Lecture # 110:
Emotional/Behavioral Disorders, Continued

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

Objectives:
1. The student will be familiar with screening processes to identify children with emotional/behavioral problems.
2. The student will know how schools specifically design programs for behavior change.
3. The student will know the steps for peer conflict resolution.

Family Related Factors
If David's parents could talk about what they wanted for their son, what do you think they would say? Would they want him to spend his elementary years and middle school years in psychiatric hospitals? Would they want him to feel angry or defiant most of the time? That he continue to have a hard time trusting other people? Unlikely. Their expectations for David are similar to those of other parents: they want him to live a happy and healthy life.

Students with behavioral/emotional problems come from all sorts of families: rich, poor, one-parent and two-parent, large and small, well supported and those in need of support. Many families have been blamed for causing a child's behavioral/emotional disorder. Some of the blame may be true, but often such blame is not true. For example, David's parents were blamed for not spending time with him. Psychiatrists wanted his father to quit his job and spend more time with David, yet expected him to pay for treatment. His parents were also told that adoption was the cause of David's problems, but his other two adopted siblings did not have the same problems.

The situations in families that are associated with behavioral/emotional problems are child abuse, child neglect, and inconsistent discipline. Other factors that might increase the probability of behavioral problems are low socioeconomic status, presence or absence of substance abuse, and lack of support outside the family (for example, church groups and neighbors).

Meditate Word By Word On These Verses:
Proverbs 2:1-6.

How Can We Know if a Child has Behavioral/Emotional Problems?
Usually, there is a process of screening as outlined below for these children.
1. In the classroom or kindergarten, the teacher gives a ranking to those students according to their characteristic behavior patterns, which correspond to externalizing or internalizing profiles. The three highest ranked students from both profiles go to stage 2.

2. The teacher completes what is called a critical events index and a frequency index on the six students who have been identified. Critical events refer to specific negative behaviors that students have such as swearing, throwing objects, or stealing. Frequency index is how often this behavior occurs within a certain period of time such as a day or week. These results are compared to normative scales and those students who exceed them are passed onto the third stage.

3. The school counselor, psychologist, or other teacher observes and records the students during academic work and the quantity and quality of their social interactions on the playground. Students who exceed normative scales in this stage are referred for further evaluation.

The screening system used for critical events and frequency is called "Systematic Screening for Behavior Disorders" developed by Walker and Severson. It is available only on order from the company Sorpis West.

Question:
1. Critical events are ____________ __________ (two words) and frequency index is _________________ (phrase).

If the teachers think the child has a disorder, a detailed evaluation begins. This evaluation includes a standardized intelligence test to determine level of intelligence. Sometimes the school psychologist also asks the student to complete a personality inventory. An achievement test is also given to find out how the behavioral/emotional disorder has affected the child's academic progress. Behavior checklists and rating scales are also used to help determine if the specific student's behavior differs significantly from his peers. It is important that the checklists and ratings include negative behaviors (tantrums, screaming, shyness) and appropriate behaviors (follows classroom rules, answers requests of teacher, initiates interactions with peers).

Direct Observation as a Means of Diagnosis
Direct observation of a child's behavior is one of the best methods for obtaining information about his behavior. Direct observation is watching and recording the behavior of a single student or for a specific period of time while he has some sort of activity - playing at recess, interacting with other children, working on an assignment in class. There are structured recording sheets to collect data and a set of codes for the behaviors the teacher wants to strengthen or diminish. The behaviors must be observable (the teacher can see them) and measurable (quantify the behaviors). Such behaviors include the following:

  1. frequency: how often it occurs
  2. duration: how often it lasts
  3. latency: how long it takes for the behavior to begin in a given situation
  4. topography: what the child's behavior is
  5. magnitude: the intensity of the behavior

How can you decide which dimension to measure? It depends on the circumstances of the child. For example, if they are interested in how often David follows a teacher's direction, latency recording is appropriate. If they want to know how often a small child interacts with his peers, they collect frequency data. It is good to record over a period of days so that the child's patterns of behavior are observed.

Here is an example below:
The teacher wants to know if Peter is working on his assignment in class. She starts the work session in science and then an assistant records Peter's behavior every 30 seconds for 10 minutes. If Peter is working, the assistant records a "+" and if he is not working, a "-". In this case there were 20 intervals - one every 30 seconds. Peter was working 14 out of the 20 intervals or 70% of the time. By using this method, the teacher knows Peter how Peter is doing and can analyze his behavior to see if he can improve his work habits.

Question:
2. Why is it important to collect data about a child's behavior?
(Only one of the following answers is correct.)
a) it makes him feel important.
b) it gives data from which a plan is made.
c) it may help us understnd him better.

