Emotionally Disturb

By: Alexandra Mancilla, Maureen Ginther, Kaitlin Thrapp, Christina Svenjak

Definition IDEA defines emotional disturbance as follows: “…a condition exhibiting one or more of the following

characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance:

An inability to learn that cannot be explained by intellectual, sensory, or health factors.

An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

Inappropriate types of behavior or feelings under normal circumstances.

A general pervasive mood of unhappiness or depression.

A tendency to develop physical symptoms or fears associated with personal or school problems.”

Definition There are a wide range of specific

conditions that differ in characteristics and treatments including Anxiety disorders Bipolar disorders Conduct disorders Eating disorders Obsessive-compulsive disorder Psychotic disorders

Anxiety DisorderThe most common psychiatric illness affecting children and adults

Irrational fear of everyday situations including Generalized anxiety disorder (GAD) Obsessive-compulsive disorder Panic disorder Post-traumatic stress disorder (PTSD) Social anxiety disorder

BipolarCauses dramatic mood swings from overly “high” to sad and hopeless and back again, with normal moods in between

Severe changes in energyCan be treated with medication and psychological treatment

Conduct DisorderOne of the most difficult disorders to treat

Great difficulty following rules and behaving in a socially acceptable way Aggression toward people and

animals Destruction of property Deceitfulness, lying, or stealing Not attending school

PrevalenceAccording to the CDC (Centers for Disease Control and Prevention), approximately 8.3 million children (14.5%) aged 4–17 years have parents who’ve talked with a health care provider or school staff about the child’s emotional or behavioral difficulties.

Nearly 2.9 million children have been prescribed medication for these difficulties.

Characteristics Child finds it hard to learn at school or at

home because of the condition making it hard for them to perform well physically and mentally.

You can notice that the child will demonstrate unusual rage or anger in normal situation.

The child gets irritated fast He can appear unhappy and generally

depressed. The child has trouble with social interaction

with his environment including both children and adults.

CharacteristicsCan affect an individual in areas beyond the emotional Hyperactivity Aggression or self injurious behavior Withdrawal Immaturity (temper tantrums, poor

coping skills) Learning difficulties (below grade

level)

Assessment Use reliable and valued methods that are specific to the purposes for

which they are being used, and as applicable, adhere to the standards put forth in Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, and the National Council on Measurement in Education, 1994)

Use multiple sources of information, such as clinical or structured interviews, systematic observations, behavior checklists and rating scales, self-reports, work samples and standardized assessment instruments

Ensure that the application of assessment practices is nondiscriminatory Include information concerning the student's family and developmental

history, health, cultural norms and expectations, and social and emotional functioning in the home and community

Gather evidence concerning educational/classroom performance Obtain information about student abilities and performance in the areas of

cognitive/academic, communication, social/emotional, personal/adaptive and perceptual/motor functioning

Analyze factors underlying the student's behavior or emotional responses by identifying the target behavior, the function or purpose of the behavior and the factors maintaining the behavior

Document student's responses to interventions.

Etiology No one knows the actual cause or causes of

emotional disturbance Several factors—heredity, brain disorder, diet,

stress, and family functioning—have been suggested and vigorously researched.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income.

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

PlacementWhere are students with ED being educated?—

General Education/Inclusion Classroom

Resource Room Separate Class (self-contained class) Separate School Residential Facility Psychiatric HospitalHomebound/Hospital

Placement: General Education or InclusionApproximately 28% of all students classified with an emotional disturbance receive their education in the general education or inclusion classroom environment

The exceptional student receives the same academic instruction as the general education students with individualized academic and behavior management services as needed

Placement: General EducationApproximately 23 % of all students classified with an emotional disturbance receive their education in a resource room.

The exceptional student receives academic instruction in the general education classroom and the special education resource room. The division of time is based on the student’s individualized academic and behavioral needs

Placement: Self-ContainedApproximately 31% of all students classified with an emotional disturbance receive their education in a special education classroom (Also referred to as a “self-contained” classroom).

