Understanding Students with

Emotional or Behavioral DisordersChapter 7

Defining EBD• 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

Diagnostic Informationin Children’s 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

Educational Classifications

• Most children with a diagnosable mental health disorder will need special education assistance

• Usual classifications will be EBD (Emotional or Behavioral Disorders) or OHD (Other Health Disorders)

• Classification does NOT dictate classroom placement; many of these students succeed in a regular education classroom

Emotional or Behavioral Disorders

• An established pattern of one or more:• Withdrawal or anxiety, depression,

problems with mood, or feelings of self-worth defined by behaviors

• Disordered thought processes with unusual behavior patterns and atypical communication styles

• Aggression, hyperactivity, or impulsivity that is developmentally inappropriate

EBD• 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

Characteristics• Internalizing• Externalizing• Cognitive• Academic

Internalizing Disorders• Anxiety - Withdrawal

• Separation anxiety disorder• Generalized anxiety• Phobias• OCD• Panic disorder • Anorexia, bulimia• Depression• Post-traumatic stress disorder

Anxiety Disorders• Frequent absences• Isolating behaviors• Many physical

complaints• Excessive worry• Frequent bouts of

tears• Frustration

• Fear of separation • School avoidance• Fear of new

situations • Drug or alcohol

abuse• See also: OCD,

PTSD

Depression• Affects thoughts,

feelings, behavior, relationships, physical health

• Irritability• In early childhood,

may appear as irritability, defiance, restlessness, or clinging

• Continuing sadness• Hopelessness, self-

deprecating remarks• School avoidance• Changed eating or

sleeping patterns• Frequent physical

complaints• Isolation,

nonparticipation

Internalizing Behavior• Psychotic behavior

• hallucinations• delusions

• schizophrenia• schizotypal (personality disorder)

Schizophrenia• 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

• 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

External Disorders• Undersocialized

Aggressive CD• CD• Attention

Problems - Immaturity

• Motor Excess• unaware of

behavioral expectations

• Socialized Aggressive CD• Socialized

delinquency• gang involvement• truancy• “looks up to other

rule violators• aware of

behavioral expectations; covert attempts

Oppositional Defiant Disorder

• 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.

• Frequent angry outbursts

• Noncompliant and argumentative

• Easily annoyed• Rejects praise, may

sabotage activity that was praised

• Deliberately annoys, provokes others

Conduct 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

• 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

Reactive Attachment Disorder

• 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

• Destructive, self-injurious

• Absence of guilt or remorse

• Extreme defiance, provokes power struggles, manipulative

• Mood swings, rages• Inappropriately

demanding or clinging

Bipolar Disorder• Frequent, intense

shifts in mood, energy, motivation

• Shifts in children are very fast and unpredictable

• “Mania” phase may appear as intense irritability or rages

• Anxiety, defiance may be seen

• Strong craving for carbohydrates

• Impaired judgment, impulsivity

• Delusions, grandiosity, possibly hallucinations

• High risk for suicide and accidents

Obsessive-Compulsive Disorder

• Intrusive, repeated thoughts

• Senseless repeated actions or rituals

• Frequently co-occurs with substance abuse, ADHD, eating disorders, Tourette Syndrome, other anxiety disorders

• Difficulty finishing work on time due to perfectionism or ritual rewriting, erasing, etc.

• Counting rituals, rearranging objects

• Poor concentration• School avoidance• Anxiety or depression

Post-Traumatic Stress Disorder

• 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

• 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

Eating Disorders• Anorexia, Bulimia• Now at earlier ages,

10-20% boys• Perfectionists, over-

achievers, athletes at highest risk

• High risk for depression, alcohol, and drug abuse

• Impaired concentration

• Withdrawn, preoccupied, anxious

• Depressed or mood swings

• Irritability, lethargy• Fainting spells,

headaches

Cognitive• Most have IQ in low range• More than half have learning

disabilities• Relationship between academic

and social behaviors are connected

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

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

• One out of every 20 Minnesota children is identified with Severe Emotional Disturbance

• Suicide is the second leading cause of death for ages 15-34 in Minnesota. The overall suicide rate is double the homicide rate in the state

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

• 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

Causes• Biological

• Genetics• Environmental

• Stressful living conditions• Child maltreatment• School factors

Stressful Living Conditions

• 38% youth with EBD come from households with annual income under $12,000

• 32% come from households with income $12,000 - $24,999

• 44% single parent households• 1/2 to 3/4 children in foster care have EBD• Homeless children experience EBD 3 to 4

times more frequently

Child Maltreatment• Neglect• Physical abuse• Sexual abuse• Emotional abuse

School Factors• Students do not receive research-

based interventions in reading• 2/3 of teachers are not certified in

EBD• Teachers working with students

with EBD experience burnout and job stress more than other teachers

Nondiscriminatory Evaluation (see pg.166)• Observation• Screening• Prereferral• Referral• Nondiscriminatory evaluation

procedures• Determination

Interventions/Techniques

• Positive Reinforcement• Response Cost• Proximity Control• Attention to Compliance• Ignoring• Group Consequences• Self Management• Contracts• Service Learning

Group Activity• Get into your group• Read Partnership Tips - Box 7-4 pg.

173• Answer the 3 questions at the end

Wraparound Supports• Family driven• Collaborative• Individualized• Culturally competent• Community and strength-based• Involves community, school, family,

mental health, and other services