Characteristics of Disabilities
n Anxiety and Depression
n Autism
n
ADHD and
Conduct Disorder
Emotional,
Social, and Behavioral Disabilities in Today’s Classroom n
Special
Education Eligibility
n Planning and Placement
Summary
Key Concepts Case Studies: Reflect and Evaluate
Applications: Interventions
n Types of Interventions
n Effectiveness of Interventions
1.
Describe how
students with emotional, social, and behavioral disabilities are
identified and served under IDEIA and Section 504.
2. Explain how anxiety and depression affect students’ academic and social functioning.
3.
Describe the
characteristics of autism, and explain how these affect academic and
social functioning.
4.
Explain how ADHD
and conduct disorder affect students’ academic and social
functioning.
5. Describe interventions that are effective in treating anxiety, depression, autism, and ADHD.
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Module 25 :
Emotional, Social, and Behavioral Disabilities
Students with emotional, social, or behavioral disabilities face unique problems that interfere with their academic progress (Epstein, Kinder, & Bursuck, 1989; Kauffman, 2001). Their problems are distinct from those of students with cognitive disabilities—intellectual disabilities (formerly referred to as mental retardation) and specific learning disabilities. Students with emotional, social, communicative, or behavioral problems are likely to have poor peer relationships, poor classroom interactions, and low academic performance. They are students with anxiety, depression, autism, attention-deficit/ hyperactivity disorder (ADHD), and conduct disorders, and they represent a heterogeneous category of students who receive special education services under federal law.
Consider
Figure 25.1, which shows the percentage of K–12 students receiving
special education under the Individuals
with Disabilities Education Improvement Act of 2004
(IDEIA),
a federal law that provides special education funding for 13
categories of disability. Autism, represented in the category labeled
“Other disabilities combined,” occurs in about 2.3% of school-age
children and adolescents. While autism is its own IDEIA category,
albeit a small one, ADHD does not have its own category. Students
with ADHD who meet eligibility criteria for special education (which
is not always the case, as we’ll discuss later) may qualify under
the “Other health impairments” category or the “Emotional
disturbance” category. Students with anxiety, depression, severe
aggression, and conduct disorder also are represented in the
“Emotional disturbance” category. 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; or
E.
A tendency to develop physical symptoms or fears associated with
personal or school problems” [Code of Federal Regulations, Title
34, Section 300.7(c)(4) (i)]
Teachers refer students for special education evaluation, serve on committees to determine the eligibility of students for special education, and implement behavioral and curricular modifications to address the unique problems of these students in the classroom. To carry out these tasks effectively, teachers need to be aware of the laws that govern special education eligibility and, most important, the characteristic behaviors of students with emotional, social, or behavioral disabilities that affect the way students learn and interact with peers.
Special Education Eligibility
Students with disabilities have the right to receive a “free and appropriate public education” through the provision of special education and related services, including academic interventions, speech and language therapy, counseling, physical therapy, social services, and transportation. Determining a student’s eligibility for these programs begins with a referral, typically by the student’s teacher and sometimes by the parent. Parents must consent for a school psychologist to conduct a comprehensive educational evaluation, which includes multiple sources of information (achievement tests, behavioral measures, etc.). Then a multidisciplinary team—consisting of the student’s parents and teachers, the school psychologist, and other relevant members—evaluates whether the student meets the eligibility criteria specified by federal law.
Cognitive
disabilities: See page 424.
>><<
Figure
25.1: An Overview of Disabilities. This
graph shows the percentage of elementary through high school students
with various disabilities receiving special education and related
services under IDEIA.
Specific
learning disabilities 47.4%
Speech
or language impairments 18.7%
Mental retardation 9.6%
Other disabilities combineda 8.8%
Other health impairments
7.5%
Emotional
disturbance 8.0%
aOther
disabilities include multiple disabilities (2.2 percent), hearing
impairments (1.2 percent), orthopedic impairments (1.1 percent),
visual impairments (0.4 percent), autism (2.3 percent),
deaf-blindness
(0.03
percent), traumatic brain injury (0.4 percent) and developmental
delay (1.1 percent).
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Disability Referral. Forms such as this one are used to refer students to be evaluated for disabilities under IDEIA.
A.
Describe specific concerns:
1. AREA(S) OF CONCERN:
Referral
date:
Activities of daily living
Other: (specify)
Referral
To Determine Eligibility For Special Education And Related Services
Student: DOB: Grade:
Age:
Parent/Guardian:
Are you aware of any special services provided for this child now or
in the past? If Yes, describe the type, location, and provider of the
service.
