Emotional+and+Behavioral+Disorders

= Emotional and Behavioral Disorders =
 * By Erin Butler, Jen Few, and Taryn Argenta**

** //"There is nothing to see in me. I am a weed fit for the ground and darkness."--// // Elizabeth Barrett Browning // **
** // Elizabeth Barrett Browning is known for her Victorian poetry. However, her manic and depressive states left historians to speculate that she suffered from an emotional disorder. Emotional disorders were unknown at the time, and in fact there are those today that still do not believe in such psychological and mental disorders, years after poets and others suffered from disorders revolving around the complexities of their emotions. // **



I. Introduction to Emotional and Behavioral Disorders
-Students whose behavior falls considerably outside the norm. -Reasons for behavior: Avoidance, communication, attention -Behavior that is harmful, meaning it interferes with learning or growth. -Reasons for this outcome include biological, environmental, and psychological factors.


 * Children go through a set of stages to attain emotional understanding and self-awareness and normative social development. Students with emotional and behavioral disorders usually express their feelings negatively and do not go through these stages appropriately as they attempt to manage their environment to satisfy personal needs.

Under IDEA emotional disturbance is defined as a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance:

a. An inability to learn that cannot be explained by intellectual, sensory or health factors; b. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers; c. Inappropriate types of behavior or feelings under normal circumstances; d. A general pervasive mood of unhappiness or depression; e. A tendency to develop physical symptoms or fears associated with personal or school problems.

Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. Eligibility determination should be based on evidence drawn from different environments and should take into account the student’s developmental stage.


 * There is a push to change the name from Emotional Disturbance to Emotional and Behavioral Disorders because of the eligibility criteria. These disorders are often comorbid and to exclude one from the definition may limit education services for students.

Identification criteria can be somewhat unclear and difficult to measurably define. For example “long period of time” and “to a marked degree” may have different definitions to different people. According to Vaughn, Bos, & Schumm (2007) the following issues in the identification of students with ED were addressed.
 * __Identification of Emotional Disturbance__**

__Reasons for Underidentitfication__ -Definitional inconsistencies: Identification lacks uniformity -Lack of distinctive criteria: Not clearly defined -Social stigma associated with the ED label -Inadequate assessment measures to facilitate identification: Most identification done through behavior scales and classroom observations. -Comorbidity: Many characteristics of emotional disturbance can be observed within multiple special education categories.

Research suggests that later identification rates have also been a concern for ED students- early identification may result in more supportive and successful interventions for these students, however many students are not identified until high-school age.

__Overidentification in Emotional Disturbance__ -Mostly males are identified, unknown why. -Minority populations are disproportionately represented: Combination of factors including cultural bias, poverty, historical practice of segregation and discrimination in schools.

In education, ED is categorized into two main groups of behavior exhibited by students, externalizing behaviors and internalizing behaviors. According to Smith (2007) externalizing behaviors are mostly observed as students acting out or being disruptive. These behaviors may include aggression, impulsivity, and noncompliance. Externalizing behaviors are usually addressed earlier and more often because they are disruptive to others in the environment. Internalizing behaviors include students who are withdrawn, lonely, depressed, or anxious. These behaviors are often overlooked and unnoticed by teachers because they are less likely to interfere with instruction. However, internalizing behaviors are equally serious, it is critical that teachers address these behaviors with the same concern in order for students to receive the most appropriate educational services. Behavior exhibited by students with emotional and behavioral disorders will often fall into one or both of these groups, however these groups do not account for all conditions that result in placement in special education under emotional disturbance. Individuals may exhibit both kinds of behaviors. Comorbidity is high.
 * __Characteristics of Students’ Behaviors__**

The following chart explains some of the common externalizing and internalizing behaviors exhibited in students with emotional and behavioral disorders. · Violates societal norms or rules · Has tantrums · Steals; causes property loss or damage · Is hostile or defiant; argues · Ignores teachers' reprimands · Demonstrates obsessive/compulsive behaviors · Causes or threatens physical harm to people or animals · Uses lewd or obscene gestures · Is hyperactive || · Exhibits painful shyness · Is teased by peers · Is neglected by peers · Is depressed · Is anorexic · Is bulimic · Is socially withdraw · Tends to be suicidal · Has unfounded fears and phobias · Tends to have low self-esteem · Has excessive worries · Panics ||
 * **Externalizing Behaviors** || **Internalizing Behaviors** ||
 * · Violates basic rights of others

