Emotional+Disorders


 * Students with Emotional Disturbances**

A nice, crackling description of youth appears at the beginning of author Robert McCammon's 1991 novel Boy's Life: //"...we all start out knowing magic. We are born with whirlwinds, forest fires, and comets inside us..."// (2)//.// Unfortunately (as the novel later somewhat explores) events, people, substances, accidents can come into the lives of the young, impacting and sometimes destroying that magic.

As teachers, we will be spending a tremendous of time each day into each year with many students, some of whom will be dealing with experiences and emotional issues far beyond that of the "normal" experiences of many classmates of a similar age. Some of these students will show incredible resilience and a //lack// of emotional disturbances given their circumstances (note that //resilience// itself can be defined as "the absence of psychopathology or as a low level of sympoms" (Wicks-Nelson, R. & Israel, A.C., 2003, p.30)), others may find themselves unable to cope with a myriad of situational, environmental, (possible biochemical) and other psychological factors that can combine and contribute to emotional disturbances. While these students may "challenge our commitment to being inclusive teachers more than deeply than anything else (Peterson, MJ. & Hittie, MM., (2003), p.288).

Below is a //brief// overview of the emotional disturbances that we may encounter with children in our classrooms. Each of these "disorders" potentially have several cognitive, emotional, social, psychophysiological and environmental components. As teachers, we are not trained as psychiatric or psychological clinicians, social workers or counselors, yet it is in our classes where these children are likely to spend the greatest amount of their weekly time. These are followed by some suggestions for classroom support and support in the greater Winnipeg community.

What we can do when teaching students with emotional disturbances, is not only provide the care and energy to support and encourage these children and youths to follow their strengths and abilities, but also provide them with perhaps one of the few (if only) places that they potentially may feel safe and not under attack from the factors that may be contributing to their condition. We can walk the walk (and not just play lip service) of truly respecting them as people. Regardless of how difficult it may be, we can work both alone and with teams to give them the integrity that each student deserves, even to the ones who are constantly "disruptive", "aggressive", "off task" or "in their own world". We have a duty to look beyond the behavior, to examine what may //behind// or //underneath// the disturbance, and to then help the student find and hold on to something, whatever it is, that will get them back to learning. This does not just mean learning curriculum, but also learning that there is a way out of whatever psychological (and in some circumstances, physical) place that is causing the disturbances; to learn that there is hope and people who care about them, and that hope when combined with work leads to ways for them to start to create //their own// paths, away from whatever awful torment they are currently experiencing.


 * __Definition for Serious Emotional Disturbances__**:

Serious Emotional Disturbances are 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 a child's educational performance" and the following: a.) Inability to learn that can't be explained by intellectual, sensory or health factors b.) Inability to build and/or maintain interpersonal relationships with peer/teachers c.) Inappropriate behavior or feelings in normal circumstances and situations d.) A general mood of unhappiness and/or depression that is pervasive e.) Tendency to develop physical symptoms and/or fears with personal or school problems (Peterson, MJ. & Hittie, MM., (2003) //Inclusive Teaching: Creating Effective Schools for all Learners.//, Pg.300//)//

__**Emotional and Behavioral Disorders**:__

Emotional Disorders can be divided into two categories: //externalizing// and //internalizing//. Often students will demonstrate a co-occurrence of two or of these more disorders. Many of the following are not necessarily mutually exclusive and may not only influence one another but also exacerbate disturbances (Wicks-Nelson, R. & Israel, A.C., 2003, pp. 62, 121, 133, 137, 160, 187, 195, 197-202, 229-230, 356-357, 384-386)).
 * //Externalizing Disorders include the following://**
 * Attention Deficit Hyperactivity Disorder (ADHD)
 * Oppositional Defiance Disorder (ODD)
 * Conduct Disorder (CD)
 * Pervasive Developmental Disorder (PDD)


 * //Internalizing Disorders include the following://**
 * Substance abuse
 * Feeding & eating disorders
 * Anxiety & social withdrawn
 * Depression
 * Schizophrenia & psychosis

__**A brief //behavioral// overview of some of these disorders, to take note of in the classroom:**__

__**Oppositional Defiance Disorder**__ __**(ODD**__) is hostile behavior that lasts at least 6 months and has at least **//4//** of the following characteristics:


 * They will lose their temper
 * Argue with adults
 * Blame others
 * Defy adults
 * Deliberately annoy people
 * Be touchy, angry, resentful, and/or spiteful.