Primary
Lang: English Other:
Address:
Referred by:
Telephone:
Relationship to child:
Academic
Health related Social/emotional
Behavior Gross/fine motor
Communication
2.
SPECIAL SERVICES HISTORY:
3.
OTHER RELEVANT INFORMATION:
4. PARENT NOTIFICATION:
Yes No
B.
Describe alternative strategies attempted and outcomes: (Use
additional pages if necessary.)
Has
the parent/guardian been notified about your concerns regarding this
student? Yes No
If Yes, method of notification:
Date(s) parent/guardian was notified:
According
to IDEIA, a prior diagnosis of a particular disorder such as anxiety,
depression, ADHD, or conduct disorder in itself does not warrant
eligibility. The student’s disability must:
n persist over a long period of time,
n exist to a marked degree, and
n
adversely affect
academic performance.
If the disability fails to meet these requirements, the student is not eligible for special education services under IDEIA.
Teachers
should be aware of the limitations of IDEIA that may affect
eligibility decisions. The ambiguous language in the definition may
lead to inconsistent diagnoses. For example, the definition says
that the disability must persist over a long period of time and exist
to a marked degree. How long is long enough? And how do we measure a
marked degree?
The requirement that the disability “adversely affect academic
performance” can also be interpreted in many ways (Jensen, 2005).
As a
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result, the determination of eligibility can vary across states and from one school district to another (Osher et al., 2004; Parrish, 2002).
In
addition, students from various ethnic groups are identified for
special education disproportionately under the IDEIA category of
emotional disturbance. Compared to Caucasian students,
African-American males and Native-American students are
overrepresented, while Asian and Latino students tend to be
underrepresented (Fierros & Conroy, 2002; Parrish, 2002; U.S.
Department of Education, 2005). As with cognitive disabilities, we
should be cautious not
to interpret these findings to mean that race or ethnicity is
associated with a greater risk for emotional and behavioral
disabilities.
n
Socioeconomic status
may be a mediating factor in the relationship between race and level
of risk for emotional and behavioral disabilities (Fujiura &
Yamaki, 2000; U.S. Department of Education, 2005).
n Disproportionate identification may be the result of educators’ failure to consider cultural context when making special education referrals based on interpretations of students’ classroom behaviors. A pattern in which students shout out answers and do not respect turn-taking rules in class discussions may reflect culturally specific, valued actions rather than disruptive behaviors, while the verbally unassertive behaviors of other students may be interpreted incorrectly as a lack of motivation or a resistance to instruction (Cartledge, Kea, & Simmons-Reed, 2002; Irvine, 1990).
Students
with special needs who do not meet the IDEIA eligibility requirements
may be eligible under Section
504 of the Rehabilitation Act of 1973,
a federal antidiscrimination law protecting the rights of individuals
with disabilities who participate in any program or activity that
receives federal funds from the U.S. Department of Education,
including public schools. Students with a physical or mental
disability are not automatically eligible for special services under
Section 504—their disability must interfere with learning.
Nevertheless, the eligibility requirements under Section 504 are more
flexible than those specified by IDEIA.
Planning and Placement
While
both IDEIA and Section 504 protect the right to “free and
appropriate education,” the term appropriate
implies different accommodations under each law:
n
Under Section 504,
appropriate
means an education that is comparable to that of students who are not
disabled. For example, providing books on tape would allow a student
who is blind equal access to the same information that is available
to his or her sighted peers. Schools develop a Section
504 plan, which
outlines the type of education (general classroom or special
education) and services for allowing the student to function as
adequately as nondisabled students.
n Under IDEIA, appropriate refers to a curricular program designed to provide educational benefit to the student. Schools develop an Individualized Education Plan (IEP), which outlines curricula, educational modifications, and provision of services intended to enhance or improve the student’s academic, social, or behavioral skills. IEPs contain several important features, shown in Box 25.1.
Both
IDEIA and Section 504 require educators to place students with
disabilities in the general education classroom “to the maximum
extent appropriate,” known as the least
restrictive environment (LRE).
Two LRE approaches have evolved from different interpretations of the
law over the past three decades.
n In mainstreaming, students with special needs are placed with nondisabled peers when appropriate. For example, they may spend most of their day in a special education classroom and be integrated with their peers for subjects such as music, art, and social studies and for activities such as lunch, recess, library and field trips.
n Inclusion, a more recent and popular approach, refers to integrating all students within the general education classroom, even those with severe disabilities (with the assistance of paraprofessionals) for most or all of the school day. Experts continue to debate whether inclusion is the best environment for every student (Benner, 1998).