The exceptional student receives all educational services in the special education classroom

Students who are placed in self-contained classrooms tend to have more severe and disruptive behaviors than students who are placed in resource rooms

Placement: Alternate Day School Approximately 14% of all students classified

with an emotional disturbance receive their education in a separate special education school (also referred to as an “Alternative Day School”).

The exceptional student receives all educational services in a setting that is separate from the regular public school.

The alternative school is specially designed for students who have academic and/or behavioral problems that are too severe or disruptive for the public school setting

Placement: Residential Day Treatment Approximately 2% of all students classified

with an emotional disturbance receive their education in a residential treatment facility (also referred to as a RTF or RTC (Residential Treatment Center)

The exceptional student receives all educational services in a residential facility providing 24-hour care for a time period normally ranging from a few months to a year or more, depending on the severity of the problem

Placement: Residential Treatment FacilityOutdoor adventure programs are often a

critical component of certain residential treatment programs

programs attempt to teach students with ED thinking and decision making skills, group cooperation, self-reliance, and social skills combined with wilderness experiences.

Although safety considerations are always factored in, there is a certain element of risk involved in some of the activities, which lends its appeal to students with ED, especially those with serious behavioral issues.

Placement: Homebound InstructionApproximately 1% of all students classified with an emotional disturbance receive their education as homebound instruction.

Individualized educational services are provided in the student’s home when he/she is unable to attend school for medical, behavioral or other reasons

PlacementRelative to other students with disabilities,

children with emotional or behavioral disorders: are more likely to be educated outside the

general education classroom (72% of the time, on average

and in almost half the cases, not educated in the general education classroom at all, e.g., self-contained, alternative day school, RSF, hospital or homebound)

Related ServicesMust provide emotional and behavioral support as well as help them master academics, develop social skills, and increase self-awareness, self-control, and self-esteem

Provide with positive behavioral support (PBS) so that problem behaviors are minimized and positive ones are fostered

Related ServicesIndividual, group, or family counselingCrisis interventionClinical consultationOther services based on their individual needs

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Role of Management Paraprofessional Supervise the child inside and outside of the

classroom. Help student with classwork

Listen to students read aloud Help students understand directions Help students complete assignments

Behavior management

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Management Paraprofessional cont. Know triggers of student and how to avoid

them or stop them. Assist teacher if there is a crisis in the

classroom Help resolve the situation Call for help Can serve as a witness if any disputes

Accommodations/Modifications Administer medication as prescribed Approve early dismissal to attend therapy Maintain weekly/daily journals; self-recording of

behavior Establish home-school communication system. Schedule periodic meetings with home and treatment

specialists Provide carry over of treatment plans into school

environment Assist with agency referrals Develop behavior management programs Write contracts for child behavior Post rules for classroom behaviors; teach

expectations.

Accommodations/Modifications Provide school counseling, social skills

instruction Ensure agency/school collaboration Educate other children/staff/school

personnel Provide carryover treatment plans into

home environment Reinforce positive behavior Schedule shorter study and work periods

according to attention span expected Be consistent

Material/Equipment Students with ED often need a place to calm

down or things to distract them Materials can include:

Stress balls Beanbag chairs/comfortable areas Textured pencil grips/toppers Scalp massagers Areas to escape or feel enclosed Personal positive behavior chart Replacing sharp objects with duller plastics

Curriculum http://learning2breathe.org/

Learning to BREATHE is a mindfulness-based curriculum for adolescents created for a classroom or group setting. The curriculum is intended to strengthen emotion regulation and attention, expand adolescents’ repertoire of stress management skills and help them integrate mindfulness into daily life.

http://relaxtolearn.com/  a research based mindfulness program that allows students

 to experience and reflect on their thoughts, emotions, and ideas during a daily prerecorded guided imagery lesson. 

