Lecture 2

Characteristics of Emotional and Behavior Disorders

Outline
Prevalence of EBD EBD in early childhood Types and characteristics of EBD i. Internalizing conditions ii. Externalizing conditions

Factors That Affect the Prevalence of EBD

Difficult to estimate the prevalence and the number of students with EBD due to the subjective and vague of federal definition WHO estimated that neuropsychiatric disorders will rise by over 50% internationally by 2020 Some experts: estimates 16%-22% 2000-2001: number of students bet ages 6 and 21 years who received sps ed services under IDEA due to having EBD was <1% (.72%) Big difference .it means thousands of students with EBD are not receiving sps ed services

Factors That Affect the Prevalence of EBD

1. Gender
Boys more often identified as having EBD than girls European American (E-A) male 4X > E-A girls Hispanic males -- 3X > girls African American -- 6X > E-A girls Boys > girls having externalizing problems and display conduct problems, immaturity, antisocial behavior, and aggressive behaviors Girls > boys having internalizing problems and display depression and social withdrawal Girls < boys causing disruptions in the classroom Because teachers see boys behavioral problems as more disturbing, boys are more often identified as having EBD

Factors That Affect the Prevalence of EBD

2. Culturally and linguistically diversity
Some culturally and linguistically diverse students are disproportionately identified (overidentified) as having EBD
Federal government data indicate that African American students historically have been overrepresented in many of the disability categories (2X than other racial groups such as Hispanics, American Indians, Alaskan Native, Asian or Pacific Islanders)

Factors of Disordered Behavior

(Coleman, 1986)
Classic study of Quay, Morse, and Cutler (1966) established 3 factors, supported by Conners, 1970; Kaufman, Swan, & Wood, 1979; Quay, 1966 Quay (1972, 1975) has identified a cluster of behaviors associated with socialized delinquency or juvenile delinquency Federal regulations excludes socially maladjusted unless it is determined that they are seriously emotionally disturbed (Federal Register, 1977)

Discuss
What are the factors that affect the prevalence of EBD?

Factors affecting disproportionate representation of EBD

Teacher bias
Lack of effective prereferral intervantions Use of inapropriate and/or inequitable assessment procedures Assignment of certain students to lowability groups/tracking Teacher expectations

Factors affecting disproportionate representation of EBD

Poverty is associated with higher identification rates of EBD poor health, poor education, poor social outcome Minority status many minorities are more likely than European Americans to be identified as having mental retardation or learning disabilities Minority status African Americans are more likely to be identified as having EBD

EBD in Early Childhood

There is a relationship between children who develop EBD and their environment Environment domestic violence, parental drug and alcohol abuse children demonstrate severe and chronic behavior problems by the time they are of school age and they seldom receive early intervention

Without a clearly defined operational definition, it is difficult to determine whether a particular behavior is within the parameters of developmental norms or the result of an EBD

EBD in Early Childhood

From birth 5 years, a childs behavior is influenced by temperament and parental interaction, and early behavior may not be predictive of later behavior Because young children are not in school, it is difficult to ascertain whether their behaviors have persisted over a long period of time or whether they are displaying behaviors that affect academic performance

EBD in Early Childhood

Coordination and collaboration between services is limited or nonexistent it means identification process for children with EBD does not begin until after they enter school Many educators, pediatricians, and other practitioners are reluctant to identify young children with EBD because they are unsure that the child has disorder or they having school problems (due to learning problems) Students with EBD are typically identified later in life they seldom receive early intervention when it could have had a substantive impact

EBD in Early Childhood

Identification and Intervention
Early identification and prevention is crucial in serving young children who are at risk of EBD
Screening in preschool or daycare setting Intervention program should include several different strategies Components of intervention include social skills instruction, parent training, and related skill building

Discuss

What are the factors that hinder the identification of young children displaying EBD?

Types and characteristics of EBD

Internalizing conditions Depression Anxiety disorders Separation anxiety disorder Generalized anxiety disorder Specific phobias Social anxiety disorder School refusal Obsessive-compulsive disorder Posttraumatic stress disorder Panic disorder Eating disorders

Externalizing conditions Conduct disorder ADHD Suicide Childhood-onset schizophrenia

Internalizing condition: depression

Categorized as mood disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities Depression generally occurs several times

Behaviors differ from one developmental stage to another, which makes it difficult to determine whether a child is going through a phase or suffering from depression

Internalizing condition: depression

A young child suffering from depression may pretend to feel sick or refuse to go to school; older children may be irritable or angry and have behavioral problems at school Adolescent depression may affect interpersonal relationships and academic performance and may lead to suicide High rates of childhood depression may be associated with being the recipient of abuse, teasing, or bullying; having a parent with mental illness; having a genetic predisposition to depression; and having other health problems

Symptoms of depression
Persistent sad, anxious, or empty mood Feelings of hopelessness Feelings of guilt, worthlessness, helplessness Losing interest in play, friends, and schoolwork, or loss of interest in activities that were once enjoyed Loss of energy or fatigue Loss of concentration Insomnia or oversleeping Change in appetite; weight loss or overeating and weight gain Thoughts of death or suicide; suicide attempts Restlessness, irritability, anger