According to Vaughn, Bos, & Schumm (2007) the following chart explains how emotional and behavior problems of children in the federal definition of emotional disorder (ED) correspond with mental disorders in the DSM-VI classification system. Communication disorders ADHD || Conduct disorder Oppositional-defiant disorder Bipolar Adjustment disorders || Adjustment disorders Other mental disorders with depression || Anxiety disorder Somatoform disorders (unsubstantiated feelings of pain in limbs, headache, etc.) || Mood disorders accompanied by psychotic features || Antisocial behavior ||
 * ED Federal Definition Terms || DSM-VI Mental Disorders ||
 * (a) an inability to learn that cannot be explained by intellectual, sensory, or health factors || Learning disorders
 * (b) an inability to build or maintain satisfactory interpersonal relationships with peers or teachers || Not specified in DSM-IV, but an element of other disorders ||
 * (c) inappropriate types of behavior or feelings under normal circumstances || ADHD
 * (d) a general pervasive mood of unhappiness or depression || Depressive disorders
 * (e) a tendency to develop physical symptoms or fears associated with personal or school problems || Separation Anxiety disorder
 * Schizophrenia (specifically included) || Schizophrenia and psychotic disorders
 * Socially maladjusted (only qualifies for ED if in conjunction with other ED characteristics) || Conduct disorder



According to the Council for exceptional children the planning and placement team, including the student’s parents, must design programs to meet the individual needs of identified students. Both behavioral and academic needs must be addressed in order for the student to access their appropriate education. Most students can benefit from support and interventions provided in regular programs. However, for some students it may be more appropriate for them to receive education in self-contained classrooms, special schools, or institutional programs.
 * __Educational Implications__**

Specialized programs attempt to provide a structured environment for students. It is important that transitions and routines are predictable and that school personnel are consistent with rules and expectations. It is also significant that students are praised and rewarded for their appropriate behavior. For some students it is essential to formulate behavior plans based on observation and measurement of behavioral change.

Behavior management techniques, such as positive reinforcement, token economies, contracting, giving choices, planned ignoring, modeling, active listening, and in specific programs “time-out” or calming areas may be a part of students’ behavior plans.

It is essential that programs address students’ social skills, emotional management, and behavioral control. This may include aspects of sensitivity and responsiveness to others in social interaction, self-esteem and self-confidence, as well as decision-making and responsibility.

Through planning, modeling, discussion, and practice students increase control over their behavior and improve their relations with others. Counseling, occupational therapy, speech and language and other support services may also assist in the fostering of self-control, confidence, and self-understanding for these students. Council for exceptional children

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**II. Historical Perspective of Emotional and Behavior Disorders**
Early educational services for children with emotional disturbance were offered within segregated, institutional environments. During the 1800s, there was a lack of support in the idea that psychological and behavioral pathologies were present in children. At the time, physicians and psychiatrists thought that insanity was an adult disorder. Most believed that expression of mental illness in childhood was a sign of mental deficiency. In 1867, Henry Maudsley affirmed the notion that adult psychoses could be observed in children (Winzer, 1993). During this time, mental deficiency and moral deficiency were first identified as separate issues of the mind and spirit, though both were often viewed as being brought on by an individual’s sins.
 * 1800s**

At this time there was little separation of individuals with emotional disturbance and intellectual disability. Although children with severe emotional problems often were not differentiated from children with mental defectiveness, Samuel Gridley Howe, founder of one of the first schools for the mentally retarded in 1848, attempted to delineate between “mental idiocy” and what he referred to as “moral idiocy." (Gelb, 1989).

Institutions for mental impairments spread throughout the second half of the 1800s (Davies, 1959). -The Pennsylvania Training School for Idiotic and Feeble-Minded Children: 1852 -New Jersey Training School for Feeble-Minded Boys and Girls: Vineland, New Jersey

In the late 1800s, specialized schools called “industrial schools” were formed with the purpose of assisting children who were not amenable to public schooling. The Industrial School Act of 1857 allowed children between the ages 7 to 14 to be sentenced to one of these institutions. These schools focused on vocational education and learning more appropriate behaviors. Industrial Schools and Reformatories

Towards the end of the 1800s, students found to be “uncorrectable” or low achieving were placed in special segregated classes called “ungraded classes”. Students who were frequently absent were also placed in these separate classes (Winzer, 1993)

For children who presented greater behavioral dysfunction, correctional facilities and reform schools developed services to rehabilitate these students. At the very least these facilities served as a way to contain these individuals. Society believed that these children were better off in an institutional setting.
 * 1900s **

In early 20th century, new categories of disability and differentiation arose. Children were now sorted in more varied ways. Two new categories surfaced, emotional disturbance and learning disability became separate entities, disconnected from mental retardation. Previously labels such as incorrigible, maladjusted, and disturbed were used to identify children who would later be referred to as emotionally disturbed (Kauffman & Landrum, 2006). Winzer (1993) indicated that the term emotional disturbance was first used around 1910.

