chapter7-情緒行為障礙

UnderstandingStudentswithEmotionalorBehavioralDisordersContentsDefinitionPrevalenceIdentificationandCharacteristicsCausesEvaluationInterventions/TechniquesEmotionalDisturbance:Aconditionexhibitingoneormoreofthefollowingcharacteristicsoveralongperiodoftime,andtoamarkeddegree,thatadverselyaffectsachild’seducationalperformance.DefiningED(IDEA)DefiningED(IDEA)Inabilitytolearn(cannotbeexplainedbyintellectual,sensory,orhealthfactors)InabilitytodevelopormaintaininterpersonalrelationshipsInappropriatetypesofbehaviorsorfeelingsPervasivemoodofunhappinessordepressionPhysicalsymptomsorfearsassociatedwithpersonalorschoolproblemsIDEADefinitionofEmotionalDisturbanceEmotionaldisturbanceincludesschizophrenia.Thetermdoesnotapplytochildrenwhoaresociallymaladjustedunlessitisdeterminedthattheyhaveanemotionaldisturbance.DifferenceofSEDorEBDSED:SeriousEmotionalDisturbanceEBD:EmotionalorBehavioralDisorderMuchofthetime,there’snodifferenceinbehaviorsofSEDorEBD;theonlydifferenceisinthelabels.PrevalenceofEBD21%ofchildrenandadolescentshaveabehavioral,emotional,ormentalhealthproblem8%ofstudentswithdisabilitiesfallundertheemotionaldisturbancelabel,thefourthlargestIDEA04disabilitycategoryThreemillionAmericanchildrenmeettheclinicalcriteriaformooddisordersMoremalesthanfemalesOlderstudentsidentifiedmorethanyoungerPovertyappearstodoubletheriskofEBDAfricanAmericanmalesareoverrepresentedOneoutofevery20MinnesotachildrenisidentifiedwithSevereEmotionalDisturbanceSuicideisthesecondleadingcauseofdeathforages15-34inMinnesota.TheoverallsuiciderateisdoublethehomiciderateinthestatePrevalenceofEBDIdentificationofEBDAnestablishedpatternofoneormore:Withdrawaloranxiety,depression,problemswithmood,orfeelingsofself-worthdefinedbybehaviorsDisorderedthoughtprocesseswithunusualbehaviorpatternsandatypicalcommunicationstylesAggression,hyperactivity,orimpulsivitythatisdevelopmentallyinappropriateIdentificationofEBDResponsesmustadverselyeffecteducationalordevelopmentalperformanceandbeseeninatleastthreesettingsincludingtwoeducationalsettings(forinstance-classroomandlunchroom)Behaviorsseenmustbesignificantlydifferentfromappropriateage,culturalorethnicnorms;andmustnotbeprimarilytheresultofintellectual,sensory,oracuteorchronichealthconditionsCharacteristicsofEBDInternalizingExternalizingCognitiveAcademicInternalizingDisordersAnxiety-WithdrawalSeparationanxietydisorderGeneralizedanxietyPhobiasObsessive-compulsivedisorderPanicdisorderDepressionPost-traumaticstressdisorderAnxietyDisordersFrequentabsencesIsolatingbehaviorsManyphysicalcomplaintsExcessiveworryFrequentboutsoftearsFrustrationFearofseparationSchoolavoidanceFearofnewsituationsDrugoralcoholabuseDepressionAffectsthoughts,feelings,behavior,relationships,physicalhealthIrritabilityInearlychildhood,mayappearasirritability,defiance,restlessness,orclingingContinuingsadnessHopelessness,self-deprecatingremarksSchoolavoidanceChangedeatingorsleepingpatternsFrequentphysicalcomplaintsIsolation,nonparticipationInternalizingBehaviorPsychoticbehavior(Schizophrenia)hallucinationsdelusionsSchizophreniaCommonlyappearsinlateteensorearlyadulthoodMaycomeongradually;mayappearinteenswithothermentalhealthdiagnoses.Earlydiagnosisandtreatmentisimperative;50percentormoremayattemptsuicideWithdrawn,lackmotivationVividandbizarrethoughtsorspeechConfusionbetweenfantasyandrealityHallucinationsordelusionsSeverefearfulnessDisorganizedspeechExternalDisordersUndersocializedAggressiveCD