Chapter 7: Emotional & Behavioural Disorders

Upon completion of this chapter, you should be able to:

 Explain the meaning of emotional & behavioural disorders

 Discuss the different types of EBD among children
 List the sign and symptoms of EBD
 Describe teachers can advise parents on EDB

7.1 Preamble
7.2 What is emotional behavioural disorder?
7.3 Emotional & behavioural disorders common among children
7.4 Generalised anxiety disorder (GAD)
7.5 Separation disorder
7.6 Phobia
7.7 Obsessive compulsive disorder
7.8 School refusal
Summary
References

Chapter 1: Introduction to Special Education

Chapter 2: Dyslexia
Chapter 3: ADHD
Chapter 4: Autism
Chapter 5: Learning Disabilities
Chapter 6: Auditory & Visual Disorders
Chapter 7: Emotional & Behavioural Disorders
Chapter 8: Giftedness

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 7.1 Preamble

This chapter discusses the types of emotional and behaviour disorders (EBD) among
preschool children. Among the common types of EBD are generalised anxiety disorder,
separation anxiety, phobias, compulsive obsessive disorder and school refusal. It is
important early childhood educators are aware and understand these types of disorder and
be able to reduce its prevalence among young children.

7.2 What is Emotional and Behavioural Disorder?

One should be cautious when using the term

‘emotional & behavioural disorder’ (EBD) to
refer to any child as it has serious implications.
According to Shakuntala Walker & J, Melvin
(2013), the term emotional and behavioural
disorder (EBD) is not a formal diagnosis, and
thus there are no well-defined guidelines for its
use. For example, you can diagnose a child as
having ADHD but it is more difficult to
diagnose a child as having a EBD.

Identifying EBD in children can be tricky

because children differ from adults in that they
experience many physical, mental, and emotional changes as they progress through their
natural growth and development. They also are in the process of learning how to cope
with, adapt, and relate to others and the world around them. Furthermore, each child
matures at his or her own pace, and what is considered "normal" in children falls within a
wide range of behaviour and abilities. For these reasons, any diagnosis of an emotional
disorder must consider how well a child functions at home, within the family, at school,
and with peers, as well as the child's age and symptom (WebMD.com. 2013).

According to the National Research Council and the Institute of Medicine, United States
(2009), EBD among young people create enormous burden for themselves, their families,
and the nation. They threaten the future health and well-being of young people. It is
estimated that abbout 15% of young people in the United States experience EBD at a
given point in time. What do you think is the percentage in Malaysia? Some reports
indicate that such disorders are rising in Malaysia. Do you agree?

The Centre for Disease Control (CDC), United States defines emotionally healthy
children as those who “have a positive quality of life and can function well at home, in
school, and in their communities.” In opposition to this, they describe EDB as “serious
deviations from expected cognitive, social, and emotional development.” It also identified

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that children with ADHD and autism are likely to experience emotional disorder,
depression and anxiety (cited in MacEgan, 2013).

EBD in children is the inability to learn (which cannot be explained by

intellectual, sensory or health factors); inability to develop or maintain
interpersonal relationships; inappropriate types of behaviours or
feelings; frequent mood of unhappiness or depression; and fears
associated with personal or school problems.

In order to formally diagnose a child with an emotional disorder, the clinician must decide
whether the child meets the criteria for diagnosis according to the classification systems.
Despite the use of elaborate classification systems, diagnosing a child often becomes
difficult because the classification systems are based on signs and symptoms for adults
which may be very different from those seen in children. The diagnosis may also be
complicated by children being unable to verbalise what and how they exactly feel, as
well as growth and development.

Emotional disorders are typically treated with psychosocial

interventions and medications alone or in combination. The
commonly used psychosocial interventions include cognitive-
behavioural therapy, family psycho-education, social skills training,
interpersonal psychotherapy, and relaxation therapy. A number of
research studies have been conducted to determine the efficacy of
treatments for emotional disorders. However, due to the nature and
variability of the conditions, studies have variable results. For some
children, certain treatments work better than others, whereas
other children might find some other therapies useful. While research
does guide a clinician about what types of treatment approaches work best for children, it
is important for the clinician to work closely with the child and the family in order to
ensure that the chosen therapy has the desired effect.