About 30% of elementary through high school students served under IDEIA for emotional disturbance spend most of the school day in the general education classroom. Special education classrooms or pull-out programs, in which students are pulled out of the general education classroom for remediation or therapy, are more common at the middle school and high school level for students with all
Module 25 :
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types of disability (U.S. Department of Education, 2005). Students with disabilities who are eligible for services under Section 504 may be placed in special education classes or remain in general education classrooms with accommodations and supports, or both, depending on their individual needs.
Did
you or someone you know receive special education services for an
emotional, social, or behavioral disability? Do you recall the type
of disability and what services or accommodations were offered to you
or this individual?
Anxiety and Depression
In
IDEIA’s emotional disturbance definition, anxiety is suggested by
the criterion “physical symptoms or fears associated with personal
or school problems,” and depression is suggested by the criterion
“a general pervasive mood of unhappiness or depression.” What are
the academic and personal characteristics of students with anxiety
and depression, and how do these affect their academic and peer
relationships? Let’s explore these questions further.
ANXIETY
Approximately 20% of children and adolescents suffer from anxiety disorder, which includes a variety of disorders: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, specific phobia, social phobia, and separation anxiety disorder (Albano, Chorpita, & Barlow, 2003; Merikangas, 2005). The description of each of these disorders is beyond the scope of this text, but we can discuss some general features of anxiety disorders.
Anxiety
disorders are much more than the occasional anxiety we all feel from
time to time. They involve distressingly unpleasant and maladaptive
feelings, thoughts, behaviors, and physical reactions (Albano et al.,
2003; Albano & Krain, 2005; Ollendick, King, & Muris, 2002).
Students with anxiety often worry about their competence, even when
they are not being evaluated. Because they tend to be overly
conforming, perfectionist, or unsure of themselves, they may redo
tasks due to excessive dissatisfaction with what they’ve produced.
Students with anxiety also may worry about catastrophes, violence,
and bullying by peers and may engage in avoidance behaviors such as
absence from school (American Psychiatric Association, 2000; DeVoe et
al., 2003). Teachers can use the behaviors in Box
25.2
to help identify cases of anxiety that may require referral to a
psychologist for further evaluation. Developmental
differences. Anxiety is
more common in adolescents, particularly females (Cull-inan, 2007).
However, the type of problem varies by age. Separation anxiety—an
anxiety related to separating from parents and caregivers—is
typical in infants and younger children, while social pho-
Information
Contained in an IEP
BOX
25.1
1.
The student’s present levels of academic achievement and functional
performance.
2.
Measurable annual goals and short-term instructional objectives.
3.
An explanation of how the student’s progress toward annual goals
will be measured and when progress will be reported to parents.
4.
Any appropriate accommodations for test taking on statewide and
district-wide assessments, especially those required by the No Child
Left Behind Act. In cases where educators determine that the student
will take an alternative assessment, the IEP needs to specify why
this assessment was selected and why it is appropriate for the
student.
5. The
types of special education and related services provided to the
student and how long the services will be needed. The IEP also needs
to specify how much of the student’s education will not be in the
general education classroom.
6.
Measurable postsecondary goals related to education, training, or
employment for students age 14 and older.
7.
A statement of transition services needed to reach goals involving
independent living, continuing education, or employment after high
school for students age 16 (or younger, if appropriate).
>><<
Anxiety:
See page 291.
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Thoughts about:
n being threatened
n being criticized
n appearing incompetent
n losing control of their thoughts and actions
n hypothetical death of a loved one
Physical symptoms of anxiety:
n increased heart rate
n excessive sweating
n fast breathing
n headache, stomachaches, nausea, bowel problems
n muscle tension
n shaking or chills
Also:
n vivid images of danger and humiliation
n avoidance of or escape from anxiety-provoking situations
n
overt signs of
negative emotion (e.g., crying, sighing)
Sources:
Albano et al., 2003; Cullinan, 2007; Egger, Costello, Erkanli, &
Angold, 1999; Freeman, Garcia, & Leonard, 2002; Nishina, Juvonen,
& Witkow, 2005.
Characteristic Behaviors of Individuals with Anxiety
BOX 25.2
Module 25 :
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Behavioral Disabilities
bia—anxiety that is evoked in certain social or performance situations—occurs more frequently in adolescents (Albano et al., 2003; APA, 2000; Verhulst, 2001).
