyperactive-impulsive – talk excessively, play

loudly, fidget, restless, tendency to interrupt,

bedwetting, sleep problems, temper tantrums,

stubbornness

iii. Combined type of ADHD and hyperactive-

impulsive




• Often overlaps with EBD, conduct disorders, andoppositional defiant disorders

• Children with conduct disorder and ADHD,

especially those with hyperactivity and/or

impulsivity, are at risk for antisocial and criminal

behavior

• Treatment – medication; behavioral management

plans




• Females > males in attempted suicide

• Males > females in successfully complete suicide

• Causes: – psychiatric problems such as depression, anxiety

disorders

-- post-traumatic stress

-- dysfunctional family

-- life stressors

-- history of family suicidal behavior

Externalizing condition: suicide



• Students with EBD are at increased risk for suicide

• Risk factors that could predict suicidal behaviors:

– substance abuse

-- exposure to suicide-- loss of a family member or friend

-- chronic illness

-- access to lethal means such as firearms-- feelings of extreme loneliness and hopelessness

-- chronic depression




• Prevention – teachers recognize the risk factors

and respond appropriately – e.g. provide

emotional support, listen and talk to the child,

refer the child to appropriate professionals

• Risk factors – sudden change in usual behavior,

problems in school, family and peer problems,giving away possessions, talk of suicide


Externalizing condition: childhood-onset



• Schizophrenia – included in federal definition of

emotional disturbance

• Characteristics of adult and child schizophrenia are

similar – delusions and hallucinations, disorders inspeech, disorganized or catatonic behavior,

inappropriate expression of emotions

• Childhood schizophrenia begins gradually withspeech and language disorders : use private

language that others do not understand; believe

that people can read their minds and they receive

special messages from the radio

Externalizing condition: childhood onset

schizophrenia



How to group behaviors

associated with EBD? Give

examples

Discuss

C lt l d i l f t



• Race, culture, and ethnicity may play a rolein the prevalence of internalizing and

externalizing conditions and in the

identification of students with EBD

• Hispanic adolescents (especially females) >

symptoms of depression than youths of other

ethnicities

• African American males higher levels of

aggression and overt aggression

Cultural and racial factors

C lt l d i l f t



• Hispanic female adolescents and African American male adolescents display higher

levels of anxiety than others of their age

• European American children and

adolescents display higher rates of suicide

than African American youths

Cultural and racial factors



Who and why should

understand characteristicsof EBD?

Discuss



Discuss• Discuss the factors that affect the prevalence

of emotional and behavior disorders.

•

Describe the factors preventing theidentification of young children displaying

emotional and behavior disorders and how

this affects providing early intervention. • Explain the differences between

internalizing and externalizing disorders.

Documents

Lect 1-2 - Characteristics