Lecture # 109:
Emotional/Behavioral Disorders

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

Objectives
1. Students will be able to identify a child who has an emotional disorder.
2. Students will understand the need for assessment of disruptive behaviors.
3. Students will be able to explain how to work with a child who has emotional disorders.

Personal Life Illustration
David is a young teenager who was adopted when he was three years old. His mother had a history of drug use and subsequently died of AIDS. As he grew, he was independent, but aggressive. David also had a history of theft, taking small appliances and games from stores. He often fought with other children in school and even hit his teacher. Consequently, he was removed from school and put into a hospital for treatment.

His adoptive parents cared for him very much and hoped that hospitalization would help him. They knew that they could not keep him at home if his behavior and aggression were not controlled. His parents also agreed to learn parenting skills. They could not take part in the hospital treatment program because of their own responsibilities at work.

The hospital experiences were not helpful to him. If he was aggressive, he was strapped in a bed. His parents were not allowed to see him and had problems getting information from the professional staff. His problems became worse and his emotions were held back so that he periodically exploded with anger.

Finally, his parents heard of another hospital that supposedly had better treatment. The staff worked with David to help him return to his community and family. David learned problem-solving steps through answering the following questions:

1. What am I supposed to do?
2. I need to review all the possible choices of behavior.
3. I need to concentrate
4. I have to make a choice.
5. How well did I do?

These steps were practiced many times while working on school tasks or in social situations with staff or other patients. The hospital staff provided David with education for the teachers in his school and found professional assistants in the community to help David. He was given opportunities to show his new skills to his parents when he came home for weekend visits. They praised him for the changes he had made in his life.

Now there is another David. He is now a 10th grader who loves to play football. He is popular with all of his classmates and participates in the student council. Through behavioral change, he is able to attend regular classes. If he needs help to get through the day, there are certain, designated people he can go and talk with.

His father thinks that David was able to change because people stopped trying to control him and gave him choices. He now has a system of problem solving steps that he can use. He now knows that through his own choice, he has increased the likelihood of making constructive decisions that help him live better in society.

Meditate Word By Word On This Verse:
Proverbs 20:11.

Definition of Behavior Disorders
Don't children, at one time or another, have conflict with teachers, other students, and their parents? What is special about David's problem? His problem was special because it was severe and chronic. It interfered with learning and his life was destructive. In order to identify these children, the following definition is used. It is a condition that has one or more of the following characteristics:

• a) inability to learn that is not explained by intellectual, sensory, or other health problems (don't learn),
• b) inability to make and maintain relationships with peers and teachers (can't relate),
• c) inappropriate behavior or feelings in normal circumstances (act strange),
• d) pervasive mood of unhappiness or depression (are sad),
• e) development of physical symptoms or fears associated with home or school problems (get sick).

This definition is ambiguous simply because of the many social and emotional disorders children have. What is a satisfactory relationship? If David's average grades are 2s, is this a sign of interference with school performance? Trying to write a good definition of social and emotional disorders is important because those children who have the disorder will get needed treatment.

Question:
1. You have read about David: what are factors before birth and after birth that may have affected his behavior?

Describing Characteristics
General Description
These children have problems learning in school. They do not seem to learn from experience in that they make repeated and seemingly mindless errors in academic tasks and interpersonal relationships. When they are with other students, they lack understanding of others, lack friends and ability to make friends. Their ability to read social situations and make their behavior fit circumstances around them is low for their age, sex, and intelligence.

David's story has given us a picture of how these children behave. Maybe a short list of his characteristics would be - aggressive, anxious, depressed, and antisocial. However, you can also include the words helpful, smart, energetic, and brave. These students do not all have the same problems and assets.

For example, if students in David's school describe him, they would say that he is artistic and a wonderful football player. His teachers might say his is creative and learns best through hands-on projects. But these positive characteristics are not why he has an emotional or behavioral disorder. He has this diagnosis because of his inappropriate behaviors.