Effect on school performance and relationships. Students with anxiety experience impairments in academic and social functioning. They tend to perform below their ability level and to receive lower grades (Langley, Bergman, McCracken, & Piacentini, 2004; Wood, 2006). Students’ heightened state of arousal impairs concentration on academic tasks and interferes with learning and/or recall of subject matter (Ma, 1999; Wood, 2006). Students who are highly anxious also may avoid peer interactions or may appear less competent in social interactions because of their preoccupation with how they appear to others, preventing them from focusing on social cues (Barrett & Heubeck, 2000; Langley et al., 2004).
Examine
the characteristics of anxiety listed in Box 25.2. What changes can
you make to your teaching and to the general classroom environment to
help students with anxiety in the grade you intend to teach?
DEPRESSION
We
all occasionally feel blue or sad, but this is not depression. Major
depressive disorders involve
at least two weeks of depressed mood or loss of interest, along with
at least four additional depressive symptoms, and can last about two
months (APA, 2000; Hammen & Rudolph, 2003). To be considered a
major depressive episode, symptoms also must cause significant
distress or impairment in social, occupational, or other types of
functioning and cannot be the result of medication, a medical
condition, bereavement, or drug abuse (APA, 2000). Examine the list
of depressive symptoms in Box
25.3.
Teachers can use tools like this list to help them accurately
identify possible cases of depression in students who may require
referral to a psychologist for further evaluation.
Developmental
differences. Depressive
disorders are very rare in young children. While only about 2% of
students have experienced some type of depressive disorder by early
adolescence, rates of depression rise to about 20% during adolescence
(Hammen & Rudolph, 2003; Lewinsohn & Essau, 2002). In late
adolescence, females are twice as likely as males to experience some
form of depression, compared to equal incidence rates for the genders
before adolescence (Cullinan, 2007).
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BOX
25.3
Symptoms include:
n pervasively sad mood
n general irritability
Characteristic
Symptoms of Depression
n inability to sustain attention, think, or concentrate
n decline in school participation and performance
n loss of interest in activities
n drastic change in weight (or failure to gain weight in children), appetite, sleeping, or energy level
n prolonged unpredictable crying
n hopelessness
n strong feelings of worthlessness or guilt
n social withdrawal
n
thoughts about death
or self-destruction
Sources:
APA, 2000; Garber & Horowitz, 2002; Gresham & Kern, 2004;
Harrington, 2002; Lewinsohn & Essau, 2002; Weller et al.,
2002.
>><<
Intellectual
disabilities: See page 427.
Appropriate
social and emotional development: See page 45 and page 61.
Effect on
school performance and relationships.
Depressive symptoms are linked to lower academic performance as well
as a higher drop-out rate (Chen, Rubin, & Bo-shu, 1995; Cheung,
1995; Franklin & Streeter, 1995). Depression also may lead to
peer isolation and suicidal behaviors in adolescence (Marcotte,
Lévesque, & Fortin, 2006).
Autism
Compared
to other IDEIA categories of disability, autism
is a rare disorder, with prevalence rates ranging from 2 per 10,000
children to 34 per 10,000 children. Similar rates are found in many
cultures (Mansell & Morris, 2004; Naoi, Yokoyama, & Yamamoto,
2007). Autism is a developmental disorder affecting social
interaction, communication, and behavior (Matson & Nebel-Schwalm,
2007; Swinkels et al., 2006):
n
Impaired social
interaction may be due to difficulties with nonverbal behaviors (eye
contact, facial expression, gestures), lack of social or emotional
reciprocity, difficulty with sharing interests, or failure to
establish developmentally appropriate peer relationships.
n
Impairment in
communication skills may range from a delay or lack of development of
spoken language to lack of spontaneous pretend play, the repetitive
use of language (e.g., repeating jingles or commercials), or an
inability to engage in or sustain conversations.
n Individuals with autism also exhibit repetitive patterns of behavior, such as hand flapping or rocking, lining up of toys, self-injurious behavior, or preoccupation with parts of objects (e.g., opening and closing the lid on a jack-in-the-box) (Turner, 1999).
Delays in social interaction, communication, or imaginative play must occur prior to age three to be considered autism (APA, 2000). Many individuals with autism also exhibit extreme sensitivity to hearing and touch (Klein, Cook, & Richardson-Gibbs, 2001). For example, a student with autism might find traffic noise outside a classroom window or being touched by others irritating or even painful (Wilson, 2003).
Comorbidity.