__**Conduct disorder**__ **(CD)** consists of persistent rule breaking, aggressive, defiance, fighting, bullying, disruptive, and problematic relationship with peers/adults. __**Substance abuse**__ for students with ED will inevitably lead to illegal acts resulting in the involvement of the juvenile justice system. __**Feeding/Eating disorders**__ consist of two categories: __**Anxiety & Social Withdrawn**__ disorder consists of the person having difficulty with situations that lead to anxiety (i.e. physical problems, worry, and the need lots of reassurance. __**Depression**__ is a growing problem for the young with characteristics such as extreme sadness, loneliness, apathy, and the avoidance of social contact. It can also lead to sleeping, eating, and elimination problems. Suicidal ideation (i.e. thoughts) and talk of suicide may also be present. Depression can turn outward leading to anger, irritability, upset, and the need to seek an emotional outlet. __**Schizophrenia/Psychosis**__ exists if two or more of the following symptoms are present: delusions, hallucinations, disorganized speech, disorganized catatonic behavior, inability to think logically or make decisions.
 * //Anorexia Nervosa// is the fear of gaining weight. Persistence will eventually lead to starvation.
 * //Bulimia// is a disorder that consists of eating binges and then induced vomiting. Results in depression, a withdrawn personality, and irritability.

In the United States, about 0.9 % of the student population is identified as emotionally disturbed (Oswald & Coutinho, 1995). Others believe that a more accurate figure would be 3 - 6% of the student population (Kauffman, 1997//).// Another study suggests that 62% of these 13 to 18 year olds were sexually abused (Brooks, 1985). Figures vary from state to state with Mississippi at 0.01 % and Minnesota as 2 % of students who have emotional disturbances (Cullinan, Epstein, & Sabornie, 1992; Office of Special Education Programs, 1999).
 * __Who has Emotional Disturbances?__**

Research also suggests that people with emotional disturbances are likely to be //(Cullinan, Epstein & Sabornie, 1992; Office of Special Education Programs, 1999**):**//
 * Male
 * African American
 * Economically disadvantaged
 * Secondary school (In 1996 3.5% of students with disabilities were labeled with ED at ages 6 -7 and 13% at ages 16 - 17)
 * Live with one parent or a foster parent or alternative living arrangements( Office of Special Education Programs, 1999).

-No direct biological causes -Some individuals have a greater risk to get ED -Effects of family, school and community experiences can be significant factors.
 * __Causes__**:

__**What are the stresses associated with ED?**__ Many things have been significantly associated with emotional disturbances and these include poverty, homelessness, family conflict, divorce, inconsistent child rearing practices, and sexual abuse. People with ED often learn by observing those who model aggressive behavior (including from teachers) (Kauffman, 1997, in Peterson & Hittie, 2003, p.303). Further, a recent study of Ontario investigations into child maltreatment found that, in 1993, 10 percent of investigations alleged emotional abuse ([|http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/html/fvemotion_e.html).]

Approximately 55% of students with ED drop out of school (Wagner, 1995, in in Peterson & Hittie, 2003, p.303). Black males from lower socioeconomic backgrounds tend to become the most segregated and least likely to get counseling and graduate (Osher & Osher, 1996, in Peterson & Hittie, 2003, p.303). Perhaps most telling about the potentially damaging consequences of students with emotion disturbances is what happens after they leave school: 73% of ED dropouts and 58% of the ED graduates are arrested within 5 years (Wagner, 1995; Wagner, Blackorby, Cameto, Hebbeler, & Newman, 1993, in Peterson & Hittie, 2003, p.303 ). Not only is the fact that this many students "fall through the cracks" a sobering statistic, but it also draws to attention the great pain and cost for not only the loved ones of these ex-students but also and the victims of these crimes and to society at large. As teachers, we have an opportunity each day to reach out to these students and provide them with emotional support and a safe environment to learn new ways to adapt and to get out of the downward cycle that many of them fall into.
 * __How well do they do?__**