Any Behavior Modification Curriculum (http://www.escambia.k12.fl.us/pbis/rtib/Behavior%20Intervention%20Guide-9.13.pdf)

Focused Breathing (Activity) Focused breathing can be used when a child is

stressed, over stimulated, or overwhelmed. Pain and stress can leave a child breathing faster and

shallower, or even holding his or her breath — all of which can actually keep the stress response going and heighten the intensity of pain. Paying attention to breathing can help calm the mind. Step 1. Sit or lie comfortably and put one hand on your stomach,

the other on your chest. Step 2. Close your eyes and try to relax all of your muscles, one by

one, from the tips of your toes to the top of your head. Don't forget to relax the muscles in your face, neck, and jaw; you may be storing a lot of tension there.

Step 3. Breathe deeply and regularly for several minutes— and try to make your stomach (abdomen) rise and fall, not only your chest. This will help you deepen your breath.

Step 4. Pay attention to each breath; try to turn all your thoughts to each inhale ... exhale. As you breathe out, imagine the tension leaving your body with the breath.

Medication All medication should be taken along with

counseling Antidepressants (Prozac, Zoloft, Paxil)

Can have suicidal feelings as a side effects in children and teens, can be habit forming

Lithium (mood stabilizer) Can be used for bipolar, depression,

schizophrenia, and eating disorders. Fairly minimal side effects, but must be monitored. It is not formally approved to treat conduct disorder, but it may help.

Behavior Intervention Plan in IEP

Behavior Modification Contract A behavior contract is an agreement between a

student, their parent and the teacher. It spells out the expected behavior, the unacceptable behavior, the benefits (or rewards) for improving behavior and the consequence for failing to improve behavior. This contract should be worked out with the parent and the child and is most effective if the parent reinforces the appropriate behavior, rather than the teacher. Accountability is an important part of the success of a behavior contract.

Prevents the need to open up the IEP again to add in an extra Behavioral Intervention Plan

Example of Behavior Modification Contract

Example of Behavior Modification Contract

Behavior Modification Activity Using the below format, think of a behavior or

habit that you would like to break. Fill out the questions below.

1.In _______ weeks, my goal is to __________________________________________________________________________________

2.What lifestyle changes will you need to make? __________________________________________________________________________________

3.How will you reward yourself?___________________________________________________________________________

Classroom Set Up Structure

Try to keep desks in rows so students cannot face each other. Add different centers and an area for group work to keep social aspects still available. Resources and materials should be readily accessible.

Routines Have the schedule posted in a viewable area for the student.

Practice routines early in the school year and prepare student when there will be change.

Constant reinforcement Any positive behavior needs to be reinforced, not just weekly or

randomly. The emphasis must be on the idea that negative behavior will not be tolerated

Clear set rules The student must be made aware of the rules and the consequences

that will follow if they fail to follow them. Minimal distractions

Facing the child away from distracting or stimulating object could help prevent behavior issues or melt downs

How to Respond to a Violent ChildIf the student is becoming a danger to himself or others, security should be called first.

He should be safely removed from the classroom

Alternative to Restraining a Violent Child As classroom teachers, unless in a special school or

specially trained, we are NOT trained to restrain a child. There are alternatives to this practice to try and prevent them from getting to the level of needing restraints. Acknowledge the frustration Find distractions Keep a steady voice and use simple language Find a calm space Don’t take it personally Use planned ignoring Give them a chance Set up activities for success Minimize risk Ask for support

Instructional MethodologiesRemember, they’re kids first. Students with emotional disturbances aren’t scary, dangerous, or time bombs waiting to go off. They are themselves, in need of your skill and support, and quite capable of learning. Do not permit bullying, teasing, demeaning, or exclusion of the student by other students or by the system.

