Running head: COUNSELING CHILDREN WITH EMOTIONAL DISTURBANCE

Counseling Children with Emotional Disturbance LaKenya Browder Liberty University

COUNSELING CHILDREN WITH EMOTIONAL DISTURBANCE

Abstract Approximately 5-10% of children have emotional disturbance (ED), making this one of the fastest growing disability populations in the school system. Children with ED tend to possess traits that hinder their overall academic success, particularly in the areas of reading, mathematics, language and written expression, with very little appearance of academic improvement over time. There has been a lack of peer consensus relating the federal definition of ED, with much criticism, ye the federal definition remains the standard. Rational Emotive Behavior Therapy (REBT) may provide an effective intervention that facilitates learning for children with ED. REBT is congruent with the general principles of Christianity, making is a resource when incorporating spirituality it the counseling session. The Five Domains Model is a Christian theory for counseling children that deals with sin within the spiritual, behavioral, cognitive, emotional, and interpersonal aspects of the childs life. With a rise in the number of children being diagnosed with ED, practical, effective educational and mental resources for these students need to be available for special and general teachers alike.

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Counseling Children with Emotional Disturbance Approximately 5-10% of children have a federal educational disability called emotional disturbance (ED), making this a national concern, as it is one of the fastest growing disability populations in the school system (Rudy & Levinson, 2008). The Individuals with Disabilities Education Improvement Act (IDEIA) includes ED as a determining factor if a child is eligible to receive special education services. Having emotional disturbance can affect a child's academic, career and social skills. Children with ED tend to possess traits that hinder their overall academic success, particularly in the areas of reading, mathematics, language and written expression, with very little appearance of academic improvement over time. It is common for them to display chronic behavioral problems (noncompliance, aggression, and disrespect toward authority figures), as well academic problems in multiple areas and are unable to maintain social relationships (Banks & Zionts, 2009; Duchnowski, & Kutash, 2011; Henderson & Thompson, 2011; Reddy, Newman, De Thomas & Chiun, 2009; Rudy & Levinson, 2008; Siperstein, Wiley & Forness, 2011). The federal definition of emotional disturbance is (i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: (A) An inability to learnt that cannot be explained by intellectual, sensory or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems. (ii) The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have emotional

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disturbance (as cited in Rudy & Levinson, 2008, p. 495; Newman, De Thomas & Chiun, 2009; Wery & Cullinan, 2011). There has been a lack of peer consensus relating the federal definition of ED, with much criticism. With failed efforts to have the term redefined, Congress continues to use the current IDEIA (Individuals with Disabilities Education Improvement Act) definition. One criticism that has been expressed is that the definition is too restrictive, and how children who are socially maladjusted are not able to utilize special education services, for children who are socially maladjusted are thought to make the purposeful decision to not conform. Children with social maladjustment must also have emotional disturbance in order to receive special education services. Another critique is with the meaning of certain terms, such as long period of time" and "adversely affects educational performance" (Banks & Zionts, 2009; Henderson & Thompson, 2011; Rudy & Levinson, 2008; Wery & Cullinan, 2011). Assessing whether a child has emotional disturbance serves multiple purposes. One purpose is to assist teachers in dealing with behavioral problems in the classroom. Another purpose is to help the student reduce and improve disruptive behavior. Other purposes for assessing whether a child has ED is to determine if they qualify for special education services and whether their family needs to be referred for additional mental health services. Assessments can be conducted through interviews, in which the counselor can observe the child's behavior and interaction styles. Interviews can be highly structured, unstructured, or semi structured interviews. Structured interviews can be time consuming and rigid, though some structured interviews provide a more conversational format. Unstructured interviews may miss the problem area if not conducted properly. Semi structured interviews are commonly used with children, allowing the most flexibility (Rudy & Levinson, 2008).

