The following section is adapted from: Center for Parent Information and Resoures, 2017), Emotional Disturbance. Retrieved 4.1.19 from https://www.parentcenterhub.org/emotionaldisturbance/  public domain

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.  (National Institute of Mental Health (NIMH), 2010).

We refer to mental disorders using different “umbrella” terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

• anxiety disorders;
• bipolar disorder (sometimes called manic-depression);
• conduct disorders;
• eating disorders;
• obsessive-compulsive disorder (OCD); and
• psychotic disorders.

(Center for Parent Information and Resoures, 2017),

Etiology

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

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.

Characteristics

Some of the general characteristics and behaviors seen in children who have an emotional disturbance include:

• Hyperactivity (short attention span, impulsiveness);
• Aggression or self-injurious behavior (acting out, fighting);
• Withdrawal (not interacting socially with others, excessive fear or anxiety);
• Immaturity (inappropriate crying, temper tantrums, poor coping skills); and
• Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

(Center for Parent Information and Resoures, 2017),

Internalizing and Externalizing Behavior

Students with EBD are a diverse population with a wide range of intellectual and academic abilities. Males, African-Americans, and economically disadvantaged students are over-represented in the EBD population, and students with EBD are more likely to live in single-parent homes, foster homes, or other non-traditional living situations. These students also tend to have low rates of positive social interactions with peers in educational contexts. Students with EBD are often categorized as “internalizers” (e.g., have poor self-esteem, or are diagnosed with an anxiety disorder or mood disorder) or “externalizers” (e.g., disrupt classroom instruction, or are diagnosed with disruptive behavior disorders such as oppositional defiant disorder and conduct disorder). Male students may be over-represented in the EBD population because they appear to be more likely to exhibit disruptive externalizing behavior that interferes with classroom instruction. Females may be more likely to exhibit internalizing behavior that does not interfere with classroom instruction, though to what extent this perception is due to social expectations of differences in male and female behavior is unclear. In any case, it is important to note that both internalizing and externalizing behaviors can and do occur in either sex;  Students with EBD are also at an increased risk for learning disabilities, school dropout, substance abuse, and juvenile delinquency.

A person with EBD with “internalizing” behavior may have poor self-esteem, suffer from depression, experience loss of interest in social, academic, and other life activities, and may exhibit non-suicidal self-injury or substance abuse. Students with internalizing behavior may also have a diagnosis of separation anxiety or another anxiety disorder, post-traumatic stress disorder (PTSD), specific or social phobia, obsessive–compulsive disorder (OCD), panic disorder, and/or an eating disorder. Teachers are more likely to write referrals for students that are overly disruptive. Screening tools used to detect students with high levels of “internalizing” behavior are not sensitive and are rarely used in practice. Students with EBD with “externalizing” behavior may be aggressive, non-compliant, extroverted, or disruptive.

Students with EBD that show externalizing behavior are often diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, and/or bipolar disorder; however, this population can also include typically developing children that have learned to exhibit externalizing behavior for various reasons (e.g., escape from academic demands or access to attention). These students often have difficulty inhibiting emotional responses resulting from anger, frustration, and disappointment. Students who “externalize” exhibit behaviors such as insulting, provoking, threatening, bullying, cursing, and fighting, along with other forms of aggression. Male students with EBD exhibit externalizing behavior more often than their female counterparts.

(Wikipedia, n.d.)

Characteristics of some of the most common Emotional Disturbances

 Anxiety Disorders

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

The term “anxiety disorder” is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias.

According to the Anxiety Disorders Association of America,  anxiety disorders are the most common psychiatric illnesses affecting children and adults.   They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment.

Bipolar Disorder

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood.

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment.

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. (14)  This may include some of the following behaviors:

• aggression to people and animals;
• destruction of property;
• deceitfulness, lying, or stealing; or
• truancy or other serious violations of rules.

Treatment will depend on the child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

• helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what’s known as cognitive-behavioral therapy);
• family therapy;
• peer group therapy (to help better social and interpersonal skills); and
• medications (although these are not typically used to treat conduct disorder).

Eating Disorders

Eating disorders are characterized by extremes in eating behavior—either too much or too little—or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to  develop an eating disorder.

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening.

Binge eating is also considered an eating disorder. It’s characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives.

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder… Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder.

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away.  Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain.  Treatment for most people with OCD should include one or more of the following:

• A therapist trained in behavior therapy;
• Cognitive Behavior Therapy (CBT);
• Medication (usually an antidepressant).

Psychotic Disorders

“Psychotic disorders” is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder.  There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling)

(Center for Parent Information and Resoures, 2017),

Universal Design for Learning UDL

The following section is an excerpt from: Educational Psychology. Authored by: Kevin Seifert and Rosemary Sutton. Located at:https://open.umn.edu/opentextbooks/textbooks/153 . License: CC BY: Attribution

Because of the potentially disruptive effects of behavioral disorders,  students with emotional behavior disorders are of special concern to teachers. Just one student who is highly aggressive or disruptive can interfere with the functioning of an entire class, and challenge even the best teacher’s management skills and patience.

General Strategies for teaching students with behavioral disorders

The most common challenges of teaching students with behavioral disorders have to do with classroom management. Three important ideas discussed there, however, also deserve special emphasis here: (1) identifying circumstances that trigger inappropriate behaviors, (2) teaching of interpersonal skills explicitly, and (3) disciplining a student fairly.

