Title: Serious Emotional Disturbance and Autism
1Serious Emotional Disturbance and Autism
2Introduction
- 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
3Prevalence 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
4Prevalence of Serious Emotional Disorder
- Associated concerns
- Suicide
- Delinquency
- Developmental disabilities
- Dual diagnosis
- Violence and abuse
5Definitions of Serious Emotional Disturbance
- Federal Law Terminology
- Determines eligibility for special education
services - CEC Terminology
- Behavior disorders
6Definitions of Serious Emotional Disturbance
- APA Terminology - DSM-IV-TR
- Definitive source of knowledge about mental
disorders - Terminology
- Diagnostic features
- Prevalence
- Course
7Classic DSM Mental Disorders
- Substance-related disorders
- Schizophrenia and other psychotic disorders
- Mood disorders
- Anxiety disorders
- Dementia
- Eating disorders
8Substance-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
9Schizophrenia
- A psychotic disturbance that lasts for at least 6
months and includes at least 1 month of two or
more of the following - Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
10Other 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
11Mood 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
12Anxiety Disorders
- Conditions of excessive worry and unease
- Treated with medication and counseling
- Panic attacks
- Panic disorder
- Phobias
- Obsessive-compulsive disorders
13Dementia
- Multiple cognitive deficits that are a
significant change from previous level of
functioning - Attributed to medical condition, aging, and/or a
substance - Alzheimers disease
- Head trauma
- Parkinsons disease
- HIV
- Long-term substance abuse
14Eating Disorders
- A gross disturbance in eating behavior
- Generally manifests in adolescence
- Anorexia nervosa
- - Amenorrhea
- Bulimia
- Recurrent episodes of binge eating
15Impact of Adult Mental Disorders on Children
- Change in child-rearing
- Change in emotional climate at home
- Creates anxiety in children
- Genetic predisposition
16DSM Disorders in Children and Adolescents
- Conduct disorder
- Oppositional defiant disorder
- Tic disorders and Tourettes disorder
17Conduct Disorder
- Pattern of persistent and repetitive behaviors
that violate the basic rights of others and/or
major age-appropriate societal norms or rules - Aggressive conduct
- Destruction of property
- Deceitfulness
- Serious violations of major rules
18Oppositional Defiant Disorder
- Recurrent pattern of hostile and disobedient
behavior toward authority figures - Various behaviors such as losing ones temper,
arguing with adults, deliberately annoying
others, blaming others, etc. - Disruptive behaviors tend to be less serious than
in conduct disorder
19Tic Disorders and Tourettes Disorder
- Tics - uncontrollable motor movement or
vocalization - Variety of different tics
- Tourettes - genetic tic disorder
- May have associated mental disorders
- Tics diminish while engaging in rhythmic
activities - Average or better intelligence
20Stereotypic 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
21Treatment 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
22Medication (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
23Psychotherapy 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
24Cooperative Home-School-Community Programs
- Challenges in providing support
- Assessing problem behaviors
- Incorporating structure in routine
- Enhancing communication
- Expanding relationships
- Increasing choice-making
- Reducing stress
25Exercise 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 individuals choice
26Adapting 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
27General Guidelines for Conducting Class
- 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
28Juveniles Who are Incarcerated
- High incidence of arrests
- Few special education services
- Utilize sport for socialization and transition
- Recreational offerings and facilities vary
- State curriculum guides
29Applied Behavior Analysis (ABA) Principles
- Target specific behaviors
- Observe, chart, and analyze behaviors
- Select and apply specific strategies
- Select and apply appropriate consequences
- Periodically evaluate progress
30Transitions 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
31Ecological 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
32Strategies for Schizophrenia
- 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
33Strategies 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
34Strategies 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
35Strategies for Anxiety, Fear, and Withdrawal
- Should not force participation
- Desensitization - planned progression of
activities to gradually reduce fear reactions - Improving situation-specific self-confidence
36Aquatics 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
37Behavior 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
students disability
38Pervasive 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
- Aspergers disorder
- Retts disorder
39Types 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
40Types 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
41Types of Pervasive Developmental Disorders
- Aspergers 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
42Types of Pervasive Developmental Disorders
- Retts 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
43Incidence of Pervasive Developmental Disorders
- Autism - 15 in 10,000 births
- More common in males than females
- Aspergers - 3 in 10,000 births
- Retts - 1 in 10,000 female births
44Autism and the Federal Law
- Considered emotional disturbance until 1981
- 1990 reclassified as a separate category
- Category encompasses all forms of PDD
45Causes of Autism
- 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
46Savantism 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
47Illustrative 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
48Intervention Programs
- Kaufmans 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
49Intervention Programs
- Ivar Lovaas
- Behavior management curriculum
- Used in many public schools
- Follows classic behavior management principles
- Emphasizes direct compliance
50Intervention 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
51Intervention 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
52Intervention 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
53Parent 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
54Motor 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
55Autistic 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
56Social 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
57Language 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
58Difficulty 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
59Motor 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
60Unusual 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
61Pathological 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
62Stimulus Overselectivity and Attention Problems
- Abnormally limited attentional scope
- Inability to select relevant cues
- Cues matched to a students specific assessed
needs - Extrastimulus prompts
- Within-stimulus prompts
63Summary 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
64Special 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