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According to McConaughty and Ritter (as cited in Rudy & Levinson, 2008), there are four attitudes relating to emotional disturbance. The first perceives emotional disturbance as a result of the child's pathology, suggesting genetic and environmental factors are the chief culprits. The second viewpoint views behavioral-environmental interactions as the cause of ED. This perspective focuses on the child's behavior and, for example, their school environment, how they interact with peers and teachers. Another attitude towards ED assumes that the child's behavior serves some type of function. By focusing on certain events, the counselor can see which ones cause, reinforces specific behaviors, as well as interventions that can change behavior. The fourth perception of ED relies heavily on intervention. Here, the counselor assesses the child dependent upon the extent to which his or her behaviors are resistance to the interventions (Rudy & Levinson, 2008). Children with emotional disturbance have difficulty following directions, completing classwork, and regulating behaviors at school; including other problems with other skills, such as organizational, interpersonal, self-control, and coping. Emotional disturbance often co-occurs with learning disorders and sensory processing problems. Studies have shown that children with emotional disturbance frequently show deficits in processing sensory environmental information. Children with learning disorders and sensory processing problems exhibit difficulties with frustration control, self-regulations, self-control, and academic tasks. Findings suggest that children with emotional disturbance may be unaware of their difficulties with self-regulation or how their behavior is perceived by others (Barnes, Vogel, Beck, Schoenfeld & Owen, 2008; Henderson & Thompson, 2011). Children with ED earn lower grades, fail more courses and are retained in school more frequently than any other group of children with disabilities, with 80-90% scoring below grade

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level on tests of reading and math achievement. They miss an average of 18-20 days of school per year and have the highest dropout rate compared to all disability groups, with only 28% graduating from high school. They have a greater risk for delinquency, with 28% being arrested at least once before leaving school, and 58% arrested within 5 years of leaving school. A major of children utilizing special education services are male, especially in the area of emotional disturbance and learning disability. Girls are at risk of being underrepresented. This may be due to some teachers perception that the needs of females are more complicated than males; traditional strategies are not as effective with girls; and the emotional and behavioral issues of females are intricate and complex. Studies have found no difference in the academic achievement patterns of students when it comes to gender. African Americans and children from low economic households are overrepresented in special education programs (Banks & Zionts, 2009; Duchnowski, & Kutash, 2011; Henderson & Thompson, 2011; Rudy & Levinson, 2008; Siperstein, Wiley & Forness, 2011). Minow (as cited in Duchnowski, & Kutash, 2011) stated that "many school systems resist the provision of related services on the theory that they are not educational but medical or psychological, even though these services are required under the act (i.e., IDEA) where necessary to enable the student's free, appropriate education. Provision of related services often fails when school districts and other agencies disagree over who should provide ad pay for them" (p. 324). In order to effectively meet the needs of children with emotional disturbance, the education system needs to integrate with the mental health system, offering better school-based mental health services, as only one-third receive the services necessary for successful outcomes. Creating a working system between the child's school, home and neighborhood continues to be a challenge for many schools, as less than 2% of students with ED receive the support they need

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(Banks & Zionts, 2009; Barnes, Vogel, Beck, Schoenfeld & Owen, 2008; Duchnowski, & Kutash, 2011). Multiple differences have been found regarding how children with ED are serviced in low income schools and high income schools. Children with ED in low income schools are below average in reading and math, while children with ED in high income schools were within the average range for reading and math. Children at risk for emotional disturbance in low income schools were a little below academically than those in high income schools. Students with ED are serviced in a separate setting in low income schools, while at high income schools they are serviced in full or partial inclusion programs. Children with ED that attend a low income school receive less counseling, social skills training, speech therapy, and occupational therapy than students with ED in high income schools. Overall, children with emotional disturbance receive less behavioral resources in low income schools than children in high income schools, though the nature or context of the special education services correlated with the students academic or behavioral improvement (Siperstein,Wiley, & Forness, 2011) Children with ED tend to exhibit internalizing (shy, anxious, depressed, and withdrawn), externalizing (noncompliant, defiant, coercive, aggressive) and co-morbid behavioral patterns. Externalizing behaviors draw more attention by teachers as they tend to disrupt the classroom and the learning process (Reddy, Newman, De Thomas & Chiun, 2009; Siperstein, Wiley & Forness, 2011). The main goal of most school-based intervention programs targeting children with ED is to reduce externalizing behaviors in school. If untreated, it can intrusively interfere with a child's ability to function in school. Studies have shown prevention and intervention programs were moderately effective art reducing internalizing behavior problems in school, thus programs that target both internalizing and externalizing behavioral problems will be essential.