7.3 Emotional and Behavioural Disorder (EBD) Common in

Children

WebMD (2013), Mental Health Center, and Cognitive Behaviour Therapy, Center of
Silicon Valley, San Jose identified several different types of EBD that can affect children:

 Generalised Anxiety Disorders

 Separation Anxiety
 Panic Disorder
 Specific Phobias
 Obsessive Compulsive Disorder (OCD)
 Eating disorders:
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Several of these disorders, continue into adulthood. It is not unusual for a child to have
more than one disorder. Selected disorders are discussed in detail in the following pages.

a) What is emotional behaviour disorder (EBD)?

b) Why is it difficult to pin-point EBD among children?
c) List the common types of EBD among children/

7.4 Generalised Anxiety Disorder

Everyone, from the youngest child to the oldest adult,

experiences anxieties and fears at one time or another.
Feeling anxious in a particularly uncomfortable situation
never feels very good. However, with kids, such feelings
are not only normal, they're also necessary. Dealing with
anxieties can prepare young people to handle the unsettling experiences and challenging
situations of life.

According to Laura Johnson (2013), generalized anxiety disorder (GAD) is characterised

by feeling stuck in worry thoughts and “What If” thinking. Generalized anxiety is
defined as excessive anxiety and worry in children a variety of everyday events or
activities such as:

 Grades / marks
 Health issues
 Safety
 Friendships
 Performance in sport

The child may tend to be very hard on himself or

herself and strive for perfection. He or she may also
seek constant approval or reassurance from teachers
and parents.

D'Arcy Lyness (2010), defines anxiety as

"apprehension without apparent cause." It usually
occurs when there's no immediate threat to a person's safety or well being, but the threat
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feels real. Anxiety makes someone want to escape the situation — fast. The heart beats
quickly, the body might begin to perspire, and " butterflies" in the stomach soon follow.
However, a little bit of anxiety can actually help people stay alert and focused.

Symptoms of Generalized Anxiety in Children

 Worrying and “what if” thinking about a number of live events and activities.
 Difficulty with uncertainty or ambiguity.
 Difficulty concentrating.
 Being easily irritated and annoyed.
 Difficulty falling or staying asleep.
 Changes in functioning including dropping grades and increased conflict with
family and friends.

Having fears or anxieties about certain things can also be helpful because it makes kids
behave in a safe way. For example, a kid with a fear of fire would avoid playing with
matches. The nature of anxieties and fears change as kids grow and develop.

7.5 Separation Anxiety in Children

Many children experience separation anxiety between 18 months and three years old,
when it is normal to feel some anxiety when a parent leaves the room or goes out of sight.
Usually children can be distracted from these feelings. It’s
also common for your child to cry when first being left at
daycare or pre-school, and crying usually subsides after
becoming engaged in the new environment.

According to Laura Johnson (2013b) if a child is slightly

older and unable to leave its mother or another family
member, or takes longer to calm down after the mother leaves
than other children, then the problem could be separation
anxiety disorder, which affects 4 percent of children. This
disorder is most common in kids ages seven to nine. When
separation anxiety disorder occurs, a child experiences
excessive anxiety away from home or when separated from parents or caregivers. Extreme
homesickness and feelings of misery at not being with loved ones are common.

Symptoms of Separation Anxiety in Children

 Excessive anxiety when separated from parents or other caregivers.

 Worry about losing parents or caregivers or that bad things will happen to
caregivers while they are apart.
 Worry about being separated from caregivers, e.g. fears about getting lost or being
kidnapped.
 Refusing to go to school or sleepovers.

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  Insisting that someone stay with them at bedtime.
 Nightmares, usually with themes of separation from parents.
 Physical complaints (stomachaches, headaches or nausea) when separated from
parents.

Stressful events or transitions, such as moving

to a new town or parent separation, may trigger
a child’s anxiety about being separated from its
parents, but this is not always the case. One
viewpoint suggests that separation anxiety is
maintained by the child’s exaggerated beliefs
about the dangerousness of being without
parents, his/her beliefs that they will not be able
to cope with their fear, and avoidance or safety
behaviours that prevent new learning. For
example, a child may be fearful of being alone
at bedtime due to fears about safety (e.g. fear of
being kidnapped). The child may employ “safety behaviours” such as insisting that parents
stay until he/she falls asleep or sleeping in the parent’s bedroom, that relieve his/her
anxiety in the short-term, but prevents the child from learning to cope with everyday
anxiety and uncertainties.

How Teachers can Advise Parents about ‘SEPARATION ANXIETY’

As a teacher, you could provide parents with the following TIPS:

 Appreciate that separation anxiety is often stressful for parents and may be
difficult for them to understand.