One of the earliest efforts to formally label students exhibiting behaviors of emotional disturbance was done by John Horn. Horn created a more extensive classification system of grouping children of various disabilities. This system included three categories and seven subcategories. Kauffman and Landrum (2006) provided the following representation of Horn’s system: The category that most closely resembles emotional disturbance was termed exceptionalities “for reasons primarily temperamental” and included the subgroup of children labeled “incorrigibles and truants.” Although methods for identification evolved, incorrigibility, meaning un-correctable would remain a label for these students throughout the first half of the 1900s. At this point there was still little differentiation between services for mental retardation, now intellectual disability, and emotional disturbance. Most were still institutionalized.

During the 1900s the servicing of children with exceptionalities improved. With the enactment of attendance laws, schools became more legally responsible to serve their students with disabilities. Many schools had previously disregarded children with disabilities and behavior problems who chose not to attend. Schools began to feel more legal pressure to effectively service these exceptional students.

In 1946 improvement of education, including non-institutionalized settings for emotionally disturbed youth, arose. The development of the ‘600’ schools in New York City serviced and provided education for youth then termed “maladjusted” or “disturbed” (Berkowitz & Rothman, 1967). These day schools were set within regular school settings, however schools in more restrictive settings, including residential facilities, were still common. Children were often placed in these settings when they could no longer be service or contained in public schools and/or by their parents. Educators and therapists focused on treatment and rehabilitation that would decrease students’ inappropriate and undesirable behaviors.

Steps towards appropriate education for students with emotional disturbance continued with the development of the first instructional texts on educating these students:

In 1955, Leonard Kornberg’s text, A Class for Disturbed Children: A Case Study and Its Meaning for Education, brought together both aspects of psychoanalysis and interpersonal therapeutic process.

Another text from Berkowitz and Rothman in 1960 reflected an educational approach based on Freudian theory. The text explained that only after mental or internal conflict has been resolved can students possess a readiness for effect learning.

During this time treatment of children with EBD followed the Freudian training of the current psychologists. Treatment began to shift as a result of B.F. Skinner and his theories on learning and Behaviorism (Skinner, 1953).
 * Treatment changed **

__ Freudian Theory __ The psychoanalytic belief explained that internal mechanisms are responsible for one’s behavior.

__ Skinner __ Skinner’s beliefs of operant conditioning explained that behavior is shaped and controlled by consequences of one’s environment. Skinner influenced education asserting the idea that positive reinforcement is more effective than punishment when shaping behavior. **Behaviorist Theory** would become the most significant influence on the classroom management of students with EBD.

**Laws changed** During 1960s there was an increase in focus on the condition of services for students with emotional disturbance. In 1963, Public Law 88-164, added “seriously emotionally disturbed” as a category of students for which colleges and universities would receive grants for the specific training of teachers.

In 1975, PL 94-142, the Education of the Handicapped Act, added a formal definition for the serious emotional disturbance category. This gave students the right to a free and appropriate education (FAPE). Thi s section would also mandate that all states provide an appropriate and individual education plan to service children with disabilities in their least restrictive environment. Prior to the Education of the Handicapped Act, students with disabilities were generally placed outside the regular education classroom. In 1975 schools began to rethink the placement of their special education students.

As a result of more responsibility being placed on schools and districts to appropriately provide for its students with disabilities, parental rights also increased. Confidentiality and due process were rights granted to parents, schools were becoming increasingly accountable for providing appropriate services.

The basis for the five criteria used in the PL 94-142 definition of serious emotional disturbance came from the writings of Bower (1960). Although controversy about SED’s definitional inconsistencies increased over the next few decades, the original criteria remained unchanged until the Individuals with Disabilities in Education Improvement Act in 2004.

**Controversies of Serious Emotional Disturbance Label**

__ Socially Maladjusted __ Students with conduct disorders and who are socially maladjusted are excluded from the SED label unless they have another qualifying condition. Students with emotional and behavior disorders are seen as students with a disability, Students with social maladjustment and conduct disorder are seen as have control and choice over their behavior. Education.com reasons for controversy over social maladjustment and conduct disorder include: 1. Definition of social maladjustment is not clear or agreed upon. 2. It is very difficult to separate the students with externalizing emotional or behavioral disorders from the students with conduct disorders. 3. If social maladjustment was included it would increase special education enrollment beyond acceptable. 4. The needs of students with conduct disorders are best met by specialists therefore they should be identified as special education students, even if technically they do not qualify as students with disabilities. 5. Many people believe these students are just choosing to misbehave and do not have disabilities.