Internalizing condition: depression

Major depression may include emotional, cognitive, motivational, and physical symptoms
A child with emotional symptoms may have feelings of: -- worthlessness -- hopelessness -- guilt -- feel rejected by peers -- act sad or lonely -- nothing in life is going right A child with cognitive symptoms may: -- unable to concentrate on academics -- feel that they are unable to do anything right -- avoid tasks and social interactions -- not motivated -- have suicidal ideation

Internalizing condition: depression

Physical symptoms: -- a change in appetite or weight -- insomnia -- too much sleep -- related conditions include eating disorders, substance abuse, anxiety disorders, and juvenile delinquency Dysthymia: -- a less severe form of depression -- symptoms are not as severe as those major depression -- not diagnosed and do not receive the needed intervention -- poor school performance, social withdrawal, shyness, irritability, sleep irregularities

Internalizing condition: depression

Bipolar disorder: -- a separate category from depression -- once known as manic-depressive illness -- begins in late adolescence -- child: extreme mood swings -- can be treated with medication

Internalizing condition: anxiety disorder

Anxiety disorder -- excessive fear, worry, and uneasiness that prevent an individual from functioning in daily life Types of anxiety disorders separation anxiety disorder, generalized anxiety disorder, specific phobias, social anxiety disorder, obsessivecompulsive disorder, posttraumatic stress disorder, panic disorder, and eating disorders

Internalizing condition: separation anxiety disorder

Separation anxiety disorder occur before the age of 6 years Separation from home or from those to whom the child is attached The child may refuse to go to school, refuse to sleep alone, refuse to leave the house Treatment systematic desensitization (step-bystep separation), modeling, shaping (gradual steps to eliminate the anxiety)

Internalizing condition: generalized anxiety disorder

Generalized anxiety disorder/GAD excessive anxiety and worry that is not caused by any recent events or activities Worries are accompanied by physical symptoms esp fatigue, headaches, muscle tension, muscle aches, difficulty with concentration, irritability, sleeping difficulties Children and adolescents with GAD often worry about their school performance or competence in sporting events

Internalizing condition: specific disorder

Specific phobias intense fear of objects or situations that pose little or no threat to the person Actively avoiding the objects or situations above Fear of -- closed-in places such as elevators and crowded malls, heights (acrophobia), spiders (arachnophobia), water (hydrophobia), blood (hemophobia), flying (aviophobia)

Internalizing condition: social anxiety disorder

Social anxiety disorder persistent and excessive fear of social situations, interpersonal scrutiny, the associated potential for embarrassment or humiliation Children may appear extremely timid and cling to familiar persons; may cry or throw tantrums Adolescents poor relationships, rejected by peers, have fewer quality friendships, have higher rates of peer victimization Students shy, quiet, withdrawn when meeting mew people or in unfamiliar social settings

Internalizing condition: school refusal

School refusal attempts by a child or adolescent to miss school May result from emotional disorder such as generalized anxiety disorder, separation anxiety, or depression, or school or family factors Fear of school environment due to tests, public bathrooms, teachers (lack of support or criticism), difficulties with peers (bullying, gang activities), attention-seeking behaviors (crying, difficulties sleeping)

Internalizing condition: obsessive-compulsive disorder

Recurrent and persistent distressful thoughts fear of contamination, fear of harming others, inappropriate impulses such as thoughts of violence and aggression The most common among children hand washing (cleaning), making sure that toys are placed in a certain order (ritual ordering), making sure everything in right place (straightening) Behaviors of children are similar to adults

Internalizing condition: obsessive-compulsive disorder

Boys more likely to develop OCD as children Girls more likely to develop OCD as young adults

Treatment medication and cognitive behavioral therapy Medication reduce anxiety Cognitive behavior therapy help students understand and cope with the disorder

Internalizing condition: posttraumatic stress disorder (PTSD)

Traumatic events real or perceived death, injury, or threat to their physical well-being Other events witnessing a violent act, experiencing the death of a close relative, experiencing sexual or physical abuse, domestic violence, community violence Other symptoms repetitive play involving the traumatic event, nightmares, social detachment, sleep difficulties, hyper-vigilance Ordinary events that remind the child of the traumatic event can trigger flashbacks

Internalizing condition: posttraumatic stress disorder (PTSD)

Three clusters of PTSD symptoms: 1. reexperiencing the traumatic event 2. persistently avoiding anything associated with the trauma 3. having persistent symptoms of increased arousal

Internalizing condition: panic disorder

children who have a panic disorder have sudden and repeated panic attacks or a period of intense, overwhelming fear may feel his or her heart is pounding and may feel weak and dizzy feel nauseated and afraid that something bad is going to happen Many children and adolescents who have panic disorder attribute them to external stimuli Rarely identified in children

Internalizing condition: eating disorders

Severe disturbance in eating behavior Most common eating disorders anorexia nervosa and bulimia nervosa Anorexia nervosa refusal to maintain a minimally normal body weight results in severe weight loss See themselves as overweight though they are thin