How Can Professionals Guide the Child's Education?
What is the purpose of educating a child with behavior/emotional disorders? You may say, "to get control of the child's behavior" and that is a typical reaction. Since the frequency and intensity of behavior problems of children is disruptive to everyone, behavior management is a central issue. BUT the purpose of education is not to control student's behavior. It is to teach them how to manage their own behaviors, get an education, learn to live with others, and help the child understand that he has certain abilities that can help him through life.

Usually, the educational program has three parts - academic, developmental (behavior), and life skills. Education emphasizes the school curriculum at the child's level of ability. He may need extra practice with an assistant or an increased amount of time to complete a task. Developmental means helping the child learn the skills that other children develop naturally. The developmental program for David might be helping him to recognize when his behavior is not acceptable, teaching him how to calm himself in class, or providing a choice for him that prevent his explosive behavior in class. Life skills means helping the child use his academics and behavior training in other environments. Children need to learn to solve their own problems and meet their own needs as they grow up. For example, the child needs to learn how to use transport and what kind of behavior is expected of him on transport.

Methods of Teaching
To improve academic skills, teachers and social workers can teach in the following way:

This is a usual teaching plan that most teachers and social workers use to help the child and to find out if he is making progress. This type of plan is used for a variety of students and can be applied to many types of disabilities.

Other effective teaching approaches involve:

Question:
3. How would you know if a child is learning multiplication tables? What kind of data would you use?

Social Skills
What happens if David falls back into the pattern of verbal and physical aggression toward authority figures? If this behavior continues, David will have a difficult time in school and among other students.

The types of approaches that are used are applied behavioral analysis, self-control curricula, and practice in recognizing when emotions are getting out of control.

With small children in an inclusive kindergarten, teachers formulate a program where the children are close together (a small tent, a circle of children, or exercises together). They also practice how to greet one another, to politely ask for a toy another child has, and table manners. When doing academic work, children learn to share instructional materials such as pencils, markers and scissors.

As children get older, behavioral analysis is used to identify behaviors that contribute to good behavior and misbehavior in the classroom. To teach new behaviors and create changes in current misbehavior, teachers can modify antecedents or consequences of those behaviors.

For example, through direct observation and measurement, John's (aged 5) teachers observed that he often had temper tantrums when they requested that he participate in activities with his classmates. His temper tantrums caused his teachers to withdraw their request that he participate. John thought this was a positive outcome for himself - he did not have to learn to be with others. John's teachers and family took several actions, based on a behavioral model to remediate this problem.

They did the following:

There are times when the above plan simply will not work because a child has too little control of himself in a school environment. The child is then taken from the classroom to a special education classroom where he progresses through a hierarchy of levels of social, academic, and behavioral requirements. When he learns one level, he progresses to the next that has a new set of requirements.

There is also a token-economy procedure. The child earns tokens or play money for appropriate behavior. Then the tokens are traded for something of value such as free time, small gifts, or extra time on the classroom computer.

A contract called contingency contract is also used. This document specifies in writing the relationship between behavior and what will happen when the child behaves in a certain way. For example, if he decides to be disruptive in the classroom, the contract may state that he is to go to the school counselor's office.

Question:
4. If a child kicks and screams, he is usually trying to say:

Collaboration
Most of these children are educated apart from the general classroom because their behaviors are disruptive to a general education class. Also, the children may need very intensive practice that cannot be done in a general classroom. However, they can attend some general education classes with their classmates. If they have a good ability in math or one of the other general educational classes, they can be part of the usual classroom for that subject.

There are many people who may collaborate to teach these children. For example, David has school counselors, the community mental health clinic, his parents, and family friends. If the child has many problems, professionals such as the juvenile court advocate, public health professionals, public welfare systems, and the community social worker may also be a part of his treatment team.

In the family setting, it is important that parents are a part of the treatment planning at the school and take the same approach toward the child as his teachers do. For example, a parent may realize that he/she is doing something for the child without his asking for it politely - which he needs to learn to do. He needs to learn "please" and "thank-you" when making requests of his parents, not simply yell or have a tantrum. The parents also need to reinforce proper behavior when the child is at home. If he says "thank you", his parent can respond by saying, "It is nice when you talk politely!"

The community can help with services to the child with behavior/emotional problems. Many times these services revolve around the school. There are after school programs for children who do not have parents at home until late in the day. Some schools have opened up their gyms for late night basketball and sport programs in an effort to keep children and teensagers off the streets and prevent drug use. Other communities have opened offices for substance abuse counseling.

Question:
5. What are some ways that churches can help children who may have behavioral problems?

Students can influence one another positively and negatively with respect to academic achievement, values and attitudes, and social skills. Children with behavioral/emotional problems are limited in their contacts with their peers because of their behavior. However, there are ways to facilitate positive interactions by group meetings in class, peer tutoring, and opportunities for healthy social interactions. One type is called peer mediation or conflict resolution. This is the voluntary solution of differences among peers that takes place in the presence of trained peer mediators. Peer mediation among students decreases the number of students who leave school early and student assaults.