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Although there is a lack of research on the effectiveness of school-based programs on externalizing behaviors in the home, intervention programs were found to be highly effective, as prevention programs were somewhat effective (Reddy, Newman, De Thomas & Chiun, 2009). Most programs the service special education students with emotional disturbance provide prevention and interventions that focus exclusively on reducing behavior deficits. There are few studies and programs that focus on the current positive behaviors of the child's social skills, adaptive functioning, general academic skills, family empowerment, and school completion. Taking this perspective suggests that programs and services are not building upon the child's current positive behaviors that may buffer the negative stigma and outcomes of children with ED (Reddy, Newman, De Thomas & Chiun, 2009). A daunting task has been laid upon the shoulders of educators, school administrators and counselors who attempt to adequately educate children who have a high risk for school failure. One problem is that some school counselors do not feel confident enough to work with children with disabilities. One solution is for school counselors to work together with community based counselors. A multidimensional, multifaceted, and multisource evaluation conducted in a systematic manner by a team, which includes school counselors, as well as the parents, administrators, teachers, outside medical and mental health agencies, and the student. Teachers who educated children with ED are more likely to either leave or request to be reassigned. Special education programs have been found to be significantly under resourced, leaving many students without the academic and mental health support they need and teachers feeling unprepared and overwhelmed (Banks & Zionts, 2009; Barnes, Vogel, Beck, Schoenfeld & Owen, 2008; Henderson & Thompson, 2011; Reddy, Newman, De Thomas & Chiun, 2009; Rudy & Levinson, 2008; Siperstein,Wiley, & Forness, 2011).

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Families are likely to be blamed when a child has ED, which add to the parents feelings of grief, shock, fear anxiety about the child having a disability (Henderson & Thompson, 2011; Rudy & Levinson, 2008). Students with emotional disturbance receive little psycho-social support, and little support for their families (Duchnowski, & Kutash, 2011). One goal for programs for families whose children have disabilities is to facilitate family empowerment. Empowerment has been defined as the reduction of powerlessness; gaining, developing, seizing, enabling or giving power; the ability to influence people, organizations, and the environment affecting one's life; attaining control over one's life and democratic participation in the life of one's community. It has been reported that having a good relationship with a service provider facilitates empowerment in families who have children with disabilities. It has also been reported that poor services serves as a motivator to seek out better services, with results in the family feeling empowered and more self-sufficient (Henderson & Thompson, 2011; Koren, DeChila, & Friesen, 1992). Rational Emotive Behavior Therapy (REBT) may provide an effective intervention that facilitates learning for children with ED, as cognitive-behavioral strategies have resulted in successful outcomes in public school systems. REBT includes psychological philosophical and educations aspects in it theory. The psychological aspect examines how emotional problems are the result of one's thoughts. The philosophical aspect suggests that one's view of life strongly influences their emotions. REBT is educational I that is treats its clients how to manage their problems (Banks & Zionts, 2009). Studies have shown that REBT used in educational setting can modify behaviors relevant to emotional disturbance. The counselor must use REBT methods that are appropriate to the child's cognitive development. Both adults and children may possess irrational beliefs that can

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lead to emotional disturbance. Given that REBT posits one's thinking process can cause extreme emotional distress, utilizing both cognitive restructuring and behavioral techniques will assist in reducing the child's self-defeating emotions and behaviors. REBT strategies in a school-based program may cause an increase in emotional distress. It is important for the counselor to teach new skills and allow the student sufficient time and a safe environment to master them, as well as reinforce skills the student has already learned. REBT may increase rational thinking, thus reducing the irrational beliefs that causes emotional disturbance. Properly utilizing REBT techniques may help students improve academically and behaviorally. Children from the age of 8 have benefited from REBT, learning emotional responsibility and techniques to reduce selfdefeating attitudes and feelings (Banks & Zionts, 2009). Spirituality is important in times of distress. Researchers who study children and spirituality suggest that spirituality is universal in that it is not dependent on age. Hay (cited in Hufton, 2006) stated that there is no such thing as a child without spirituality. He states that we can expect children to be more spiritually aware than many adults, due to the lack of cultural pressure and the acceptance of their spiritual perceptions (Hufton, 2006). It has been suggested that a child's spirituality is expressed through behavior and verbal communication, thus some cues of spiritual distress in a child may be overlooked due to his or hers inability to communicate his or her needs. Hart and Schneider (as cited in Hufton, 2006) identified observation and listening as two essentials in identifying spiritual distress in a child. Coles (as cited in Hufton, 2006) suggests that counselors focus on the child's "wordless narration." Identifiable cues of a child's spiritual distress may include crying, nightmares, asking numerous questions and regressive behavior, which are commonly expressed at night-time.