** __**//Impact on Development//**__: Students dealing emotional disturbances often first require emotional support, before we as teachers can give them any educational support. Unfortunately, schools can //reinforce// the student’s problematic behaviour, and treatment itself can exacerbate their problems. As stated in the text, an ‘out of control child’ needs more trust and more love, //not// (likely more) medication, punishment or isolation. However, students with ED (emotional disturbances) usually receive: (Peterson & Huttie, Pg. 303) 1. Separation from other students and the larger community 2. Isolation and punishment 3. Medications (Lewis, TJ, Chard, D., & Schott, TM. (1994)//beavioral disorders, 277-293)// It is not surprising that these students’ difficulties are often //increased// by schools and organizations whose purpose is to help. As extreme aggression is often motivated by “futility and self hatred-inspired ultimately by feelings of worthlessness and humiliation.” (As the text states in both instances) (BregginP., & Ross-Breggin, G. (1994)//The war against children: How the drugs, programs and theories of the psychiatric establishment are threatening America's children with a medical "cure" for violence. New York: St. Martin's).// According to the text, when a school is set up for success and is prepared to take on the students with ED, they can be very successful. An example given was the Emily Dickenson School (P.S. 75) in New York, who decided to include students from a nearby education school who were labeled severely emotional disturbed. The administrators form the two schools blended resources to provide joint professional development resources and ongoing in-class supports, and this helped the school and students succeed. Adding to their difficulties was the fact that the school district had organized separate special education districts throughout the city (Peterson & Huttie, Pg. 310).
 * //__ Connections to Learning and Potential Education Implications: __//

//__**Impact on Learning**__//: In the past and still occurring today, schools have tended to focus on controlling students instead of building on student strengths, and shift students frequently form place to place. As stated previously, students with ED first need is emotional support, before they can receive educational support. The teachers need to build community in our classrooms, use engaging practices and collaborate with and support families. As teachers, we need to bring the National Agenda to life. (see below in the strategies) (Peterson & Huttie, Pg. 304). It is us the teachers that are ultimately responsible for implementing responsible inclusion.

**There are many strategies, services and supports for students with disabilities and ADHD that are directly applicable to students with ED. There are 12 characteristics, listed in the following area strategies, but can also relate to supports and services as well. (Peterson & Huttie, Pg. 304-311) __**//Strategies//**__ 1. //School-wide planning//: The schools want to develop a culture in which all staff share a common child-centered orientation, seeing every student as theirs and focusing on their strengths and needs. ( Peterson & Huttie, Pg. 304)
 * //__ Key Interventions: __//

2. //Problem solving//: This problem solving approach //rejects// punitive strategies, and focuses on positive strategies. No student is suspended or expelled, and they refer to this as a “Zero Reject Policy”. (Peterson & Huttie, Pg. 304)

3. //Clear Expectations and// //Proactive// //School// //wide Discipline Plan//: The schools state the expectations in positive terms, and communicate them in friendly ways. The students can role play the positive/negative behaviour at the beginning of the year for a better understanding. (Peterson & Huttie, Pg. 304)

4. //Social support structures and options:// Support structures are developed to provide assistance to students, teachers and parents. (Support teams) They can develop behaviour intervention and support plans for students with extremely problematic behaviours. Students need flexible options such as partial day programs as they work to re enter the school and cope with emotional difficulties. An example would be planning centers, cooling off time, academic assistance or just a quiet place to problem solve with an adult. (Peterson & Huttie, Pg. 305)

5. //Positive Learning Opportunities//: Instruction of Students with ED in active, student-centered, engaging instruction provides an opportunity for students to build on their strengths. We need to make our classrooms a place for engaging, fun and interesting activities (Peterson & Huttie, Pg. 305)

