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Understanding Students with Emotional or Behavioral Disorders
Presented by:Amber Melton
Defining EMDO Inability to learn (cannot be explained
by intellectual, sensory, or health factors)
O Inability to develop or maintain interpersonal relationships
O Inappropriate types of behaviors or feelings
O Pervasive mood of unhappiness or depression
O Physical symptoms or fears associated with personal or school problems
Diagnostic Informationin Children’s Mental
HealthO DSM-IV is the accepted guide to
psychiatric diagnosisO Many disorders show similar
symptomsO Some tend to occur together in the
same childO It may take years to reach an
accurate diagnosis as symptoms change with time and development
Educational Classifications
OMost children with a diagnosable mental health disorder will need special education assistance
OUsual classifications will be EMD (Emotional Disorders) or OHI (Other Health Impairment)
OClassification does NOT dictate classroom placement; many of these students succeed in a regular education classroom
EMDO 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)
O 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
CharacteristicsO InternalizingO ExternalizingO CognitiveO Academic
Internalizing DisordersO Anxiety - Withdrawal
O Separation anxiety disorderO Generalized anxietyO PhobiasO OCDO Panic disorder O Anorexia, bulimiaO DepressionO Post-traumatic stress disorder
Anxiety DisordersO Frequent absences
O Isolating behaviors
O Many physical complaints
O Excessive worry
O Frequent bouts of tears
O Frustration
O Fear of separation
O School avoidance
O Fear of new situations
O Drug or alcohol abuse
O See also: OCD, PTSD
DepressionO Affects thoughts,
feelings, behavior, relationships, physical health
O IrritabilityO In early childhood,
may appear as irritability, defiance, restlessness, or clinging
O Continuing sadnessO Hopelessness, self-
deprecating remarks
O School avoidanceO Changed eating or
sleeping patternsO Frequent physical
complaintsO Isolation,
nonparticipation
Internalizing BehaviorO Psychotic behavior
O hallucinationsO delusions
O schizophreniaO schizotypal (personality disorder)
SchizophreniaO Commonly appears
in late teens or early adulthood
O May come on gradually; may appear in teens with other mental health diagnoses.
O Early diagnosis and treatment is imperative; 50 percent or more may attempt suicide
O Withdrawn, lack motivation
O Vivid and bizarre thoughts or speech
O Confusion between fantasy and reality
O Hallucinations (visual) or delusions (auditory)
O Severe fearfulnessO Odd, regressive
behaviorO Disorganized
speech
External DisordersO Undersocialized
Aggressive CDO CDO Attention
Problems - Immaturity
O Motor ExcessO unaware of
behavioral expectations
O Socialized Aggressive CDO Socialized
delinquencyO gang
involvementO truancyO “looks up to
other rule violators
O aware of behavioral expectations; covert attempts
Oppositional Defiant Disorder
O Above average level of anger, blaming, hostile, or vindictive behavior
O May be a reaction to frustration, depression, inconsistent structure, or constant failure due to undiagnosed ADHD, learning disabilities, etc.
O Frequent angry outbursts
O Noncompliant and argumentative
O Easily annoyedO Rejects praise,
may sabotage activity that was praised
O Deliberately annoys, provokes others
Conduct DisorderO Serious, repetitive,
and persistent misbehavior
O Aggression toward people or animals
O Property destruction
O Deceitfulness, theftO Three or more
incidents in last year; one during last six months
O Problem must be persistent, not a reaction to stress, crisis, cultural, or social life context
O Co-occurs with ADHD, learning disabilities, depression
O See also: Oppositional Defiant Disorder
Reactive Attachment Disorder
O Disturbed and developmentally inappropriate social relatedness in most contexts
O Begins before age five, usually after a period of grossly inadequate care or multiple caretaker changes
O Destructive, self-injurious
O Absence of guilt or remorse
O Extreme defiance, provokes power struggles, manipulative
O Mood swings, ragesO Inappropriately
demanding or clinging
Bipolar DisorderO Frequent, intense
shifts in mood, energy, motivation
O Shifts in children are very fast and unpredictable
O “Mania” phase may appear as intense irritability or rages
O Anxiety, defiance may be seen
O Strong craving for carbohydrates
O Impaired judgment, impulsivity
O Delusions, grandiosity, possibly hallucinations
O High risk for suicide and accidents
Obsessive-Compulsive Disorder
O Intrusive, repeated thoughts
O Senseless repeated actions or rituals
O Frequently co-occurs with substance abuse, ADHD, eating disorders, Tourette Syndrome, other anxiety disorders
O Difficulty finishing work on time due to perfectionism or ritual rewriting, erasing, etc.
O Counting rituals, rearranging objects
O Poor concentrationO School avoidanceO Anxiety or
depression
Post-Traumatic Stress Disorder
O Affects children who are involved in or witness a traumatic event
O A concern with refugee populations
O Intense fear and helplessness predominate at event and during flashbacks
O Flashbacks, nightmares, repetitive play re-enactments
O Emotional distress when reminded of incident(s)
O Fear of similar places, people, events
O Easily startled, irritable, hostile
O Physical symptoms such as headaches, dizziness
Eating DisordersO Anorexia, BulimiaO Now at earlier ages,
10-20% boysO Perfectionists, over-
achievers, athletes at highest risk
O High risk for depression, alcohol, and drug abuse
O Impaired concentration
O Withdrawn, preoccupied, anxious
O Depressed or mood swings
O Irritability, lethargyO Fainting spells,
headaches
CognitiveO Most have IQ in low rangeO More than half have learning
disabilitiesO Relationship between academic and
social behaviors are connected
AcademicO Achieve below grade level in
reading, math, and written expression
O Drop out of school at a higher rate than any other students
O Mean achievement level at the 25th percentile
O More academic problems with externalizing behaviors
O Less likely to attend post-secondary school
On Any Given Day…OThree million American children meet
the clinical criteria for mood disorders
O21% of children and adolescents have a behavioral, emotional, or mental health problem
Risk FactorsResearch shows both biological and psychosocial
factors influence the development of the brain, and brain disorders
Many brain disorders cluster in families, showing a genetic component or predisposition
O Some symptoms relate to damage due to injury, infection, poor nutrition, or exposure to toxins
O Stressful life events, malnutrition, childhood maltreatment, and aggression may lead to short or long-term symptoms and increase the likelihood of adverse outcomes
CausesO Biological
O GeneticsO Environmental
O Stressful living conditionsO Child maltreatment (neglect, physical
abuse, sexual abuse, emotional abuse)
O School factors
What would you do if this was your student?