However, Section 504 and ADA do not exclude social maladjustment and the educational system is required to make accommodations for these students.

__ Duration and Severity __ There is a lack of clarity over how to measure “long period of time” and “to a marked degree”. School systems have be left without proper methods and instructions on how to measure this duration and severity.

** More Change ** In 1989, the Council for Children with Behavioral Disorders suggested the term //serious emotional disturbance// be changed to //emotional or behavioral disorder// (EBD). This label was thought to be less stigmatizing and also included behavioral disorders that had been previously excluded from the definition. It was said that administrators of special education opposed the definition in fear of significant increase in identified students with EBD.

This reconsideration of the label was not recognized until the reauthorization of the Individuals with Disabilities Act in 1997. The term “serious” was dropped, however the emotional disturbance label remained in place.

In the early 1990s, the National Mental Health and Special Education Coalition attempted to recognize some of the misunderstanding within the federal criteria for emotional disturbance. A new definition was proposed by the NMHSEC, being more inclusionary of children with conduct disorders and social maladjustment. Although this new definition was proposed nothing was changed.

IDEA: Building the Legacy

In 1990, the Education of the Handicapped Act was revised to The Individuals with Disabilities Education Act. It was renamed to use more appropriate people first language. IDEA included several changes, along with an increased focus on transition from school to post-secondary settings.

One shift away from the categorical identification of children with emotional disturbance was lead by Gresham (1991). He recommended that behavioral disorders should be identified by RTI (Resistance to Intervention). He thought teachers and other personnel should observe and record student’s behaviors in order to make necessary changes to school environment before identifying that they have an emotional or behavioral disorder. He believed that if student had not responded to interventions then it could be determined they had EBD.

In 1997, IDEA was further revised. These amendments directly effected students with EBD. School districts were responsible for developing a behavior plan for any student with a disability that had a behavior problem. This gave an introduction to Functional Behavior Analysis (FBA) and the Behavior Intervention Plan (BIP). Manifestation Determination or the process to determine if a student’s behavior was or was not a manifestation of the student’s disability was first introduced in the 1997 amendments.

At the turn of the century controversies surrounded full inclusion of students with disabilities in general education. Although many students with disabilities were now being included in the regular education curriculum, ED students were more likely to be educated in separate classes.

In 2001, the No Child Left Behind Act was aimed at changing general education, however it had very specific implications on special education. This held schools accountable for the educational performance of students. Schools were now responsible in determining whether students in all groups, including ED, were making Adequate Yearly Progress (AYP). NCLB also established that all teachers must be highly qualified.

In 2004, IDEA was further revised. The IEP would no longer include benchmarks or short-term objectives. The law also implemented a standard that correlated behavior with disability. Schools were given the ability to use Interim Alternative Educational Setting (IAES). It provided students with services and modifications in their IEP’s to allow them to progress in the general education curriculum. The setting must provide student’s specific program to prevent reoccurrence of behavior that prompted placement in the first place. Lastly the inclusion of //Serious Bodily Injury to Another Person,// would justify a move of a child to an alternative placement, the length of time was changed to 45 days.

Brief History of IDEA : Child & Adolescent Bipolar Foundation

**III. Controversies surrounding Emotional Disorders **

An emotional disorder is used to describe psychological disorders that affect one's emotions. Depressive and anxiety disorders are popular mental health disorders that usually manifest themselves in social situations. Anxiety disorders specifically have only been in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1975, when “anxiety neurosis” was divided into two separate categories: anxiety states and phobic states. Arguably, there are several controversies regarding the diagnoses since it is still relatively new compared to other emotional disorders. The three main controversies revolve around the question whether those with diagnosed anxiety disorders should be medicated, whether medication is the key to anxiety disorder relief, and if anxiety disorders are even a true scientific disorder. With more students under the age eighteen being diagnosed with anxiety disorders every year (even to the point where Individualized Education Plans are created for these students under the primary disability of “Emotional Disturbance”), the controversies surrounding this new disorder is more popular than ever. ("K-12 iep," 1996)

