Transcript Serious Emotional Disturbance and Autism Chapter 22

Serious Emotional Disturbance
and Autism
Chapter 22
Introduction
• Many social problems place individuals at
risk for serious emotional disturbance
• Statistics vary across socioeconomic level,
ethnic group, cultural background, family
structure, and neighborhood
• Behavior is caused by a multitude of factors
Prevalence of Serious Emotional
Disorder
• Varies widely because of differing
definitions and criteria
• 2 to 22% of school population
• Higher rate in boys
• 7 to 8% require special education services
Prevalence of Serious Emotional
Disorder
• Associated concerns
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Suicide
Delinquency
Developmental disabilities
Dual diagnosis
Violence and abuse
Definitions of Serious Emotional
Disturbance
• Federal Law Terminology
– Determines eligibility for special education
services
• CEC Terminology
– Behavior disorders
Definitions of Serious Emotional
Disturbance
• APA Terminology - DSM-IV-TR
– Definitive source of knowledge about mental
disorders
– Terminology
– Diagnostic features
– Prevalence
– Course
Classic DSM Mental Disorders
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Substance-related disorders
Schizophrenia and other psychotic disorders
Mood disorders
Anxiety disorders
Dementia
Eating disorders
Substance-Related Disorders
• Abuse or dependence on substance
• Results in behavioral changes that
negatively affect various aspects of life
• Legal or illegal
• Prescribed or open market
• Toxic substances
• Inability to reduce or stop use and episodes
of overuse
Schizophrenia
• A psychotic disturbance that lasts for at
least 6 months and includes at least 1 month
of two or more of the following
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Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
Other Psychotic Disorders
• Manifestation of delusions, hallucinations or
serious symptoms that grossly interfere with daily
life, but do not meet the criteria for Schizophrenia
or other mental disorders
• Managed by daily medication
• Acute episodes during active phase
• Tardive dyskinesia - motor abnormality
Mood Disorders
• Unipolar - usually episodes of extreme
depression
• Bipolar - mood shifts from mania to
depression and vice versa
• Associated with ADHD in children
• Persons may deny they have a problem and
refuse to take medication
Anxiety Disorders
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Conditions of excessive worry and unease
Treated with medication and counseling
Panic attacks
Panic disorder
Phobias
Obsessive-compulsive disorders
Dementia
• Multiple cognitive deficits that are a significant
change from previous level of functioning
• Attributed to medical condition, aging, and/or a
substance
• Alzheimer’s disease
• Head trauma
• Parkinson’s disease
• HIV
• Long-term substance abuse
Eating Disorders
• A gross disturbance in eating behavior
• Generally manifests in adolescence
• Anorexia nervosa
- Amenorrhea
• Bulimia
– Recurrent episodes of binge eating
Impact of Adult Mental Disorders
on Children
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Change in child-rearing
Change in emotional climate at home
Creates anxiety in children
Genetic predisposition
DSM Disorders in Children and
Adolescents
• Conduct disorder
• Oppositional defiant disorder
• Tic disorders and Tourette’s disorder
Conduct Disorder
• Pattern of persistent and repetitive
behaviors that violate the basic rights of
others and/or major age-appropriate societal
norms or rules
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Aggressive conduct
Destruction of property
Deceitfulness
Serious violations of major rules
Oppositional Defiant Disorder
• Recurrent pattern of hostile and disobedient
behavior toward authority figures
• Various behaviors such as losing one’s
temper, arguing with adults, deliberately
annoying others, blaming others, etc.
• Disruptive behaviors tend to be less serious
than in conduct disorder
Tic Disorders and Tourette’s
Disorder
• Tics - uncontrollable motor movement or
vocalization
– Variety of different tics
• Tourette’s - genetic tic disorder
– May have associated mental disorders
– Tics diminish while engaging in rhythmic
activities
– Average or better intelligence
Stereotypic Movement Disorders
• Repetitive, seemingly driven, nonfunctional
motor behaviors that interfere with normal
activities or result in self-inflicted injury
• Coexist with other conditions
• Self-injurious behaviors associated with
severe mental retardation
• Major problem is social acceptance
Treatment of Serious Emotional
Disturbance
• Medication
• Psychotherapy and/or counseling
• Cooperative home-school-community
intervention programs
• During acute phases the individual may not
be attending school
Medication (Drug Therapy or
Pharmacotherapy)
• Four categories of drugs commonly used
• Understanding of side effects and support of
individuals
• Bipolar drugs - high risk of serious side
effects
• Exercise may alter effects of medication
Psychotherapy and Counseling
• Psychotherapy - combined use of drugs and
other helping techniques
– Dance therapy is one form
• Counseling - interactive verbal
communication by individual trained in
counseling
• Peer counseling, small-group sharing, and
support networks may be beneficial
Cooperative Home-SchoolCommunity Programs
• Challenges in providing support
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Assessing problem behaviors
Incorporating structure in routine
Enhancing communication
Expanding relationships
Increasing choice-making
Reducing stress
Exercise and Serious Emotional
Disturbance
• Reduction of depression, anger, disruptive
behaviors, and stereotypies