Identifying the circumstances that trigger inappropriate behaviors

Dealing with a disruption is more effective if you can identify the specific circumstances or event that triggers it, rather than focusing on the personality of the student doing the disrupting. A wide variety of factors can trigger inappropriate behavior (Heineman, Dunlap, & Kincaid, 2005):

• physiological effects—including illness, fatigue, hunger, or side-effects from medications
• physical features of the classroom—such as the classroom being too warm or too cold, the chairs being exceptionally uncomfortable for sitting, or seating patterns that interfere with hearing or seeing
• instructional choices or strategies that frustrate learning—including restricting students’ choices unduly, giving instructions that are unclear, choosing activities that are too difficult or too long, or preventing students from asking questions when they need help

By identifying the specific variables often associated with disruptive behaviors, it is easier to devise ways to prevent the behaviors, either by avoiding the triggers if this is possible, or by teaching the student alternative but quite specific ways of responding to the triggering circumstance.

Teaching interpersonal skills explicitly

Because of their history and behavior, some students with behavior disorders have had little opportunity to learn appropriate social skills. Simple courtesies (like remembering to say please or thanks) may not be totally unknown, but may be unpracticed and seem unimportant to the student, as might body language (like eye contact or sitting up to listen to a teacher rather than slouching and looking away). These skills can be taught in ways that do not make them part of punishment, make them seem “preachy”, or put a student to shame in front of classmates. Depending on the age or grade-level of the class, one way is by reading or assigning books and stories in which the characters model good social skills. Another is through games that require courteous language to succeed; one that I recall from my own school days, for example, was called “Mother, May I?” (Sullivan & Strang, 2002). Still another is through programs that link an older student or adult from the community as a partner to the student at risk for behavior problems; a prominent example of such a program in the United States is Big Brothers Big Sisters of America, which arranges for older individuals to act as mentors for younger boys and girls (Tierney, Grossman, & Resch, 1995; Newburn & Shiner, 2006).

In addition, strategies based on behaviorist theory have proved effective for many students, especially if the student needs opportunities simply to practice social skills that he has learned only recently and may still feel awkward or self-conscious in using (Algozzine & Ysseldyke, 2006). Several behaviorist techniques, including the use of positive reinforcement, extinction, generalization, and the like. In addition to these, teachers can arrange for contingency contracts, which are agreements between the teacher and a student about exactly what work the student will do, how it will be rewarded, and what the consequences will be if the agreement is not fulfilled (Wilkinson, 2003). An advantage of all such behaviorist techniques is their precision and clarity: there is little room for misunderstanding about just what your expectations are as the teacher. The precision and clarity, in turn, make it less tempting or necessary for you, as a teacher, to become angry about infractions of rules or a student’s failure to fulfill contracts or agreements, since the consequences tend already to be relatively obvious and clear. “Keeping your cool” can be especially helpful when dealing with behavior that is by nature annoying or disrupting.

Fairness in disciplining

Many strategies for helping a student with a behavior disorder may be spelled out in the student’s individual educational plan. The plan can (and indeed is supposed to) serve as a guide in devising daily activities and approaches with the student. Keep in mind, however, that since an IEP is akin to a legal agreement among a teacher, other professionals, a student and the student’s parents, departures from it should be made only cautiously and carefully, if ever. Although such departures may seem unlikely, a student with a behavior disorder may sometimes be exasperating enough to make it tempting to use stronger or more sweeping punishments than usual (for example, isolating a student for extended times). In case you are tempted in this direction, remember that every IEP also guarantees the student and the student’s parent’s due process before an IEP can be changed. In practice this means consulting with everyone involved in the case—especially parents, other specialists, and the student himself—and reaching an agreement before adopting new strategies that differ significantly from the past.

Instead of “increasing the volume” of punishments, a better approach is to keep careful records of the student’s behavior and your own responses to it, documenting the reasonableness of your rules or responses to any major disruptions. By having the records, collaboration with parents and other professionals can be more productive and fair-minded, and increase others’ confidence in your judgments about what the student needs in order to fit in more comfortably with the class. In the long term, more effective collaboration leads both to better support and to more learning for the student (as well as to better support for you as a teacher!).

(Seifert and Sutton, 2009)

Assistive Technology

Research AT that supports self-management and self-regulation. This includes, awareness of one’s behavior, monitoring ones’ actions and feelings and the ability to make desired changes.

More about School & Related Service

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem.  A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (Learn more about PBIS at https://www.pbis.org/ )

For a child whose behavior impedes learning (including the learning of others), the team developing the child’s Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It’s important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

(Center for Parent Information and Resources, 2017)

Supplementary Resources

Hanover Research. (n.d.). Behavioral Support Checklists: Internalizing Behavior. Washington Association of School Administrators (WASA).

Hanover Research, (2013). Effective Programs for Emotional Behavioral Disorders from http://psych.hsd.ca/Effective%20Programs%20for%20EBDs.pdf

McRaney, K, Bridley, A, and Daffin, L. (2019). Behavioral Disorders in Children, CC NC SA, 4.0, https://opentext.wsu.edu/behavioral-disorders-childhood/

NASET (n.d.) Eligibility Criteria Checklist for a Classification of Emotional Disturbance North Dakota Dept. of Public Education, (2016)

North Dakota Dept of Public Instruction (2016) Guidelines for Serving Students with Emotional Disturbance in Educational Settings. From https://files.eric.ed.gov/fulltext/ED594653.pdf  comprehensive guidebook.

References

Center for Parent Information and Resoures, 2017), Emotional Disturbance. Retrieved 4.1.19 from https://www.parentcenterhub.org/emotionaldisturbance/  public domain

Kevin Seifert and Rosemary Sutton. Located at:https://open.umn.edu/opentextbooks/textbooks/153 . License: CC BY: Attribution

Wikipedia (n.d.) Emotional and Behavioral Disorders from https://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders

Updated 6/16/23