“Recent trends in the use of psychotropic medication—drugs used to treat behavioral and emotional disturbances—from large population-based studies show substantial growth in pediatric and adolescent use of antidepressants and stimulants […] According to a study by Medco Health Solutions, an organization that monitors drug spending, the number of children under 19 years of age taking one or more behavioral drugs rose over 20% between 2000 and 2003. Between 2001 and 2005, the number of children under 19 years of age taking antipsychotic medications rose 73% “ (Johnston, 2008). Many doctors prescribe medications for a child if that doctor decides that the disorder and the disorder’s symptoms are categorical rather than dimensional. Due to the fact that many doctors view emotional disorders as categorical, clinicians must choose whether or not to treat disorders that are “inevitably categorical. Nonetheless, critics of the categorical approach worry that the various categories of emotional and behavioral disorders are too numerous and nonspecific, and that they can do harm by bringing children with normal temperamental differences within the purview of medicine” ( [|The Hastings Center] ). Another factor in choosing whether or not to medicate a child is the fear of a misdiagnosis, especially in temperamental teenagers. This is why doctors urge those who believe themselves to have anxiety disorders to try behavioral therapy before they use medications in order to relieve their symptoms. With behavioral therapy, the therapist teaches techniques that will stop the unwanted anxious behavior, such as breathing exercises (those with anxiety disorders often have rapid breathing and hyperventilate). Exposure therapy, a technique that involves a therapist gently exposing the person to whatever frightens them, is also encouraged before medications are used ( [|National Institute of Mental Health] ). The question still remains: What categorizes an emotional disturbance, or more specifically, an anxiety disorder? IDEA defines an emotional disturbance as, “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” ( [|School Psychological Files] ).

=== [|The following chart describes the close connection between a child with an emotional disturbance and a child who is socially maladjusted in relation to behaviors and relationships in and out of school. There has been some controversy over the exclusion of social maladjustment from the emotional disturbance definition for the sole reason that misdiagnosis is so prevalent in children with anxiety disorders. The main difference is that a child labeled with an emotional disturbance has a tendency to be "unable" to meet certain requests of tasks, whereas a child labeled with a social maladjustment is "unwilling" to meet such tasks and requests.] ===


 * Behavior Area || Emotional Disturbance || Socially Maladjusted ||
 * ** School Behavior ** || Unable to comply with teacher requests; needy or has difficulty asking for help || Unwilling to comply with teacher requests; truancy; rejects help ||
 * ** Attitude Toward School ** || School is a source of confusion or angst; does much better with structure || Dislikes school, except as a social outlet; rebels against rules and structure ||
 * ** School Attendance ** || Misses school due to emotional or psychosomatic issues || Misses school due to choice ||
 * ** Educational Performance ** || Uneven achievement; impaired by anxiety, depression, or emotions || Achievement influenced by truancy, negative attitude toward school, avoidance ||
 * ** Peer Relations and Friendships ** || Difficulty making friends; ignored or rejected || Accepted by a same delinquent or socio-cultural subgroup ||
 * ** Perceptions of Peers ** || Perceived as bizarre or odd; often ridiculed || Perceived as cool, tough, charismatic ||
 * ** Social Skills ** || Poorly developed; immature; difficulty reading social cues; difficulty entering groups || Well developed; well attuned to social cues ||
 * ** Interpersonal Relations ** || Inability to establish or maintain relationships; withdrawn; social anxiety || Many relations within select peer group; manipulative; lack of honesty in relationships ||
 * ** Interpersonal Dynamics ** || Poor self-concept; overly dependant; anxious; fearful; mood swings; distorts reality || Inflated self concept; independent; underdeveloped conscience; blames others; excessive bravado ||
 * ** Locus of Disorder ** || Affective disorder; internalizing || Conduct disorder, externalizing ||
 * ** Aggression ** || Hurts self and others as an end || Hurts others as a means to an end ||
 * ** Anxiety ** || Tense; fearful || Appears relaxed; “cool” ||
 * ** Affective Reactions ** || Disproportionate reactions, but not under student’s control || Intentional with features of anger and rage; explosive ||
 * ** Conscience ** || Remorseful; self critical; overly serious || Little remorse; blaming; non-empathetic ||
 * ** Sense of Reality ** || Fantasy; naïve; gullible; thought disorders || “Street-wise”; manipulates facts and rules for own benefit ||
 * ** Developmental Appropriateness ** || Immature; regressive || Age appropriate or above ||
 * ** Risk Taking ** || Avoids risks; resists making choices || Risk taker; “daredevil” ||
 * ** Substance Abuse ** || Less likely; may use individually || More likely; peer involvement ||