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Spiritual distress may be alleviated by therapeutic play, music, and reading; with art being one of the most common forms of a childs spiritual expression (Hufton, 2006). One study has found that churches are used as a support for Protestant youth with a serious emotional disorder, as well as support among many families of children with serious emotional disorders. Though most of the youth in the study participated in religious activities, youth with more externalizing problems were slightly less likely to participate, with only one in ten used pastoral counseling. Faith based services can be a support for families who have children with a serious emotional disorder, as well as an environment where children can practice healthy social and emotional goals. Church leaders can also be included in the behavioral management of a child, continuing along a systems approach by incorporating religion into the treatment planning and intervention (Pinkard & Heflinger, 2006). REBT is congruent with the basic principles of Christianity. For example, many religious clients believe the irrational beliefs cause psychopathology. It has been found that incorporating a religious aspect top REBT has resulted in a significant reduction in depression, automatic negative thoughts and general symptom distress. Counselors can integrate REBT strategies with Christianity, or any other organized religion. Incorporating a child's familial religious worldview can assist in positive therapeutic outcomes (Nielsen, Ridely & Johnson, 2000). The Five Domains Model is a Christian theory for counseling children, who are the most vulnerable group. It posits that childhood pathology and emotional distress is basically rooted in sin. It suggests that diagnosis should not be the focus of treatment, but rather issues from the domains of the spiritual, behavioral, cognitive, emotional, and interpersonal of the individual should be assessed, in which techniques are applied to the specific situations. The Five Domains states that pain caused by sin affects children in three ways, idiopathic pain, which results from

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one's sinful behavior (feeling guilty for not telling the truth); inflicted pain, which is the effect of the sins of others and a fallen world (a tornado that destroys one's home); and inherited pain, the result of a fallen gene pool, making it possible to inherit pathological disorders (Sisemore, 2003). The Five Domains suggests that behavioral techniques can include the use of rewards and consequences for certain behaviors, but behavioral strategies alone does not address the sinful nature of a child. The Five Domains initiates three areas of change processes, cognitive, emotional and interpersonal. Cognitive change processes may include teaching skills and clarifying communication, using techniques such as symbolic play and sociodramatic role play. Emotional change processes may include an assessment of the how well the child identifies his or her feelings; how the child understands his or her emotions; scaffolding techniques to measure the intensify of emotions or reconstructive techniques to evoke strong emotions and learn their meaning; and teaching the child how to manage their emotions. Interpersonal change processes include developing a solid therapeutic relationship with the child, though the relationship alone is not sufficient for change. This may also include teaching the child good relationship building (Sisemore, 2003). Although the Five Domains Model includes parents, teachers and other relevant people in managing a child's behavior, it sees God as an active agent in the counseling process, in which the therapist's spiritual health significantly affects the progress of the child. This model teaches children adaptive ways to use faith to cope, uses biblical stores to teach cognitions, coping strategies, and management of emotions. It even encourages children to pray about current issues that are brought up in the counseling session (Sisemore, 2003). Children with emotional disturbance are a nation problem that needs to be addressed in and out of the school system. With a rise in the number of children being diagnosed with ED,

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practical, effective educational and mental resources for these students need to be available for special and general teachers alike. Though many students are being underserviced when it comes to treating and managing ED, some intervention and preventative programs have shown progress. A childs spirituality must also be considered, as it can be a positive influence on his or her personal and academic progress.

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Reddy, L. A., Newman, E., De Thomas, C. A., Chun, V. (2009). Effectiveness of school-based prevention and intervention programs for children and adolescents with emotional disturbance: A meta-analysis. Journal of School Psychology, 47(2), 77-99, doi: 10.1016/j.jsp.2008.11.001. Rudy, H., & Levinson, E. (2008). Best practices in the multidisciplinary assessment of emotional disturbances: A primer for counselors. Journal of Counseling and Development : JCD, 86(4), 494-504. Siperstein, G., Wiley, A., & Forness, S. (2011). School context and the academic and behavioral progress of students with emotional disturbance. Behavioral Disorders, 36(3), 172-184. Sisemore, T. A. (2003). Christian counseling for children: The five domains model. Journal Of Psychology & Christianity, 22(2), 115. Wery, J. J. & Cullinan, D. (2011). State definitions of emotional disturbance. Journal of Emotional and Behavioral Disorders. doi: 10.1177/1063426611418234