 Tell parents to listen to their child and be open-minded in listening to his or her
fears because anxiety and uncertainty is a normal part of growing up. Parents
could tell about their own fears as a child.

 Get parents to assure their child that the teacher or other adults will keep
him/her safe and that they can trust these adults when parents are not there.

 Get parents to teach ‘coping strategies’ to their child to face the fears – teach the
child new ways to respond to worries and fears such a positive self-talk, ‘brave’
statements and calming strategies.

a) What is generalised anxiety disorder (GAD)?

b) List the signs of GAD among children?
c) What is the reason for ‘separation anxiety”?
d) Do you have children in your school experiencing ‘separation
anxiety?
e) How can you advise parents? Check the internet for details.

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 7.6 Phobia

What's a Phobia?

When anxieties and fears persist, problems can arise. As

much as a parent hopes the child will grow out of it,
sometimes the opposite occurs, and the cause of the anxiety
looms larger and becomes more prevalent. The anxiety
becomes a phobia, or a fear that's extreme, severe, and
persistent.

A phobia can be very difficult to tolerate, both for kids and

those around them, especially if the anxiety-producing
stimulus (whatever is causing the anxiety) is hard to avoid.

Common childhood phobias include animals, storms, heights, water, blood, the dark, and
medical procedures. If a child has a phobia, he/she will avoid situations or things that they
fear, or endure them with anxious feelings, which can manifest as crying, tantrums,
clinging, avoidance, headaches, and stomachaches. Unlike adults, children do not usually
recognise that their fear is irrational.

"Real" phobias are one of the top reasons kids are referred to for counselling by
professionals. But the good news is that unless the phobia hinders the everyday ability to
function, the child sometimes won't need treatment by a professional because, in time, the
phobia will be resolved.

Symptoms of Phobias in Children

 Extreme anxiety or panic response (e.g. crying,

tantrums, somatic complaints) when confronted with
the feared object or situation
 Avoidance of the feared object or situation that gets in
the way of normal routine. For example, your child
may be unable to engage in recreational activities, or
have distressing dreams due to phobia

The causes of phobias in children are not always clear. Some children develop a phobia
after a specific triggering event (e.g. developing a fear of dogs after being bitten by one) or
learn the fear from parents or other caregivers who have similar phobias. The phobia is
maintained by the child’s exaggerated beliefs about the dangerousness of the feared object
or situation, his/her beliefs that they will not be able to cope with their fear, and avoidance
or safety behaviors that prevent new learning.

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How Teachers can Advise Parents about ‘PHOBIAS’

When parents ask teachers what they should do with their child who has a phobia, teachers
advise parents and the following are some TIPS:

 Recognise that the fear is real. As trivial as a fear may

seem, it feels real to the child and it's causing him or her
to feel anxious and afraid. Being able to talk about fears
helps — words often take some of the power out of the
negative feeling. If parents and teachers talk about it, it
can become less powerful.

 Never belittle the fear as a way of forcing the child to

overcome it. Saying, "Don't be ridiculous! There are no monsters in your closet!"
may get the child to go to bed, but it won't make the fear go away.

 Don't cater to fears, though. If a child doesn't like dogs, don't cross the street
deliberately to avoid one. This will just reinforce that dogs should be feared and
avoided. Provide support and gentle care as you approach the feared object or
situation with your child.

 Teach kids how to rate fear. A child who can visualise the intensity of the fear on
a scale of 1 to 10, with 10 being the strongest, may be able to "see" the fear as less
intense than first imagined. Younger kids can think about how "full of fear" they
are, with being full "up to my knees" as not so scared, "up to my stomach" as more
frightened, and "up to my head" as truly petrified.

 Teach coping strategies. Try these easy-to-implement techniques. Using the

parent or teacher "home base," the child can venture out toward the feared object,
and then return to you for safety before venturing out again. The child can also
learn some positive self-statements, such as "I can do this" and "I will be OK" to
say to himself or herself when feeling anxious. Relaxation techniques are helpful,
including visualisation (of floating on a cloud or lying on a beach, for example) and
deep breathing (imagining that the lungs are balloons and letting them slowly
deflate).

a) What is a phobia?
b) List the common types of phobias among children.
c) How can you as a teacher advise parents about handling their
child’s phobia or fear?

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 7.7 Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is characterised by unwanted and intrusive

thoughts (obsessions) and feeling compelled to repeatedly perform rituals and routines
(compulsions) to try and ease anxiety. If a child has obsessive-compulsive disorder (OCD),
he/she might be unable to stop worrying no matter how much they want to.