Externalizing Emotional or Behavioral Problems
There are two broad categories of behavior problems for emotion and behavior disorders - externalizing problems and internalizing problems. Externalizing problems are persistent aggression, physically acting out negative feelings (for example, throwing a book in anger), and noncompliant behavior. Most often the overt behavior problems are destructiveness, temper tantrums, refusal to follow directions, fighting, verbal threats, arguing, loudness, and swearing. David has overt behavioral problems. But there are other children who have more undercover antisocial behaviors such as lying, stealing, setting fires, gang membership, and alcohol or drug abuse. The term "conduct disorder" is used for those students who become aggressive and commit antisocial acts.

All students have some externalizing behavior problems as they grow and develop. However, students with externalizing behavior problems have a high frequency and intensity of negative behavior so that everyday functioning is disrupted in school, home, and in the community. These students are more at risk for long-term failure in school and serious maladjustment problems in adulthood.

Question:
2. What are externalizing behavior problems?
(One or more of the following answers may be correct.)
a) outward behavior toward others.
b) aggression, noncompliant behavior.
c) throwing books and other classroom materials.

There are two types of behavior problems these students have in school: teacher/authority related adjustment and peer-related adjustment. Teacher-related problems refer to meeting classroom expectations of following classroom rules, completing assignments, and attending to daily tasks. Peer-related relationships are those skills needed to interact with other students in social settings outside the classroom.

Teachers notice the child's behavior and may say the following:

• "He gets frustrated so easily."
• "When he gets angry, he is verbally abusive."
• "Some days he understands what is happening and other days can't follow a simple direction."

Here are the types of behavior patterns that emotionally/behaviorally disabled students have:

Teacher related:
Externalizing:

• Non-compliant behavior
• Defiance toward the teacher
• Behavioral excesses
• Low academic achievement
• Disruption of the classroom
• Resistant to social patterns and behaviors in class

Internalizing:

• High level of appropriate classroom behavior
• Nonassertive behavior patterns
• Low achievement
• Problems with self image

Peer Related:
Externalizing:

• Failure to use social skills that will give them acceptance among their peers
• Peers may accept them, but often they are rejected
• High level of aggressive behavior toward peers
• Like to talk and joke

Internalizing:

• Neglected by classmates
• Low level of participation in activities that classmates organize
• Social isolation and withdrawal
• Low level of negative social behavior

Here is an example interchange between a teacher and a behaviorally disordered student. During a reading assignment, John was to finish reading history and do fill out a study guide. Although John's book was on his desk, his teacher noticed that he was reading a magazine hidden in the book. Their interaction was like this:
Teacher: John, you are to be working on history.
John: I am.
Teacher: It looks to me like you are reading a magazine.
John: I'm reading a magazine because I am finished reading history.
Teacher: Very good. May I see your completed study guide?
John: What study guide?
Teacher: The study guide that goes with the history reading.
John: You never said anything about a study guide!!!
Teacher: John, we always complete a study guide with the history reading.
John: No way, the only thing I know is that you are an awful person.
Teacher: John, that attitude is not helpful. Please give me the magazine and get to work.
John: No way!!
(Charlie, who sits next to John, cues him to give the teacher the magazine. John kicks over a desk on the way to the teacher.)
Teacher: John, pick up the desk on the way back to your seat.
(John picks up the desk.)
Teacher: Good, John!
(John begins to fill out his study guide.)

It is obvious that teachers need to understand what happens with this child and be prepared to keep control during temper tantrums. To work successfully with these students, we must understand their lack of appropriate social behaviors in the same way we understand their lack of academic skills: skills need to be taught. That does not mean that we have to accept their inappropriate behaviors. Instead, the student is taught the appropriate behaviors for the situation. These students can learn correct social behaviors just as they learn academic behaviors.

Question:
3. The teacher in the above example was:
(One or more of the following answers may be correct.)
a) assertive in making John obey.
b) accepted his behavior.
c) was not moved by his insolent behavior.

Another aspect of helping children with emotional disorder is to examine the environment where he learns. There may also be other factors that contribute to his actions: maybe the child has a reading problem or maybe his father and mother had an argument before he left for school in the morning; maybe he has not had the opportunity to express confusion about understanding history or had few opportunities to make choices. maybe he is upset that he doesn't have a friend. If we can identify his needs and respond to them, we can help these children. Often, these children have conflicts at home where they are negative, noncompliant, and destroy property.