Internalizing condition: eating disorders

Excessive exercise and may induce vomiting or misuse laxatives to control their weight Frequently come from over-controlled homes Mortality rate 12x > other females ages 1524 years

Internalizing condition: eating disorders

Bulimia nervosa eats an abnormally large amount of food and then self-induces vomiting or misuses laxatives to control weight weight is usually normal for their age and height Aware of abnormal eating habits, thus keep their behavior secret Majority of anorexia nervosa and bulimia nervosa are females

Externalizing condition: conduct disorder

Individuals with CD show a repetitive and persistent pattern of behavior in which they violate the basic rights or major age-appropriate societal norms or rules at home == antisocial behaviors E.g. fighting, assaulting others, destroying property, stealing, lying, being physically cruel to people or animals Affect the school environment disrupt the classroom, hindering other students from learning Academic underachievers, experience peer rejection Prevalence rate for boys is higher than girls

Externalizing condition: conduct disorder

Associated with early age of onset Children with conduct disorder tend to show covert behaviors such as lying, stealing, and truancy -- inappropriate behaviors increase in intensity and severity as they get older -- they are oppositional, aggressive, inattentive, impulsive -- develop delinquent, antisocial behaviors at the beginning of adolescence At risk for criminal behaviors in adolescence

Externalizing condition: conduct disorder

Dispositional risk factors: child temperament -- neuropsychological deficits and difficulties -- poor academic performance -- temperament: having easy, slow to warm up, and difficult temperaments Any child with any types of temperaments could develop emotional and behavior disorders but a child with a difficult temperament could develop EBD

Externalizing condition: conduct disorder

Causes -- social factors relationship child-family, culture, socioeconomic status of the environment, acceptance by peers, the quality of the school setting -- model the behavior observed in family and friends -- dysfunctional homes family risk variables: large family, a single parent, inadequate parent involvement and discipline, low education level of a parent, parental involvement in criminal activity and substance abuse -- from family with low socioeconomic status

Externalizing condition: ADHD

Estimated 60%-70% of children with LD and behavior disorders have ADHD symptoms: - inattention -- hyperactivity -- impulsivity -- exhibit these symptoms before age 7 years in at least 2 setting, usually at home and school Interfere with the childs developmentally appropriate social, academic, or occupational functioning

Externalizing condition: ADHD

Three types of ADHD: i. Attention-deficit disorder (ADD) inattentive, daydreaming, occupied with internal thoughts, forgetful

ii. Hyperactive-impulsive talk excessively, play loudly, fidget, restless, tendency to interrupt, bedwetting, sleep problems, temper tantrums, stubbornness
iii. Combined type of ADHD and hyperactiveimpulsive

Externalizing condition: ADHD

Often overlaps with EBD, conduct disorders, and oppositional defiant disorders Children with conduct disorder and ADHD, especially those with hyperactivity and/or impulsivity, are at risk for antisocial and criminal behavior

Treatment medication; behavioral management plans

Externalizing condition: suicide

Females > males in attempted suicide

Males > females in successfully complete suicide

Causes: psychiatric problems such as depression, anxiety disorders -- post-traumatic stress -- dysfunctional family -- life stressors -- history of family suicidal behavior

Externalizing condition: suicide

Students with EBD are at increased risk for suicide Risk factors that could predict suicidal behaviors: substance abuse -- exposure to suicide -- loss of a family member or friend -- chronic illness -- access to lethal means such as firearms -- feelings of extreme loneliness and hopelessness -- chronic depression

Externalizing condition: suicide

Prevention teachers recognize the risk factors and respond appropriately e.g. provide emotional support, listen and talk to the child, refer the child to appropriate professionals Risk factors sudden change in usual behavior, problems in school, family and peer problems, giving away possessions, talk of suicide

Externalizing condition: childhood-onset schizophrenia

Schizophrenia included in federal definition of emotional disturbance Characteristics of adult and child schizophrenia are similar delusions and hallucinations, disorders in speech, disorganized or catatonic behavior, inappropriate expression of emotions Childhood schizophrenia begins gradually with speech and language disorders : use private language that others do not understand; believe that people can read their minds and they receive special messages from the radio

Discuss
How to group behaviors associated with EBD? Give examples

Cultural and racial factors

Race, culture, and ethnicity may play a role in the prevalence of internalizing and externalizing conditions and in the identification of students with EBD

Hispanic adolescents (especially females) > symptoms of depression than youths of other ethnicities
African American males higher levels of aggression and overt aggression

Cultural and racial factors

Hispanic female adolescents and African American male adolescents display higher levels of anxiety than others of their age European American children and adolescents display higher rates of suicide than African American youths

Discuss
Who and why should understand characteristics of EBD?

Discuss
Discuss the factors that affect the prevalence of emotional and behavior disorders. Describe the factors preventing the identification of young children displaying emotional and behavior disorders and how this affects providing early intervention. Explain the differences between internalizing and externalizing disorders.