6. //Trust and Safely: Building Community and Providing Emotional Support:// A key strategy will be to use positive behavioural support strategies, “standing strong while treating the students with respect and trying to meet their needs. As teachers we want to encourage participation and involvement in group activities to strengthen their social connections". An example would be to let students deal with their emotional stress in different ways such as quiet time, group work, individual work and time in a study carrol. Another example would be to let students communicate their feelings through art, writing, or actions, even if they may be disturbing (These //allow// for self-expression, without making it mandatory) As teachers will do our best to help students develop and strengthen relationships and friendships: (Peterson & Huttie, Pg. 306) Teachers must give choices that will allow them to help structure their lives in the classroom (i.e. enable them to have more control)
 * -cooperative learning
 * -having students write about desires for relationships
 * -rope course and other outdoor adventure activities
 * -peer buddies
 * -circles of support
 * -provide guidance to other student who may want to help

7. //Skill Development: Academic and Social skills:// Students with ED must feel emotional support before academic (facilitators of learning). Dealing with students with ED is a critical part of a teacher’s job. Teachers need to identify which students’ social skills and abilities need improvement and provide learning opportunities as an integral part of the regular curriculum. Several curricula have been developed to help us teach students social skills by modeling such behaviours and having students act out such behaviours in simulations (i.e. social Skills Instruction) (Peterson & Huttie, Pg. 307).

8. //Positive behavioural supports:// Teachers must understand the __//student’s point of view//__ and should take it seriously and reach out seeking to establish a personal connection.

//**LISTEN—STATE ALOUD—RESPOND TO THEIR NEEDS.**// (Peterson & Huttie, Pg. 308)

9. //Professional Support//: This support consists of individual counselling, counselling groups, support groups in the school for special problems, such as divorcing parents) and tutoring. (Peterson & Huttie, Pg. 308-9)

10. //Collaboration with and support for Families:// “Wraparound services connect interagency teams, local informal community resources, neighbours and friends, who come together to provide intensive supports to families.” MAPS* teachers would also want to invite parents to our classroom so they can learn how to react more positively with their child. We want to invite them because often parents have received negative reports form schools and we must build strong relationships with them. As teachers, we may be directly involved in some supports such as in home parent training, support groups, in school parent centers and integrated social services in school. (Peterson & Huttie, Pg. 309). Note that it is critical that the family situation (such as physical or emotional abuse, neglect, socioeconomic issues and so on) be taken into account.


 * MAPS (Making Action Plans - a program to create a plan of action to help students deal with their stories, fears, wishes, strengths and needs).

11. //Supporting ourselves: Networking for Teachers:// The support for teachers may include behavioural consultation by specialist, a school support team, in-class collaboration with special education teachers and in-service training. Unfortunately, if this is not available…teachers must develop a support system ourselves, such as identifying teachers who may have some insight, collaborating with in-class support teachers, trusted counsellor or school psychologist. We can also identify and attend professional conferences. We must be very careful to maintain confidentiality(Peterson & Huttie, Pg. 309-10). This point is extremely important, as dealing with children and youths with emotional disturbances can be extremely demanding. To provide the best care and instruction to students, we must make sure that our own physical and emotional needs are being met so that we can truly offer our maximum to those students in need.

12. //How students with Emotional Disturbance can improve our class:// The students with ED bring importance of building community and honouring our skills for pro active and positive behavioural supports. Working with students with intense emotional challenges will provide the rest of the class with concrete, authentic experience in developing their own emotional and social skills-learning experiences that will be invaluable throughout their lives. (Peterson & Huttie, Pg. 311)

__**//Services//**__: In the past, and the present, services have been often fragmented or insufficient. In 1994, the US department of Education commissioned a group to develop a “**national agenda** for achieving better results for children and youth with serious emotional disturbance” to improve services for these students. These include (Peterson & Huttie, Pg. 304) In addition, the National agenda state that collaborate efforts must extend to initiatives that prevent emotional and behavioural problems form developing or escalation; services must be provided in culturally sensitive and respectful manner; and service must empower all stakeholders and must maintain a climate of hospitality and accountability (Peterson & Huttie, Pg. 304).
 * -Expanding positive learning opportunities and results
 * -strengthening school and community capacity
 * -valuing and address diversity
 * -collaborating with families
 * -promoting assessment of services
 * -providing ongoing skill development and support
 * -creating comprehensive and collaborate systems.