With OCD, a child may experience upsetting or scary thoughts or images, called
obsessions, that are are hard to ignore or dismiss. A child with OCD feels strong urges to
do certain things repeatedly — called rituals or compulsions — in order to reduce the scary
thoughts, avoid something dreaded from happening, or to make extra sure that things are
safe, clean, or right in some way.

A child may have a difficult time explaining a reason for their rituals and say they do them
“just because.” In general, a child with OCD is trying to relieve anxiety by engaging in a
ritual. The child may want to feel absolutely certain that something bad won’t happen or
to feel “just right.”

OCD is like an “overactive alarm system.” The rise in anxiety or worry is so strong that a
child feels like he or she must perform the task or dwell on the thought, over and over
again, to the point where it interferes with everyday life. Most kids with OCD realise that
they really don’t have to repeat the behaviors over and over again, but the anxiety can be
so great that they feel that repetition is “required” to neutralize the uncomfortable feeling.
And often the behaviour does decrease the anxiety — but only temporarily. In the long
run, the rituals may worsen the severity of OCD and prompt the obsessions to return.
Most children with OCD are diagnosed around age 10, although the disorder can strike
children as young as two or three. Boys are more likely to develop OCD before puberty,
while girls tend to develop it during adolescence.

Symptoms of OCD in Children

 Intrusive and unwanted thoughts or impulses that are distressing and bothersome to
the child.
 Repetitive rituals aimed at reducing or preventing distress.
 Difficulty completing daily routine or problems with school performance and
social relationships due to the obsessions and compulsions.

Among children with OCD, the most common obsessions include:

 fear of dirt or germs

 fear of contamination
 a need for symmetry and order
 religious obsessions
 preoccupation with body waste
 lucky and unlucky numbers
 sexual or aggressive thoughts
 fear of illness or harm coming to oneself or relatives
 preoccupation with household items

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  intrusive sounds or words

The most common compulsions among children are:

 grooming rituals, including hand washing, showering, and teeth brushing

 repeating rituals, including going in and out of
doorways, needing to move through spaces in a special
way, or rereading, erasing, and rewriting
 checking rituals to make sure that an appliance is off or
a door is locked or repeatedly checking homework
 rituals to undo contact with a “contaminated” person or
object
 touching rituals
 rituals to prevent harming self or others
 ordering or arranging objects
 counting rituals
 hoarding and collecting things of no apparent value
 cleaning rituals related to the house or other items

Generally, it is normal for children to experience intrusive thoughts and impulses from
time to time. Children with OCD, however, view these experiences as threatening and
assign a great deal of importance to these thoughts. For example, a child with OCD may
hear about violence on the news and begin to fear that something similar could happen to a
family member, causing intrusive thoughts that they can’t get rid of about harm coming to
the family member. Because the thoughts seem so real and the child can’t dismiss them,
this results in significant distress or anxiety. The child may then attempt to soothe
him/herself with a ritual or compulsion that he/she believes will keep the loved one safe,
and this temporarily reduces anxiety. Because anxiety is relieved in the short-term, the
anxiety cycle continues at the next intrusive thought.

7.8 School Refusal in Children

Some children experience persistent and excessive

anxiety that interferes with their academic, behavioural,
emotional, and social development. If the idea of
returning to school or starting a new school brings out
severe anxiety symptoms in your child, then he/she may
have an anxiety disorder.

As a result of anxiety, children may refuse to go to

school or may have problems staying in school. The
child may regularly complain about feeling sick on
school days or ask to stay home from school with minor
physical complaints, such as stomachaches or headaches
that are not related to a physical illness. If the child is allowed to stay at home, the
symptoms quickly disappear, only to reappear the next morning. Common physical
symptoms include headaches, stomachaches, nausea, or diarrhea. But tantrums,
inflexibility, separation anxiety, avoidance, and defiance may show up too.
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Starting school, moving, and other stressful life events may trigger anxiety and a child may
refuse to go to school. Anxiety-based school refusal affects 2 to 5 percent of school-age
children. It commonly takes place between the ages of five and six and between ten and
eleven, and at times of transition, such as entering secondary school.

Symptoms of School Anxiety/School Refusal

 Being reluctant or refusing to attend school most days.

 Tantrums, crying, physical complaints, clinginess and other signs of emotional
distress around going to school.
 Negative comments about school or negative beliefs about abilities at school.
 Fears that “something bad” will happen while at school and separated from parents.
 Excessive shyness around or avoidance of unfamiliar people and situations.