ConductdisorderAttentionProblems-ADHDMotorExcessunawareofbehavioralexpectationsSocializedAggressiveCDSocializeddelinquencyganginvolvementtruancyawareofbehavioralexpectations;covertattemptsOppositionalDefiantDisorderAboveaveragelevelofanger,blaming,hostile,orvindictivebehaviorMaybeareactiontofrustration,depression,inconsistentstructure,orconstantfailureduetoundiagnosedADHD,learningdisabilities,etc.FrequentangryoutburstsNoncompliantandargumentativeEasilyannoyedRejectspraise,maysabotageactivitythatwaspraisedDeliberatelyannoys,provokesothersConductDisorderSerious,repetitive,andpersistentmisbehaviorAggressiontowardpeopleoranimalsPropertydestructionDeceitfulness,theftThreeormoreincidentsinlastyear;oneduringlastsixmonthsProblemmustbepersistent,notareactiontostress,crisis,cultural,orsociallifecontextCo-occurswithADHD,learningdisabilities,depressionSeealso:OppositionalDefiantDisorderReactiveAttachmentDisorderDisturbedanddevelopmentallyinappropriatesocialrelatednessinmostcontextsBeginsbeforeagefive,usuallyafteraperiodofgrosslyinadequatecareormultiplecaretakerchangesDestructive,self-injuriousAbsenceofguiltorremorseExtremedefiance,provokespowerstruggles,manipulativeMoodswings,ragesInappropriatelydemandingorclingingBipolarDisorderFrequent,intenseshiftsinmood,energy,motivationShiftsinchildrenareveryfastandunpredictable“Mania”phasemayappearasintenseirritabilityorragesAnxiety,defiancemaybeseenStrongcravingforcarbohydratesImpairedjudgment,impulsivityDelusions,grandiosity,possiblyhallucinationsHighriskforsuicideandaccidentsObsessive-CompulsiveDisorderIntrusive,repeatedthoughtsSenselessrepeatedactionsorritualsFrequentlyco-occurswithsubstanceabuse,ADHD,eatingdisorders,TouretteSyndrome,otheranxietydisordersDifficultyfinishingworkontimeduetoperfectionismorritualrewriting,erasing,etc.Countingrituals,rearrangingobjectsPoorconcentrationSchoolavoidanceAnxietyordepressionPost-TraumaticStressDisorderAffectschildrenwhoareinvolvedinorwitnessatraumaticeventAconcernwithrefugeepopulationsIntensefearandhelplessnesspredominateateventandduringflashbacksFlashbacks,nightmares,repetitiveplayre-enactmentsEmotionaldistresswhenremindedofincident(s)Fearofsimilarplaces,people,eventsEasilystartled,irritable,hostilePhysicalsymptomssuchasheadaches,dizzinessCognitiveMosthaveIQinlowrangeMorethanhalfhavelearningdisabilitiesRelationshipbetweenacademicandsocialbehaviorsareconnectedAcademicAchievebelowgradelevelinreading,math,andwrittenexpressionDropoutofschoolatahigherratethananyotherstudentsMeanachievementlevelatthe25thpercentileMoreacademicproblemswithexternalizingbehaviorsLesslikelytoattendpost-secondaryschoolCausesBiologicalGeneticsEnvironmentalStressfullivingconditionsChildmaltreatmentSchoolfactorsStressfulLivingConditions38%youthwithEBDcomefromhouseholdswithannualincomeunder$12,00032%comefromhouseholdswithincome$12,000-$24,99944%singleparenthouseholds1/2to3/4childreninfostercarehaveEBDHomelesschildrenexperienceEBD3to4timesmorefrequentlyChildMaltreatmentNeglectPhysicalabuseSexualabuseEmotionalabuseSchoolFactorsStudentsdonotreceiveresearch-basedinterventionsinreading2/3ofteachersarenotcertifiedinEBDTeachersworkingwithstudentswithEBDexperienceburnoutandjobstressmorethanotherteachersEvaluation(seepg.166)ObservationScreeningPrereferralReferralNondiscriminatoryevaluationproceduresDeterminationHowareStudentswith

EBDIdentified?InterviewswithparentsandteachersUseofacademictestingObservationsInformaldatacollectionFunctionalBehavioralAssessment