====In __Conquering Panic and Anxiety Disorders__ by Jenna Glatzer, the author discusses how she always had this irrational fear that would never go away, and when she saw commercials about mental illnesses being introduced on the television in the 1950s and 1960s, she believed herself to be mentally ill and knew that she had to keep this fact hidden from her parents. One of the biggest controversies concerning anxiety disorders is the fact that it is still a relatively new disorder, thus older generations do not believe in it. The author kept these attacks under control until around 1981 when she could not control them any longer. Worse than her fear was the fact that her anxiety increased when she realized others could see her panic and knew something was wrong with her (Glatzer, 2002). This shame over being considered “mentally ill” by society is seen in many older generations of people. As shown in the interviews below, age is a key factor in understanding how anxiety disorders and other emotional disorders are viewed due to the fact that for many years, physical disabilities were seen as the only “true” disabilities. Even when the author went to a therapist in the 1980s, the therapist told her that she just had a stressful job and that she should just “relax”, once again not acknowledging that anxiety disorders were a true disorder. Either way, the crippling symptoms of anxiety disorders and other emotional disorders are undeniable. It is up to each individual person to choose the method that works best for him or her. ====

** Anxiety Disorder Interviews ** **Interview #1 with M.F.**

1. **Age:** 56 2. **Level of Education:** Bachelor of Science-Nursing 3. **Gender:** Female 4. **Have you ever experienced a high level of anxiety?** Yes, many times. 5. **Have you ever been diagnosed with an emotional disorder, specifically anxiety disorder, by a licensed professional? When?** No 6. **Are you on prescription drugs for anxiety order? What medication specifically?** No 7. **Have you ever tried other medications for your anxiety disorder?** No  8. **What therapies did you try before you began using prescription medications for your anxiety?** N/A 9. **How do you feel when you are using your prescription medication?** N/A 10. **What do you think effects anxiety disorder? (Genetics, environment, epigenetics?)** All of the above to a certain extent. 11. **Do you know others in your career field that have diagnosed anxiety and/or depressive disorders? Are they older/younger than you? Are they on prescription medications for their anxiety/depressive disorder? Are they in the same/different career field as you? What is their opinion of his/her disorder? Do they view it as a disorder?** Yes, many nurses and doctors are diagnosed with anxiety disorders. Some are younger than me and some are older than me—there is a wide range. Many of the younger nurses and doctors are on prescription medications. People cope differently. During my generation, you were expected to “push through” more than today’s generation. There are more medications out there for anxiety and depression. When I was younger, they didn’t view this as a disorder. Once, this all caused embarrassment, but now it is “normal.” To me, people give in more to the “crutch” or medications rather than fight through it. I believe a true anxiety disorder to be an irrational panic. It is a fear reaction that the individual cannot bring under control in order to function. 12. **If you answered yes to questions 5 and 6, explain your symptoms.** N/A 13. **What categorizes your symptoms as an anxiety disorder opposed to general anxiety experienced by most of the population?** N/A 14. **Do you think that anxiety disorders are over diagnosed? Why?** I think that there is more general anxiety than anxiety “disorders.” For example, hormonal or pregnancy, sadness/grief, loss, etc. I think it is all thrown into one bag and now the pharmaceutical companies are making a profit. So are therapists. Anxiety disorders are the “in” thing. 15. **Do you think that age affects how certain people view anxiety and depressive disorders? How? Why?** People fought through issues more than they do now. Now there are more needs for psychiatrists and therapists, which means more meds and doctors capitalizing on “fear.” 16. If **you could use one word to describe anxiety disorders, what would it be? Why?** Fear. A person has a lack of control over circumstances in their life and it is scary. There has always been some sort of dysfunction or stress and there always will be.