The Peer Counseling Structure is Outlined Below:

Step 1: Open counseling Session

Step 2: Gather Information

Step 3: Focus On Interests

Step 4: Create Options

Step 5: Evaluate Options - Decide on a Solution

Step 6: Write Agreement and Close

Question:
6. What does peer counseling do to solve conflicts between students?
(One or more of the following answers may be correct.)
a) It gives the strongest person the advantage.
b) It helps two teens meet and try to solve conflict in a fair manner.
c) It points out consequences of unresolved conflict.

What are Some Model Programs for Children Through the Educational Years?

A program called Rainbow for preschool children offers them language development activities such as story telling and sharing, active listening, and acting or role playing. these activities help the child to develop the ability to express feelings and encourage them to socialize with other children and staff. By developing such bonds, the children also have good mental health. There are also learning centers within the school where the children can write, read, participate in musical activities, or work on computers. The centers help the children to be effective with these academic skills. Along with this program, children receive social praise and encouragement.

In the middle school years, there are programs that give parents and children the ability to live at home rather than being admitted to a psychiatric hospital. The program is very intense with in-home counseling, parenting skills training, behavior-management, and financial assistance. The family is "wrapped around" with the services they need so their child is not hospitalized. One part of this program is called the buddy system. A buddy is a person older than the child who gives support to him through social activities, academic help, or on-to-one relationships. A buddy also helps the parents.

Here is one example:
Becoming a buddy was very easy. At the beginning, I was briefed on my student's personality and what behaviors I could expect from him. I also learned a few of the general rules that I needed to know to be part of the buddy program.

When I met Marcus for the first time, I was a bit nervous. On that day, his grandparents picked me up and drove me to their home, where Marcus lived. I remember that Marcus was swimming in the pool. It was obvious that he was trying to show off for me. I think he must have been a bit nervous too. We spent the afternoon talking to one another.

Let me tell you a little about Marcus. That summer, he was eleven years old. He wasn't very active; he seemed to prefer spending most of his time in front of the TV. One of his main problems was that he had poor speaking skills. It was easy to see how frustrated he got when he couldn't share his thoughts or ideas effectively. We spent a lot of time talking, which seemed to improve his speaking skills. I learned that much of Marcus's poor behavior came from frustration: not having the skills to do the right thing. I think that may be the cause of many students' emotional/behavioral problems.

Marcus and I spent a lot of time together. One way in which we tried to channel some of his frustrations was through physical activities. I often visited Marcus and his grandparents at their cabin, where we went fishing and swimming. Whenever possible, I would get other children to join our activities. I was important that he develop friendships with other children his own age.

Being Marcus's buddy was very rewarding. But as I said earlier, it was sometimes challenging. Patience was a must. His social skills improved, but gains were often achieved slowly. To maintain his interest, we had to change activities from time to time. But we really began to see results when we found a variety of activities we both enjoyed. I kept working at change for him because it was obvious that Marcus was working hard to change. When his energies were directed positively, he could be a very likeable child. My job was to try and redirect him and teach him how to redirect himself.

One of the most rewarding things that happened to Marcus is that he eventually joined an after-school sports team. He was not the best player on the team, but he did his best. Perhaps the most important, he was spending time playing with other children his own age.

Marcus and I learned a lot that summer. He learned how to channel his excess energies and some new social skills. I enjoyed watching his progress.

Question:
7. What were some social problems that Marcus had?

In high school, these students are taught the academic, social, and vocational skills to obtain and keep full-time employment. Work experiences begin in the tenth grade. The student spends one half day in school three days per week and then the rest of the day at a work site. There are a variety of work sites for students - warehouses, restaurants, stores, banks, and office buildings. Students rotate through all the different work sites to assess their preferences and vocational abilities.

Four to six students are trained at a work site with a teacher for supervision. Eventually supervision is turned over to co-workers in the work setting. Not all of the instruction is at the work site, students get instruction in such general areas as work behaviors, social skills, job procurement, and career opportunities. Upon graduation, the teacher provides necessary support as the student transitions to full time work.

What about David's Future?
David's father believes that by David's own intelligence and work, along with his family, friends, and professionals, will survive. His father said that he used to give David only a 1-99 chance to succeed. With the help of the rehabilitation team, he thinks David has a 50-50 chance of succeeding.

David himself is a fine athlete and perhaps will have a scholarship based on his sport ability. With an IQ of 130, college academics will be manageable for him. He already knows that he likes to work with his hands and usually by himself. Woodworking, agriculture, and farming appeal to him. Recently, he has begun to paint and draw.

David also has a good support system. He will continue therapy and have his medications monitored by the doctor. He and his family will also need consistent support from people they trust. They cannot tolerate the long process of working with their son without help from others for emotional, physical, and financial help.