Stressful events or transitions may trigger your child’s

anxiety about school, but this is not always the case.
Refusing to go to school maintained by the child’s
exaggerated beliefs about the danger of being alone at
school, his/her beliefs that they will not be able to cope
with their fear, and avoidance or safety behaviours that
prevent new learning. For example, your child may be
fearful of being alone at school due to fears about safety
(e.g. fears of being kidnapped, fears that parents will be
in an accident).

The child may employs “safety behaviors” such as avoiding school, calling parents
throughout the day, or coming home sick, that relieve his/her anxiety in the short-term, but
prevent a child from learning to cope with everyday anxiety and uncertainties.

How Teachers can Advise Parents about ‘SCHOOL REFUSAL’

The following are some TIPS you can tell parents:

 Help the child to identify the feelings and thoughts that maintain his/her fears and
worries about school, to learn to cope with anxiety in new ways, and to use his/her
new coping strategies to face the fear of school.
 Teach the child new ways to respond to worries and fears about school, such as
positive self-talk, “brave” statements, and calming strategies.
 Support the child in practicing these skills in the real world and how to manage
anxiety-provoking situations.
 Develop healthy and realistic beliefs and expectations about school.
 Reduce avoidance and safety behaviours that maintain the fear of school.
 Increase comfort and independence in being in public environments without
parents. Remind the child that he/she is safe and will be protected.

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a) What is school refusal?
d) List the common signs of school refusal among children.
e) How can you as a teacher advise parents about handling their
child’s refusal to go to school?

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SUMMARY

 One should be cautious when using the term ‘emotional & behavioural disorder’
(EBD) to refer to any child as it has serious implications.

 Identifying EBD in children can be tricky because children differ from adults in
that they experience many physical, mental, and emotional changes as they
progress through their natural growth and development.

 Emotional and behavioural disorder (EBD) is not a formal diagnosis, and thus there
are no well-defined guidelines for its use.

 In order to formally diagnose a child with an emotional disorder, the clinician must
decide whether the child meets the criteria for diagnosis according to the
classification systems.

 Emotional and behavioural disorder (EBD) is not a formal diagnosis, and thus there
are no well-defined guidelines for its use.

 Children with anxiety disorders respond to certain things or situations with fear and
dread, as well as with physical signs of anxiety (nervousness), such as a rapid
heartbeat and sweating.

 A phobia can be very difficult to tolerate, both for kids and those around them,
especially if the anxiety-producing stimulus (whatever is causing the anxiety) is
hard to avoid.

 Obsessive Compulsive Disorder (OCD) is characterised by unwanted and intrusive

thoughts (obsessions) and feeling compelled to repeatedly perform rituals and
routines (compulsions) to try and ease anxiety.

 Many children experience separation anxiety between 18 months and three years
old, when it is normal to feel some anxiety when a parent leaves the room or goes
out of sight.

 Teachers and parents can help kids develop the skills and confidence to overcome
fears so that they don't evolve into phobic reactions.

 Stressful events or transitions, such as moving to a new town or parent separation,

may trigger your child’s anxiety about being separated from you, but this is not
always the case.

 Obsessive Compulsive Disorder (OCD) is characterised by unwanted and intrusive

thoughts (obsessions) and feeling compelled to repeatedly perform rituals and
routines (compulsions) to try and ease anxiety.

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  As a result of anxiety, children may refuse to go to school or may have problems
staying in school.

 Children may refuse to go to school or may have problems staying in school. The
child may regularly complain about feeling sick on school days or ask to stay home
from school with minor physical complaints

\REFERENCES

 Shakuntala Walker J, Melvin JK. 2013. Emotional Disorders in Children and

Adolescents. In J.H Stone, M Blouin, (Eds). International Encyclopedia of
Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/7/

 Laura Johnson (2013). Obsessive Compulsive Disorder, Child Therapy and

Counseling. Centre. San Jose/Silicon Valley. Palo Alto.

 Laura Johnson (2013). Separation Anxiety. Child Therapy and Counseling Centre.
San Jose/Silicon Valley. Palo Alto.

 Mary Ellen O'Connell, Thomas Boat, and Kenneth E (2009). Warner. Preventing
Mental, Emotional, and Behavioural Disorders Among Young People: Progress
and Possibilities by the National Research Council and Institute of Medicine,
United States

 Matthew MacEgan (25 May, 2013). Mental disorders increasing among US

children. World Socialist Web Site.

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