This won’t work!
Or this…
Not this either!
Stages of a Meltdown
OAnxiety/Starting Out – a noticeable Anxiety/Starting Out – a noticeable change in behaviorchange in behaviorOCan be an increase or a decreaseCan be an increase or a decreaseOExamples:Examples:
Stages of a Meltdown
ODefensive/Picking Up Steam – Defensive/Picking Up Steam – beginning stage of loss of beginning stage of loss of rationalityrationalityO Student may become belligerent Student may become belligerent O Student may challenge authorityStudent may challenge authorityO ExamplesExamples
Stages of a MeltdownO Acting-Out/Point of No Return – total Acting-Out/Point of No Return – total
loss of control which results in loss of control which results in physical or emotional acting out physical or emotional acting out episodeepisodeO It’s on!!!!!It’s on!!!!!O Flight or fight mechanism is triggeredFlight or fight mechanism is triggeredO ExamplesExamples
Stages of a MeltdownO Tension Reduction/Recovery Period – Tension Reduction/Recovery Period –
a decrease in physical and emotional a decrease in physical and emotional energy that occurs after one has energy that occurs after one has acted outacted outO This is your goalThis is your goalO Can happen after any stageCan happen after any stageO ExamplesExamples
Your ResponseO Supportive – be non-judgemental Supportive – be non-judgemental
and empathic to attempt to alleviate and empathic to attempt to alleviate anxietyanxietyO ListenListenO Show concernShow concernO Ask questionsAsk questionsO Acknowledge the student’s feelingsAcknowledge the student’s feelingsO Understand that students with ASD Understand that students with ASD
and EMD sometimes do not have and EMD sometimes do not have automatic sensory regulation automatic sensory regulation
Your Response
Your ResponseO Remove the audienceRemove the audienceO Allow the student to vent and just listenAllow the student to vent and just listenO Silence is okSilence is okO Do not attempt to touch the student unless Do not attempt to touch the student unless
he is a threat to himself or othershe is a threat to himself or others
Your ResponseO Once the student has reached Once the student has reached
tension reduction, re-establish tension reduction, re-establish communicationcommunication
O Reassure the student that your Reassure the student that your relationship is not damagedrelationship is not damaged
O Allow “down” timeAllow “down” time
Keys to Verbal Intervention and Setting
LimitsO Simple and clearO ReasonableO Enforceable
OStay calmO Be aware of body languageO Give undivided attention
Why the Meltdown?
O Precipitating Factors Precipitating Factors – internal or external – internal or external causes of acting out behavior over which staff causes of acting out behavior over which staff have little to no control have little to no control O examples: poverty, rejection, bullyingexamples: poverty, rejection, bullying
O Sensory Processing ProblemsSensory Processing Problems– the inability – the inability to filter external sensations or organize to filter external sensations or organize sensory messagessensory messagesO Sensitivity to light, noise, touch, taste, or smellSensitivity to light, noise, touch, taste, or smell
O Perfumes, crowded areas, scratchy clothing, bright Perfumes, crowded areas, scratchy clothing, bright lightinglighting
Why the Meltdown?O Difficulty with Abstract Thinking Difficulty with Abstract Thinking – –
inability to imagine what is not directly inability to imagine what is not directly perceived by the senses perceived by the senses O If I can’t see it, hear it, or touch it, it must If I can’t see it, hear it, or touch it, it must
not be true! not be true! O DiffiDifficulty with Perspective Taking culty with Perspective Taking – the – the
inability to feel empathy (to feel what inability to feel empathy (to feel what others feel)others feel)
O Inflexibility Inflexibility – inability to accept change or – inability to accept change or alter what is expectedalter what is expected
What Can You Do?O Offer sensory breaksOffer sensory breaksO Teach social skillsTeach social skillsO Give specific Give specific
directions and directions and questionsquestions
O Break tasks into Break tasks into smaller stepssmaller steps
O Use visual images to Use visual images to teach abstract teach abstract thoughtsthoughts
O Use visual schedulesUse visual schedulesO Use timers for Use timers for
transitionstransitionsO Warnings about Warnings about
schedule changesschedule changesO Use video modelingUse video modelingO Help peers Help peers
understand their understand their behavior and ask behavior and ask them to be supportive them to be supportive and acceptingand accepting
What can you do?
O Use rewards, punishment is not as successful with EMD students
O Be consistentO Be structuredO Positive
reinforcement
O Structure the classroom Structure the classroom setting to offer a quiet setting to offer a quiet place to workplace to work
O Avoid demanding eye Avoid demanding eye contactcontact
O Implement the use of a Implement the use of a “safe person” for “safe person” for needed breaksneeded breaks
O Avoid a power struggleAvoid a power struggle