• Intervention guidelines include enjoyable,
aerobic, noncompetitive, nonthreatening,
moderate intensity for 20-30 minutes, and
used 2 to 3 times per day
• Utilize music of individual’s choice
Adapting the Public School
Program
• May be assigned to separate adapted
physical education instruction
• Class size no larger than 12 students
• Paraprofessionals assigned to students
• In general classes peer counselors or
partners should be assigned
General Guidelines for
Conducting Class
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Display appropriate authority
Explain class goals and routines
Meet individually with each student
Keep class rules simple
Clearly explain consequences
Involve students in setting consequences
Demonstrate consistency
Use visual cues
Constantly check understanding
Juveniles Who are Incarcerated
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High incidence of arrests
Few special education services
Utilize sport for socialization and transition
Recreational offerings and facilities vary
State curriculum guides
Applied Behavior Analysis (ABA)
Principles
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Target specific behaviors
Observe, chart, and analyze behaviors
Select and apply specific strategies
Select and apply appropriate consequences
Periodically evaluate progress
Transitions From Activity to
Activity in the Gym
• Transitions may be difficult
• Using stations may be contraindicated
• Structure transitions from one part of the
lesson to the next
• Use more time on each activity
• Specific instructions for formations may be
needed
Ecological Pedagogy and
Specific Conditions
• Matching content with student interests and
needs
• Provide choices to students
• Utilize small class sizes
• Provide the necessary supports
• Requirements become part of the IEP
Strategies for Schizophrenia
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Do not respond well to firm discipline
Seem out of contact with reality
Criticism can elicit destructive behavior
Combine friendliness and warmth with
consistent enforcement of limits
• Physical restraint may be necessary
Strategies for Anger and
Aggression
• Guidelines for schizophrenia apply
• Adult and peer counseling to help identify
the source of anger and learn to avoid it
• Talking-bench strategy
• Express hostility in socially acceptable
ways
• Students taught coping skills
Strategies for Depression and
Withdrawal
• Need to be kept active but often refuse to
participate
• Display a rough, noncommittal exterior
• Mirror or restate thoughts rather than
contradict
• Will follow instructions but may need to be
taken by the hand to participate
Strategies for Anxiety, Fear, and
Withdrawal
• Should not force participation
• Desensitization - planned progression of
activities to gradually reduce fear reactions
• Improving situation-specific self-confidence
Aquatics and Individuals With
SED
• Recommended for individuals who
demonstrate overanxious, aggressive, and
hyperactive behaviors
• Warm temperatures provide relaxing effect
• Increases in self-image and self-confidence
• Learn social skills and make friends
Behavior and Disciplinary
Placement Change
• Behavioral intervention plan (BIP)
• Functional behavioral assessment determine the function of behavior
– To obtain or maintain something desirable
– To escape from or avoid something undesirable
• Manifestation determination - determine
that the inappropriate behavior was not
caused by the student’s disability
Pervasive Developmental Disorders
or Autism Spectrum Disorder
• Diagnostic category for severe impairment
in reciprocal social interaction or
communication skills and/or the presence of
stereotyped behavior, interests, and
activities
– Autism
– Asperger’s disorder
– Rett’s disorder
Types of Pervasive
Developmental Disorders
• Typical development initially
• Delays or abnormal function become
pervasive and affect all aspects of life
• Specific diagnosis is difficult
• Autism continuum or spectrum
Types of Pervasive
Developmental Disorders
• Autistic disorder
– Impaired functioning in social interaction,
language as used in social communication,
imaginative or social imitative play, and
repetitive, stereotyped patterns of behavior
– Self-absorption and withdrawal
– Associated with other disabilities and lower IQs
– Intellectual assessment may not be accurate
Types of Pervasive
Developmental Disorders
• Asperger’s disorder
– Severe and sustained impairment in social
interaction, coupled with repetitive, stereotyped
patterns of behavior, that seriously impacts
function
– No significant delays in language, cognitive
function, self-help skills, adaptive behaviors
(except for social interaction), or curiosity
about the environment
– Clumsiness
Types of Pervasive
Developmental Disorders
• Rett’s disorder
– Affects only females
– Severe degenerative condition diagnosed by
deceleration of head growth, loss of previously
acquired hand skills, loss of interest in the
social environment, appearance of stereotyped
handwringing movements and gait and
coordination problems, and subsequent
development of severe impairment in language
and psychomotor function
Incidence of Pervasive
Developmental Disorders
• Autism - 15 in 10,000 births
– More common in males than females
• Asperger’s - 3 in 10,000 births
• Rett’s - 1 in 10,000 female births
Autism and the Federal Law
• Considered emotional disturbance until
1981
• 1990 reclassified as a separate category
• Category encompasses all forms of PDD
Causes of Autism
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Neurobiological and genetic
No specific gene - but often affects siblings
Family history of other disabilities
Appears to be acquired and linked to
