Emotional/Behavioral Disorder

Emotional/Behavioral Disorder


"Emotional or behavioral disorders" means an established pattern of one or more of the

following emotional or behavioral responses:


A. withdrawal or anxiety, depression, problems with mood, or feelings of self-worth


B. disordered thought processes with unusual behavior patterns and atypical communication styles


C. aggression, hyperactivity, or impulsivity


The Disorders

Below are descriptions of particular emotional and behavioral disorders that may occur during childhood and adolescence. All can have a serious impact on a child's overall health. Some disorders are more common than others, and conditions range from mild to severe. Often, a child has more than one disorder (U.S. Department of Health and Human Services, 1999).

Anxiety Disorders

Young people who experience excessive fear, worry, or uneasiness may have an anxiety disorder. Anxiety disorders are among the most common of childhood disorders. According to one study of 9- to 17-year-olds, as many as 13 of every 100 young people have an anxiety disorder (U.S. Department of Health and Human Services, 1999).



Anxiety disorders include:


Phobias, which are unrealistic and overwhelming fears of objects or situations.
Generalized anxiety disorder, which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience.

Panic disorder, which causes terrifying "panic attacks" that include physical symptoms, such as a rapid heartbeat and dizziness.


Obsessive-compulsive disorder, which causes children to become "trapped" in a pattern of repeated thoughts and behaviors, such as counting or hand washing.


Selective mutism is defined as a failure to speak in specific s ocial situations despite speaking in other situations, and it is typically a symptom of an underlying anxiety disorder. Children with selective mutism can speak normally in certain settings, such as within their home or when they are alone with their parents. However, they fail to speak in other social settings, such as at school or at other places outside their home. Other symptoms associated with selective mutism can include excessive shyness, withdrawal, dependency upon parents, and oppositional behavior. Most cases of selective mutism are not the result of a single traumatic event, but rather are the manifestation of a chronic pattern of anxiety. Mutism is not passive-aggressive behavior. Mute children report that they want to speak in social settings, but are afraid to do so.

Eating Disorders
Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Eating disorders can be life threatening. Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys (National Institutes of Health, 1999). http://journal.naeyc.org/btj/200611/BTJFoxSupplementalActivities.asp
Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food in one sitting). After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates of bulimia vary from one to three of every 100 young people (National Institutes of Health, 1999

Post-traumatic stress disorder
which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness of violence, or exposure to other types of trauma such as wars or natural disasters.

Severe Depression
Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Studies show that two of every 100 children may have major depression, and as many as eight of every 100 adolescents may be affected (National Institutes of Health, 1999).

The disorder is marked by changes in:

Emotions—Children often feel sad, cry, or feel worthless.


Motivation—Children lose interest in play activities, or schoolwork declines.


Physical well-being—Children may experience changes in appetite or sleeping patterns

and may have vague physical complaints.


Thoughts—Children believe they are ugly, unable to do anything right, or that the world or

life is hopeless.


It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide.

Bipolar Disorder
Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (sometimes called manic depression). Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder (about one in 100) often experienced their first symptoms during their teenage years (National Institutes of Health, 2001).

Conduct Disorder
Young people with conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism. Current research has yielded varying estimates of the number of young people with this disorder, ranging from one to four of every 100 children 9 to 17 years of age (U.S. Department of Health and Human Services, 1999).

Schizophrenia
Young people with schizophrenia have psychotic periods that may involve hallucinations, withdrawal from others, and loss of contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia occurs in about five of every 1,000 children (National Institutes of Health, 1997).


Tourette syndrome
Gilles de la Tourette syndrome (Tourette Syndrome or TS) is a neurological disorder which becomes evident in early childhood or adolescence before the age of 18 years. Tourette syndrome is defined by multiple motor and vocal tics lasting for more than one year. The first symptoms usually are involuntary movements (tics) of the face, arms, limbs or trunk. These tics are frequent, repetitive and rapid. The most common first symptom is a facial tic (eye blink, nose twitch, grimace), and is replaced or added to by other tics of the neck, trunk, and limbs.
Although the symptoms of TS vary from person to person and range from very mild to severe, the majority of cases fall into the mild category. Associated conditions can include attentional problems (ADHD/ADD, impulsiveness (and oppositional defiant disorder), obsessional compulsive behavior, and learning disabilities. There is usually a family history of tics, Tourette Syndrome, ADHD, OCD. Tourette Syndrome and other tic disorders occur in all ethnic groups. Males are affected 3 to 4 times more often than females.

Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person.
Most often, the first indications that an infant may be experiencing significant problems will be delays in normal development. An infant who is unresponsive to his or her environment (doesn't show emotion such as pleasure or fear that is developmentally appropriate, doesn't look at or reach for objects within reach or respond to environmental changes such as sound or light), who is over-responsive (easily startled, cries), or who shows weight loss or inadequate weight gain that is not explainable by a physical problem (failure to thrive), should have a thorough evaluation.