Some of the students who have antisocial, aggressive behavior eventually commit a crime that brings them to court. If they are convicted, they will spend time in prison or juvenile centers for offenders. This topic is discussed because a large percentage of juvenile offenders have been identified as having emotional or behavioral disorders. Secondly, social workers and educators work with juvenile offenders in centers, schools, camps, and ranches. Thirdly, these students need help with their education since they have a disability.

Personal Experience Report
Here is an opinion of one social worker who helps juvenile delinquents: I am frequently asked how I can do the work that I do. I always answer, "How can I not?" I see these students as one of the most socially excluded, underrepresented, and ignored parts of society. They must survive in society where they are powerless and cannot direct themselves positively. Consequently, they empower themselves through the only means they have. I meet these youths after they have been arrested, that is, those with emotional problems. My job has three basic steps:

1. find out what the youth's needs are,
2. determine what is needed to meet the identified needs,
3. advocate to get those needs met.

Who are the students who are juvenile delinquents? From my experience, they have many negative strikes against them before they are even born. Many come from poor communities; sometimes the only thing that is wrong with them the section of the city where they live. Their families do the best they can for their children, but it is often not enough. Even though these children come from troubled communities, each child is unique, with unique strengths, needs and histories.

One of the most special children I have known is Carl. At the age of twelve, he was living with his grandmother. His mother was ill from AIDS-related complications and his father had been violently killed. One day Carl's grandmother was rushed to the hospital and there was no one to care for Carl. While he was alone in the house, he found a gun that his grandmother had for protection. He took it outside to play with his friend. While they were playing, his friend was accidentally, fatally shot. Carl was arrested. Some saw him as just another delinquent. I saw him as a child who was depressed. He got educational and medical help in a residential program. He then went to live with a foster family. He wants to return to his grandmother's home. Carl is working hard and we are hopeful for him.

Behaviors seem to reflect what students have learned to feel about themselves. As a society, it is too easy to label these children as delinquents and shut the door on them. How can I do the work that I do? Again, how can I not? How can we all not try and help?

Question:
4. What is a large factor in the behavior of children with emotional/behavior problems? (one word answer)

Internalizing Emotional Problems
Behavior that is internalizing includes social withdrawal, depression, and anxiety. A smaller part of this group of children also has obsessions and compulsions. Obsessions are repetitive, persistent, and intrusive images or thoughts - such as repetitive thoughts about illness or accidents. Compulsions are repetitive, stereotypical behaviors such as continual washing. Repetitive and compulsive behavior can occur together. Teachers of these students may say that:

• at recess, he rarely talks to anyone or plays in the games,
• she always seems so depressed,
• it is embarrassing to admit, but sometimes I forget that she is even in class.

Internalizing behaviors usually do not place students in conflict with teachers. On the contrary, many of these students have good levels of classroom behavior. By their very behavior, these students reduce their chances of being identified and getting special help. They have low status with peers and seldom participate in peer group activities. Sadly, they are rejected by their peers.

Often students with emotional disability are withdrawn from their classmates physically and emotionally and this separation makes relationships with others difficult. They may display the following behaviors:

• infrequently acts with peers,
• declines to participate in activities even when urged,
• fails to show feelings,
• stares blankly into space,
• shows little compassion for others,
• avoids eye contact,
• looks solemn and seldom smiles.

Fortunately, these students can be identified by their behavior and programs for social skills intervention help them with learning strategies. Although social skills and emotional stability may not be prerequisites for attaining academic competence, they help with school learning. They are critical to successful adaptation to not only the school, but to the larger society.

Depression is another common symptom of emotional disability. Children and youth who are depressed have a depressed mood and loss of interest in productive activity over a period of time. Young children have a variety of behaviors including pains in various parts of their bodies, psychomotor agitation, clinging to parents, refusing to go to school, or expressing fears of their parents' death. These children are at greater risk for suicidal behavior. Depression is the primary risk factor for suicide.

Question:
5. Depression may be the most important symptom of internalizing emotional problems.
yes / no.

Academic Performance
Most students with emotional or behavioral disorders also have academic problems. The average IQ is 90-95. The classroom behavior of these students may include poor academic work skills, frequently not on the task to be finished, uneven skills in basic academics, and underachievement. Students' academic performances often deteriorate as they leave elementary school and enter secondary school.