 * Interview #2 with A.F.**
 * 1) **Age:** 27
 * 2) **Level of Education:** Doctorate
 * 3) **Gender:** Female
 * 4) **Have you ever experienced a high level of anxiety?** I don’t know – yes?
 * 5) **Have you ever been diagnosed with an emotional disorder, specifically anxiety disorder, by a licensed professional? When?** No. I have been told that I have a problem with anxiety by a licensed professional, but he didn’t provide a “diagnosis.”
 * 6) **Are you on prescription drugs for anxiety order? What medication specifically?** I have a prescription for anxiety and I take it as needed. Clonazepam and Zoloft.
 * 7) **Have you ever tried other medications for your anxiety disorder?** No
 * 8) **What therapies did you try before you began using prescription medications for your anxiety?** Psychotherapy
 * 9) **How do you feel when you are using your prescription medication?** Calm
 * 10) **What do you think effects anxiety disorder?** (Genetics, environment, epigenetics?) Environment, genetics. I don’t know enough about epigenetics to consider it a factor.
 * 11) **Do you know others in your career field that have diagnosed anxiety and/or depressive disorders? Are they older/younger than you? Are they on prescription medications for their anxiety/depressive disorder? Are they in the same/different career field as you? What is their opinion of his/her disorder? Do they view it as a disorder?** Most people in high stress jobs are some sort of anxiety…I don’t know if it is a disorder but people “self-medicate” in different ways. A lot of the lawyers that I work with do. Then again, it isn’t a hot topic of discussion. You tend to keep that to yourself.
 * 12) **If you answered yes to questions 5 and 6, explain your symptoms.** Shaking, trembling, rapid heart beat, minor disorientation, my mind “goes blank” whenever I’m put on the spot or in a group of people.
 * 13) **What categorizes your symptoms as an anxiety disorder opposed to general anxiety experienced by most of the population?** The degree of the symptoms – how debilitating it is to the point where I can’t function
 * 14) **Do you think that anxiety disorders are over diagnosed? Why?** Probably
 * 15) **Do you think that age affects how certain people view anxiety and depressive disorders? How? Why?** Yes, because “anxiety” as a disorder hasn’t been around that long compared to physical ailments
 * 16) **If you could use one word to describe anxiety disorders, what would it be? Why?** Debilitative. It is completely crippling, especially when you know that you depend on a medication to function.

**IV. What this means for Teachers in Schools**

There are many strategies that teachers can implement in the classroom that will help children with Emotional Behavioral Disorders. Many of these strategies are very simple and are already used in the regular classroom setting. These strategies can help students with EBD better function in the classroom as well as help their typical peers. Some of these strategies include: · Have a set routine for the day and inform students of any changes in the normal routine ahead of time. · Give students responsibilities such as classroom jobs to build self-esteem and confidence. · Have classroom rules and protocols for when these rules are broken. · Have logical consequences for all misbehaviors. · Use positive reinforcement and praise for appropriate behavior.
 * __Simple Strategies__**


 * __Incorporate Social Emotional learning as part of Academics__**

One important concept for teachers to consider is to incorporate social and emotional learning into the academic curriculum. Collaborative for Academics, Social, and Emotional Learning (CASEL) is a nonprofit organization that works to promote Social Emotional Learning (SEL) throughout school districts. Social Emotional learning is the idea of helping children and adults understand and manage their emotions in an appropriate manner. This includes developing empathy of others, being aware of one’s feelings, managing these feelings, building healthy relationships, and making responsible decisions. CASEL is currently working with congress to change the policy related to the use of SEL in Elementary and Secondary School settings.

There are many SEL programs, for teachers, which have already been developed. Some examples of these are:


 * The Ruler Approach **focuses on five key emotional literacy skills of:


 *  Recognizing emotions in oneself and others
 *  Understanding the causes and consequences of emotions
 *  Labeling the full range of emotions using a rich vocabulary
 *  Expressing emotions appropriately in different contexts
 *  Regulating emotions effectively to foster healthy relationships andachieve goals




 * School Connect **is a forty-lesson curriculum based on increasing high school aged students social and emotional skills. It provides training and resources for teachers.


 * Making Meaning **is a program that incorporates social skills into the area of reading.

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Teacher education is an important element when working with students who have EBD. Cheney and Baringer (1995) conducted a study on teacher competence, student diversity, and staff training for the inclusion of middle school students with Emotional and Behavioral Disorders. In this study they found that teachers described themselves as having little to no competence when working with students who have Emotional and Behavioral Disturbances.
 * __Teacher Education__**

Training programs such as Life Space Crisis Intervention (LSCI) provide opportunities for teachers to become better prepared in dealing with students with emotional or behavior problems. This program uses interactive therapeutic strategies that teachers can use for turning crisis situations into learning opportunities when working with students who have EBD.

The Council for Children with Behavioral Disorders has a Professional Development Support Team that school districts can request professional development on working with students Emotional Behavioral Disorders.

Under IDEA Educators are responsible for conducting and implementing a Functional Assessment of Behavior (FAB) and a Behavior Intervention Plan (BIP).
 * __Requirements under IDEA__**

According to IDEA :

//The team must explore the need for strategies and support systems to address any behavior that may impede the learning of the child with the disability or the learning of his or her peers (614 (d)(3)(B)(i));//

//In response to certain disciplinary actions by school personnel, the IEP team must, within 10 days, meet to formulate a functional behavioral assessment plan to collect data for developing a behavior intervention plan, or if a behavior intervention plan already exists, the team must review and revise it (as necessary), to ensure that it addresses the behavior upon which disciplinary action is predicated (615(k)(1)(B)); and//

//States shall address the needs of in-service and pre-service personnel (including professionals and paraprofessionals who provide special education, general education, related services, or early intervention services) as they relate to developing and implementing positive intervention strategies (653(c)(3)(D)(vi)).//

** V. Fut **** ure Research in Emotional and Behavior Disorders **



[|The Handbook of Research in Emotional and Behavioral Disorders] is composed of research studies from 70 experts in the field. Students with EBD are more likely to drop out of school, receivepoorer grades, suffer with substance abuse, and mental health problems. According to the handbook empirical research is still needed to improve professionals knowledge of the various emotional and behavioral disorders. There is also a need for research in the particular needs of these students and best instructional practices for teachers.