childhood diseases, metabolic problems,
and brain injury but the link is not well
understood
Savantism and Autism
• Ability to perform skills at exceptional
levels without the benefit of instruction or
practice
• Appear at an early age
• Incidence in autism is 10%
• Lack understanding of what they are doing
Illustrative People with Autism
• One-third of people with autism live and
work fairly independently by adulthood
while the rest remain severely disabled
• Dr. Temple Grandin - associate professor
• Raun Kaufman - graduate of Brown
University
Intervention Programs
• Kaufman’s parents established a training
center for parents of children with autism
– Emphasizes a psychotherapy approach
• Acceptance and imitation of behaviors until the
child gives them up or replaces them
• Presence of an adult 24-hours per day
Intervention Programs
• Ivar Lovaas
– Behavior management curriculum
– Used in many public schools
– Follows classic behavior management
principles
– Emphasizes direct compliance
Intervention Programs
• TEACCH
– Uses a cognitive approach that manages
behavior by addressing it indirectly
– Visual approach based on the skills, interests,
and needs of individuals
– Key areas of instruction are functional skills,
communication, and social and leisure skills
that will enhance community integration
Intervention Programs
• REACCH
– Therapeutic riding program
– Follow same schedule at the stable as at school
– Improvement in most areas of sensory
processing and their reactions to the
environment around them after riding
Intervention Programs
• Daily Life Therapy
– Provide individuals with a systematic education
through meaningful and real life experiences
within a controlled environment
– Develop ability to be close to peers, physically,
emotionally, socially, and intellectually to
achieve social independence and dignity
Parent Involvement Programs
• Need for comprehensive, structured
programming across all environments all 52
weeks of the year
• Services now written into the IEP or IFSP
– In-home training
– Parent training
– Extended, school day, year-round services
Motor Clumsiness and
Generalization Problems in Autism
• Motor clumsiness is typical with autism
• Motor clumsiness and motor incoordination
• Assessment may be misleading
– Unresponsive to test directions
– Can actually perform better than scores indicate
• Perform assessment in informal settings
• Focus goals on functional motor competence
Autistic Behaviors and Pedagogy
• Social interaction and social learning impairments
• Language and speech impairments
• Difficulty thinking in words and responding
appropriately
• Motor planning and executive control problems
• Unusual responses to sensory input, including
stimming
• Pathological resistance to change
• Stimulus overselectivity and attention problems
Social Interaction and Social
Learning Impairments
• Learning appropriate nonverbal social behaviors
• Seldom learn through imitation and listening to
instructions or advice
• Functionally deaf
• Tactile defensiveness
• Insistence on eye contact
• Wanders aimlessly in the gym
• Emphasis on personally meaningful reinforcers
• Partners or buddies need special training
Language and Speech
Impairments
• About 50% learn to talk and use language more or
less appropriately
• Use stereotyped and repetitive phrases
• Pronominal reversal - avoidance of “I”
• Utilize behavior management plan
• Speech used to talk to self not others
• Social interaction impairment affects ability to
initiate and sustain meaningful conversations
Difficulty Thinking in Words and
Responding Appropriately
• Difficulty processing auditory input
• Visual thinkers
• Pictures are first language and words are
second language
• Utilize visualization skills as strengths to
help master content
• Demonstrations more helpful than verbal
directions
Motor Planning and Executive
Control Problems
• Motor planning, sequencing, and other
aspects of executive control are weak
• Verbal working memory is limited
• Utilize memory games
• Imitation should progress from single
movement to increasingly longer sequences
• Self-talk, verbal rehearsal, and visualization
activities should be used
Unusual Responses to Sensory
Input, Including Stimming
• Unaware of stimuli or exaggerated
responses are typical
• Some sound stimuli may be painful
• Visual stimuli may result in stimming
• Organization and synthesis of excessive
visual input
• Tactile defensive
Pathological Resistance to
Change
• Emotional outbursts may occur
• Utilize a hierarchy of prompts and
reinforcements
• Physical guidance - if not tactile defensive
• Verbal/visual and verbal/physical teaching
models can also be beneficial
• Transitions may be contraindicated
Stimulus Overselectivity and
Attention Problems
• Abnormally limited attentional scope
• Inability to select relevant cues
• Cues matched to a student’s specific
assessed needs
• Extrastimulus prompts
• Within-stimulus prompts
Summary of Teaching Suggestions
• Teach to the preferred modality and learning styles
• Minimize unnecessary external stimuli
• Limit the amount of relevant stimuli presented at
one time
• Limit the use of prompts (some disagreement)
• Teach in a community-based gamelike environment
to facilitate generalization
• Avoid change in routines
• Provide a variety of activities that focus on the same
goals
Special Olympics and Community
Sports
• Individuals with IQs under 70 can benefit from
programming similar to that for mental retardation
including Special Olympics
• Preoccupation with sameness is a strength in
fitness and sport training
• Models of schedule adherence and hard work
• Programs support transition to independent use of
community sport and fitness facilities