Toddlers may have a tremendous range of behaviors that would be considered developmentally appropriate, depending on the child's own history. However, any significant delays (six months or more) in language development, motor skills or cognitive development should be brought to the attention of the child's pediatrician. Children who become engrossed in self-stimulating behavior to the exclusion of normal activities or who are self-abusive (head banging, biting, hitting), who do not form affectionate relationships with care providers such as baby-sitters or relatives, or who repeatedly hit, bite, kick or attempt to injure others should be seen by their pediatrician or family physician and, if indicated, by a competent mental health professional.


Characteristics

Impulsive.
Inattentive, distractible.
Appears pre-occupied.
Disregards all classroom rules.
Poor concentration.
Extreme resistance to change and transitions.
Speaks out, repeatedly.
Is aggressive.
Bullies and intimidates others.
Regular truancy from school.
Dishonest, consistently blames others.
Low self esteem.
Unable to work in groups.
Engages in self injurious behavior.
Has no regard for personal space and belongings.
Persistently tries to manipulate situations.


Best Practices and Accommodations

Develop consistent behavior expectations.
Involve the student in setting academic and personal goals.
Engage in role playing situations.
Communicate with parents so that strategies are consistent at home and school.
Set limits and boundaries.
Apply established consequences immediately, fairly and consistently.
Acknowledge and reinforce acceptable behavior.
Avoid confrontation and power struggles.
Provide a highly structured classroom environment.
Clearly post rules and expectations.
Establish a quiet cool off area.
Provide and teach opportunities for the student to use self control/self monitoring techniques to control behavior.
Teach self talk to relieve stress and anxiety.
Teach and provide time for relaxation techniques.
Establish cues as reminders for inappropriate behavior.
Redirect to avoid situations that may increase anxiety levels.
Remain calm and aware of your body language when addressing the student.
Provide a positive and encouraging classroom environment.
Use a study carrel.
Use visually stimulating material for assignments/learning presentations.
Use specialized technology and software.
Develop and use behavior contracts.
Give frequent feedback.


Practices in my preschool classroom:


Bal-A-Vis-X is a series of Balance/Auditory/Vision eXercises, of varied complexity, all of which are deeply rooted in rhythm.Exercises are done with sand-filled bags and racquetballs, sometimes while standing on a balance board.
A training on Bal-A-Vis-X taught me the benefits of using this technique with my kids.
Bal-A-Vis-X is effective for:
Learning disabled: Results include improved cognitive integration.
Behaviorally deficit disordered/attention deficit hyperactive disordered: Results include decreases in impulsivity and increases in attention span for behaviorally disordered students -- BEHAVIOR "SETTLES

Calming techniques:


The Pretzel and Balloon are both breathing exercises which are fun for all of us to do together. When I see the child becoming upset during the day I prompt him to do the "pretzel" to relieve stress.


Self talk- I coach the children to take three deep breaths, count to five, and say "calm down"


Relaxation thermometer- a hand out from the "mental health lady" (this is the expert called into my facility when I really, really, need a specialist for a child). The colorful thermometer helps the child visualize his feelings on the chart.


Recommended reading for helping children establish emotional vocabulary - courtesy of
Head Start.

Annie, Bea, and ChiChi Delores by Donna Maurer
Do You Want To Be My Friend by Eric Carle
Guess How Much I Love You by Sam McBratney
Lucky Song by Vera Williams
Oh My Baby, Little One by Kathi Appelt
Owl Babies by Martin Woddell
The Temper Tantrum Book by Edna Mitchell Preston
Alexander and the Terrible, Horrible, No Good Very Bad Day by Judith Viorst
And My Mean Old Mother Will Be Sorry by Martha Alexander
Andrew’s Angry Words by Dorthea Lachner


I read a lot to my kids and we discuss, act out, make graphs, and create our own books which are so beneficial for increasing their ability to verbalize their feelings.


Modifications include:

a "safe place" for the child to retreat to when feels the need to calm down and regroup.


visual cues placed throughout the room to help the child understand visually where toys belong and how many people are allowed in each center.



When needed the child is given heavy objects (dictionary, medicine ball, weighted jug) to carry down the hall. This helps him get back in control of himself. This is done with him understanding how "important" this job is that he is being asked to perform. Works wonders!



Technology

Timers are used so child has auditory cues as to when his turn is over at certain centers.


Annotations
http://www.bags-balls-and-brains.com/%20-%20fun%20activities%20involving%20gross%20motor%20and%20cooperative%20skills.


http://www.candicosgrove.com/what/balavisx/balavisx.html - information regarding the BAVX method.


http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/


www.vanderbilt.edu/csefel/modules/module2/script.pdf - excellent source for handouts
feelings wheel; temperature chart


http://journal.naeyc.org/btj/200611/BTJFoxSupplementalActivities.asp - super website for expanding children’s emtional vocabularies through fun activities