__**//Supports//**__ In the past and the present, supports for students with ED have been inadequate and often fragmented or insufficient. In the US, more than 50% are labeled and placed in segregated schools, classes or private or public psychiatric institutions (Peterson & Huttie, Pg. 303). Again, as stated previously a couple of times, support system must be in place BEFORE a successful inclusion can take place. In the schools that we currently work in, there are typically support teachers (i.e. resources teachers), education assistants, guidance counselors and the principle and vice principle that can support the teacher. If we need support, it is our responsibility to ask and seek it out.

The key is to develop collaborative and flexible supports through a partnership of professionals for agencies, friends, family and the overall community.

Many of these children are dealing with extreme psychological situations. We must be aware that it is their own //perception// of these situations that is often causing or adding to the behavioral issues, working in concert with the issues discussed above (such as social situations with friends and family, socioeconomic issues, emotional and/or physical abuse, sexual abuse, substance abuse, sleep disruption and so on) against the child's wellbeing. We can't control all these outside factors, but we //can//, to a large degree, control the atmosphere of our classrooms and our own acceptance, support, caring and encouragement of these children. We can offer them a safe place, while the rest of their world may be crumbling around them (emotionally or literally), for at least part of five days of each week, for them to explore their strengths and hopes and to help them find a way out.

Some Winnipeg agencies that exist to provide support to youth**:**


 * Winnipeg Child and Family Services:**
 * http://www.gov.mb.ca/fs/org/csd/wcfs.html**


 * Macdonald Youth Services** (providing several programs to help youth, including shelters):
 * http://mys.ca/**


 * Klinic Community Health Centre:** (including resources and professional help with crisis and trauma, sexual assault, domestic abuse, drop in counseling, suicide counseling, community outreach, Teen Klinic, education and training, prenatal and baby wellness, rural/farm help and several other programs) :
 * http://www.klinic.mb.ca/**


 * North End Women's Centre:**
 * http://www.newcinc.org/Top/centre.htm**


 * Winnipeg Health Science Centre Child Life Department** (helping children cope with hospital experiences):
 * http://www.hsc.mb.ca/placecard23.htm**


 * Winnipeg Health Science Centre Child Protection Centre:**
 * http://www.hsc.mb.ca/placecard16.htm**


 * Manitoba Family Services:**
 * http://www.gov.mb.ca/fs/

Manitoba Health Services For Children, Youth & Families: http://www.matc.ca/MATC_main.htm**


 * Winnipeg Regional Health Authority** (overview of health and social services):
 * http://www.wrha.mb.ca/community/wis/about_hss.php**


 * Manitoba Health Substance Use Services For Youth** (excellent web list of resources):
 * http://www.gov.mb.ca/health/mh/directory/youth.html**

http://ww.wsd1.org/childguidance/cgchome.htm**
 * Winnipeg School Division Child Guidance Clinic:


 * Manitoba Healthy Child:**
 * http://www.gov.mb.ca/healthychild/**

Art City** **(non-profit Broadway community drop in centre for children and youth to take part in art programming): http://www.artcityinc.com/**
 * Teen Talk Winnipeg Youth Resources**:
 * http://www.teen-talk.ca/YouthResources.htm

REFERENCES:**

Bromley, M. Children's Special Services. Discussion. Feb. 12, 2008.

McCammon,R. //Boy's Life.// (1991). Pocket Books. New York, NY. USA.

Peterson, J.M. & Hittie, M.M. (2003). //Inclusive Teaching//. Pearson Education, Inc. USA.

Wicks-Nelson, R. & Israel,A.C. (2003). //Behavior Disorders of Children. 5th Ed.// Pearson Education, Inc. New Jersey, USA.

http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/html/fvemotion_e.html Retrieved on Feb.13, 2008. Last updated March 3, 2006.