Instructional Methodologies Consistent routines (All subjects or life skills

taught at specific times of the day everyday) Consequences (Behavior modification plan) Positive reinforcement (this should be seen

everyday) Positive modifications( Must be set on

frequency scales) Frequency scales: subject rewards, daily

rewards, weekly, monthly etc. Very basic directions(Must be clear)

Instructional Methodologies Only give one to two step directions at a time. Play to students strengths and personal interest. Support students during group work, peer

interactions and activities. Allow time for student to work alone or take a

break. Communication with parents and psychologist is

key.( It is always good to be informed with what goes on outside the classroom. Students behavior may fluctuate with changes in medication)

Instructional Methodologies Be sensitive- model your sensitivity to their

needs. Be proactive– Knowing triggers that may offset

an episode is essential.  Always think prevention.

Be an advocate– Advocate for the child’s ability to cope with the emotional disorder in varied settings. Encourage them to be active, remind them that they are in control of their behavior.

Make a plan with student to replace inappropriate responses with appropriate responses.

Instructional MethodologiesPost a general class schedule that indicates what students should be expected to do as they enter your classroom, when homework is collected, etc.

To prevent frustration, combine challenging work and review work.

Provide time for the student to catch up on missed work or to review concepts that they are struggling with. 

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School Phobia Students who are emotionally disturbed have

trouble learning in school. May function 2 or more years below grade level Language problems-understanding others and

expressing themselves May not have memorization skills Lack organization and time management skills

They also have trouble building and maintaining relationships. Lack social skills Don’t act appropriately with peers or adults

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School Phobia cont. May have covert aggression - lying, cheating May have relational aggression - manipulating,

gossiping, excluding others. Students can have severe anxiety.

May be unable to attend, listen and learn in school. Can show signs of depression.

These can cause the student to not want to go to school. They don’t want to be wrong. They don’t want to be isolated by peers.

Peer Mediation This is both a program and a process where

students of the same-age group facilitate resolving disputes between two people or small groups.

Types of conflicts they resolve could be classroom outburst, bullying or minor problems in the class.

This process is voluntary on both sides and has been proven to be effective.

Peer mediators are selected and trained for this program.

Peer Mediation There are many benefits to peer mediation. A

few of these include improved self-esteem, listening and critical thinking skills and school environment.

At the end the mediators and small group sign a contract. This is very effective and allows the students to move forward and reflect back to their contract.

Class Meetings Set aside time for students to discuss

classroom issues. It is important to keep the students updated

and aware of what is going on in the classroom.

This time could be a great chance for students to collaborate and work together to find a solution.

It is important that the class comes together as one to resolve conflicts.

Activity You are a teacher in a self contained 12 to 1 to 1

classroom. There is one child in particular who has conduct disorder. In his IEP, there is a behavior modification plan that states he works best with planned schedules, positive reinforcement, and easy to follow directions. Today, there is a change in schedule. There will be an assembly in the auditorium fourth period. It is also raining out and they cannot go outside for recess as they have been for the past few weeks. He spoke out of turn one too many times, and the para yelled at him during class. What could help prevent all of these triggers? How should you address each of these situations?

Post Secondary/Vocational Many students who are mildly emotionally

disturbed wind up living very typical lives. Students with more severe emotional

disturbances are phased out of BOCES, District 75 schools or 853 schools in New York at the age of 21.

There are work programs provided for these students and residential settings.

Recreational Programs Music Therapy

Speech and communication – Singing custom written songs, i.e. Big Bear Takes a Bubble Bath, to isolate speech sounds and get lots of repetition without monotony.

Fine and gross motor – Using traditional and adaptive percussive instruments, like maracas, to address specific fine and gross motor skills.

Academic – Putting academic information into a song format so that recall is improved.

Social skill development – Music therapy groups where children practice greetings, turn taking, eye contact, requesting, etc., through musical activities.

Behavioral  – Creating songs and musical stories about appropriate behavior.

Social-Emotional – Singing songs that teach a child how to identify feelings and how to cope with “big” emotions.

http://www.youtube.com/watch?v=wXcmWwSQGI4

Recreational Programs Art Therapy

Artwork, in general, has a tendency to be abstract and complex. Artists who create these artworks have to have a sense of focused behavior and individual creativity. Exceptional children can relate to this idea due to the many various abstract and sometimes complicated disabilities they experience.