The following areas have been considered important areas for continuous research.



There are currently many medications that are used in the treatment of children and adolescents with emotional behavioral disorders. The following chart shows some of the ongoing research in using different medications to treat various disorders.
 * Psychoactive Medication**


 * ** ONGOING PEDIATRIC STUDIES AT UBHC/RWJMS ** ||
 * DRUG || DISORDER || MANUFACTURER ||
 * Olanzapine (Zyprexa) || children and adolescents with bipolar disorder || Lilly Research Laboratories, Inc. ||
 * Olanzapine (Zyprexa) || children with severe emotional disturbance || Lilly Research Laboratories, Inc. ||
 * Citalopram (Celexa) || children and adolescents with depression || Forest Laboratories ||
 * Tomoxetine Hydrochloride || children ages 6 to 18 with depression || Lilly Research Laboratories, Inc. ||
 * Sertraline (Zoloft) || children and adolescents with major depressive disorder || Pfizer, Inc. ||
 * Paroxetine (Paxil) || multicenter, placebo-controlled study of children and adolescents with obsessive compulsive disorder || SmithKline Beecham Pharmaceuticals, Inc. ||
 * Venlafaxine (Effexor) || children with generalized anxiety disorder (GAD) || Wyeth-Ayerst Laboratories ||
 * Venlafaxine (Effexor) || children with social phobia || Wyeth-Ayerst Laboratories ||
 * Risperidone (Risperdal) || children with psychosis || Janssen Pharmaceutica ||
 * // PRINCIPAL INVESTIGATOR: ROBERT HENDREN, DO // ||

According to the National Network on Youth Transition for Behavioral Health (NNYT)  a “Successful transition into adulthood for youth include achievement of their potential and progressing on their personal goals in the transition domains of employment, education, living situation, personal effectiveness/wellbeing, and community life functioning (2009)” NNYT is an organization solely devoted to conducting research on transition programs for students with EBD.
 * Transition Programs**

The need for research in the assessment of students with EBD is an area of concern (Wehby et al., 2003). Due the behavior of these students they often fall below grade level. Continuous research in the area of Curriculum Based Assessment (CBA) with the use of direct instruction is being conducted.
 * Assessment and Instruction**

The use of Applied Behavioral Analysis with children and adolescents with emotional behavioral disorders is an area of current research. ABA is analyzing of behaviors in order to manipulate the environment and teach the correct behaviors and responses through repeated trials. This form of intervention is commonly used with children who have ASD, but has been used among children with other disorders.
 * ABA**

There is a need for more research in the areas collaboration between special education teams, child psychiatrists, and psychologists. Research on these collaborations related to student outcomes is important.
 * Professional Collaborations**


 * Resources **

Council for exceptional children Education.com Building the Legacy: IDEA 2004 Child & Adolescent Bipolar Foundation Council for Children with Behavioral Disorders @http://www.pacer.org/parent/php/PHP-c81.pdf

=== ** **Controversies surrounding Emotional Disorders ** ** === National Institute of Mental Health [|K12 America] The Hastings Center School Psychological FIles

** What this means for Teachers in Schools **
[|http://www.as.wvu.edu/~scidis/behavior.html] [|http://www.casel.org/downloads/SELACT_2009.pdf] [|http://www.therulerapproach.org/] [|**http://www.school-connect.net/curriculum.htm**] [] [|http://ebx.sagepub.com/content/3/3/174.abstract] [] [|http://www.ccbd.net/documents/bb/25-30FunctionalAssessment5.pdf]

[|http://www.ccbd.net/documents/bb/BB%2016(1)%20handbook%20of%20research.pdf]. [|http://nnyt.fmhi.usf.edu/] [|http://crins08lerberg.wmwikis.net/file/view/Wehby+et+al.pdf] [|http://www.ccbd.net/documents/bb/BB16(3)%20Payne.pdf]
 * Future Research in Emotional and Behavior Disorders **


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