Research shows that a large percentage of students with emotional or behavioral problems also have learning disabilities. Statistics for graduation rate of students with emotional or behavioral disorders is 36%. However, not all of these students have academic problems. About one third of them function at grade level or above. The research also shows that children with behavioral problems are irritating to adults, cannot relate to other children, and have negative self-perceptions. Which came first, the emotional disability or the academic problems? That is a hard question to answer.

There are probably students whose behavior problems have contributed to their school failures, and their continued failures at school intensify their behavior problems. There are probably children whose frustrations and difficulties in learning have led to disruptive behavior or social withdrawal. Finding the cause for this behavior may be impossible, but it is important that both academic and emotional/behavioral problems need resolution.

Question:
6. Why do you think it is hard to find the cause for emotional/behavior disorder in children?
(Select the best answer.)
a) they are too young to understand and express the problems that affect them and their behavior.
b) it may be difficult to find out about their family environment.
c) it is difficult to know their intelligence level.

Causes of Emotional or Behavioral Disorders
There is seldom any one cause that we can say is the reason for emotional disorder. "There is a complexity of interactions between biological, social, educational, psychological, and environmental factors. For example, genetic factors have been the cause of several disorders; biological insults, such as physical injury or exposure to toxins, put children at risk for behavior disorders; and persistent psychosocial adversity, such as poverty, abuse, or neglect, increase the risk of mental problems in children" (Johnson and Frisen, 1993). Кnowledge of possible causes may lead to more intelligent guesses about how to help the child.

Biology
The role of biology in determining emotional or behavior problems is extremely complex. There are genetic influences for behavior problems such as depression or schizophrenia. Most experts agree that depression has a biological basis. Extremely stressful events can cause depressive episodes. If a person's body chemistry is genetically linked to depression, just any stress may cause a depressive episode.

Psychosocial Factors
Since school and family are important social environments for a child, we can discuss each and its relation to behavior/ emotional disabilities.

School Related Factors
Sometimes the school environment seems to be the causes of troublesome behavior. The following questions are important to ask when a child has behavioral disorders.

• How well do I understand this child's individuality?
  Teachers who demand strict uniformity and regimentation may increase the tendency of some children to have problematic behavior. Children need some way to express their individual differences.
• Are the expectations for the child appropriate for his abilities?
  Expectations that are too high for the child's ability lead to feelings of failure; expectations that are too low lead to boredom and lack of progress. A good parent or teacher adjusts expectations to fit the level of the child's ability so that improvement is both possible and challenging.
• Are we consistent in managing the child?
  One of the best ways to help a child with behavior problems is to give him "structure" at home and in the classroom. This means that instructions for schoolwork or work at home are clear, expectations that instructions will be followed are firm, and consequences for behavior are consistent. When there is consistency in routine, the consequences for behavior are highly predictable.
• Are the skills being taught valuable for the child?
  Children often do not see the relevance of the skills learned for other life activities. For example, simply learning multiplication tables may be difficult for some children, but if they learn a story or rhyme with it, the task may be fun. Or if the children need to find out how many cartons of eggs will feed the whole class, that may also be a good, practical exercise.
• Is right behavior being reinforced?
  In many classes, a child with behavior problems is ignored when he is behaving well and given a lot of attention when he misbehaves. This arrangement is almost certain to continue the child's behavioral difficulties.
• Are desirable models of behavior being demonstrated?
  Children are great imitators. If the teacher has desirable model, the children will imitate her and appropriate conduct encouraged. Children also imitate their peers. The teacher needs to let students know which behavior is a good example for others. For example, she may say, "The bell has rung and most of us are already at our desks ready for our first lesson. Thank you for being prompt."

Match these terms with the definitions below:
A. Reinforcement, - B. Structure, - C. Relevance, - D. Modeling.

7-1. An instructional plan with expectations and consequences.
A, B, C, D.

7-2. An imitation of behavior that a child sees - may be good or bad.
A, B, C, D.

7-3. A learned skill that can be used in other life activities.
A, B, C, D.

7-4. Commending expected behavior for home or classroom, ignoring non-compliant behavior.
A, B, C, D.