Art therapy’s purpose, regardless of the circumstance, is to encourage children and adolescents to express their feelings, participate in new tasks, such as those involving focused attention, and to learn creativity

http://www.youtube.com/watch?v=n8zlBJDZanc Activity: think of a feeling you had today. Draw a

picture, either abstract or realistic of that feeling

Recreational ProgramsGreen Chimneys

http://www.greenchimneys.org/residential/ Residential school, day camp and facility

designed to work with this community. Pet therapy is also provided

Pet therapy http://www.animalleague.org/about-us/new-york-services/pet-assisted-therapy.html

The LDA of NYS has many different summer camps and educational programs for students with ED and other disabilities all over NY.

Organization and Agencies Office of Mental Health

“Promoting the mental health of all New Yorkers with a particular focus on facilitating hope and recovery for adults with serious mental illness and children with serious emotional disturbances.”

http://www.omh.ny.gov/ League Center

The League Education & Treatment Center 501c3 is a nonprofit agency dedicated to the evaluation, treatment and education of individuals with psychiatric and developmental disabilities. At League, every individual is a success story waiting to begin.

http://www.leaguecenter.org/#home There are organizations and agencies all over the

United States that have to do with mental health. Here is a list of addresses and sites organized by state: http://www.pathwaysrtc.pdx.edu/pdf/pbNatlDirectoryOrganizations.pdf

Bibliography Up and Down the Worry Hill: A Children's Book About Obsessive-

Compulsive Disorder and Its Treatment In this uniquely creative and heart-warming book, Dr. Wagner, an

internationally recognized expert in the treatment of childhood OCD, uses the powerful real-life metaphor of the Worry Hill to describe OCD and its treatment clearly and simply through the eyes of a child. Children and adults will identify with Casey's struggle with OCD, his sense of hope when he learns about treatment, his relief that neither he nor his parents are to blame, and eventually, his victory over OCD.

Worry, Worry, Go Away!: A Kid's Book about Worry and Anxiety by Christine Adams All kids experience worries. Helping children understand what

worry is, where it comes, from and how to challenge it, is the first step in overcoming anxieties. The little elves in this book help children to learn to STOP, to THINK TWICE, and see their worries for what they are.By presenting new ways of evaluating and overcoming the psychological, spiritual, and physical dimensions of fear, this creative book will help your child find the confidence and courage to say Worry, Worry, Go Away!

Bibliography Affirmation Weaver: A Believe in Yourself Story Designed to Help

Children Increase Self-Esteem While Decreasing Stress and Anxiety A Believe in Yourself Story designed to help children boost self-

esteem while decreasing stress and anxiety. Children love to turn self-doubt into self-belief. Children relate to the dolphin in this story as the sea creatures show him how to believe in himself. Watch your child increase self esteem and build inner strength as the sea creatures weave a web of positive statements. This "feel good" technique can be used to bolster self-image, manage stress and anxiety, and accomplish goals. This encouraging story will bring a smile to your face and give your child a tool that will last a lifetime

Shoulder Buddies: Helping Kids With Self-esteem Shoulder Buddies: Helping Kids with Self-Esteem is an interactive,

creative teaching tool for younger children on the importance of healthy self-esteem. Utilizing bright, colorful characters called Shoulder Buddies, children are taught how to become aware of how they talk to themselves and how to make those conversations positive. With step-by-step instructions and opportunities to make their own rules, kids are given the tools they need to carry them through adolescence and beyond.

Bibliography Know and Follow Rules by Cheri J. Meiners

A child who can’t follow rules is a child who’s always in trouble. This book starts with simple reasons why we have rules: to help us stay safe, learn, be fair, and get along. Then it presents just four basic rules: Listen, Best Work, Hands and Body to Myself, and Please and Thank You. The focus throughout is on the positive sense of pride that comes with learning to follow rules. Includes questions and activities adults can use to reinforce the ideas and skills being taught.

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