Comorbidity refers to the coexistence of two or more disorders. About
75% of individuals with autism also have an intellectual disability
(formerly called mental retardation), with about 40% of individuals
with autism having a severe intellectual disability (Fombonne, 1999;
Howard, Williams, Port, & Lepper, 2001). One criterion for a
diagnosis of intellectual disability is significantly low
performance on IQ tests compared to same-age peers (another criterion
is deficits in
>><<
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Module 25 :
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adaptive behavior). Individuals with autism tend to have weaker verbal than nonverbal performance on IQ tests because of their deficits in communication (APA, 2000).
Developmental
differences. The degree
of social and communicative impairment may change over time (APA,
2000). Infants with autism may appear unresponsive emotionally
and so -cially—not making eye contact, cuddling, showing physical
affection, or responding to parents’ voices. As children
develop, though, they may become more interested in and willing to
passively engage in social interaction.
However,
even in these cases, children with autism tend to interact with
others in unusual ways, such as being inappropriately intrusive in
interactions or having little understanding of others’ boundaries.
At adolescence, some individuals experience deterioration in
behaviors, while others experience improvements. About two-thirds
of individuals with autism do not develop independent living skills
by adulthood and continue to struggle with the social aspects of jobs
and daily functioning (APA, 2000; Howlin, Mawhood, & Rutter,
2000).
While autism is four to five times more likely in males than females, the gender difference in rates of occurrence depends on IQ (APA, 2000; Filipek et al., 1999). Individuals who have more severe cognitive impairments in IQ, especially girls, are more likely to be identified with autism (Bryson, 1997; Ehlers & Gillberg, 1993). Girls who have mild cognitive impairments may be diagnosed less frequently than boys because their communicative abilities might make them appear more socially adept than boys with the same level of cognitive ability, masking some symptoms of autism (McLennan, Lord, & Schopler, 1993; Volkmar, Szatmari, & Sparrow, 1993).
Effect on
school performance and relationships.
Because of their intellectual disabilities, students with autism face
major academic challenges in the general education classroom. Their
problems in communication and social interaction present added
challenges to learning and impair their ability to develop
age-appropriate peer relationships. They often appear aloof, avoid
eye contact and physical displays of affection, and sometimes do not
develop expressions of empathy (Rutter, 1978). Contrary to common
belief, individuals with autism do not prefer to be alone, even
though they lack social and communication skills that would allow
them to develop friendships. Development of a few close friendships
can be very beneficial, as the quality of friendships—not the
number—affects whether individuals with autism feel lonely (Burgess
& Gutstein, 2007).
ADHD and Conduct Disorder
Rather than identifying specific types of behavioral disorders, the IDEIA definition of emotional disturbance broadly lists “inappropriate types of behavior or feelings under normal circumstances.” Educators often interpret this criterion as aggression and/or impulsivity. We’ll discuss two types of behavioral disorders that fit this criterion: Attention Deficit/Hyperactivity Disorder (ADHD) and conduct disorders.
ADHD
Individuals with ADHD have a neurological condition that impairs self-regulation compared to same-age peers (Barkley, 1997, 2007; Douglas, 2005). Self-regulation involves maintaining attention,
Communication Skills.
Individuals
with autism, like the autistic character Raymond in the hit movie
Rain Man,
often exhibit repetitive language and are unable to sustain
conversations.
>><<
The
normal development of empathy: See page 82.
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inhibiting impulsive or inappropriate responses, maintaining executive control over planning, monitoring progress, and selecting appropriate strategies in working memory (Douglas, 2005; Martinussen, Hayden, Hogg-Johnson, & Tannock, 2005). ADHD is found in all cultures, although prevalence figures differ (Ross & Ross, 1982). From 3% to 7% of U.S. children and adolescents have a diagnosis of ADHD, with boys diagnosed four to nine times more often than girls (Cullinan, 2007; Pastor & Reuben, 2002; Waschbusch, 2002).
Individuals can have one of three subtypes of ADHD:
1. The predominantly inattentive subtype is characterized by symptoms of inattention, such as difficulty sustaining attention, forgetfulness, or difficulty organizing tasks.
2. The predominantly hyperactive-impulsive subtype is represented by symptoms of hyperactivity or impulsivity, such as fidgeting, constant physical activity, excessive talking, and difficulty playing quietly.
3. The combined subtype consists of both inattentive symptoms and hyperactivity-impulsivity.
For
a diagnosis of ADHD, symptoms must persist for at least six months.
Additional criteria for an ADHD diagnosis are these:
n
Individuals must
show some symptoms before age seven. However, this does not mean that
the child must be diagnosed prior to age seven. ADHD typically is
first diagnosed in elementary school when school adjustment is
impaired. Many ADHD-like behaviors of toddlers and preschoolers are
normal for their age or developmental stage, making it difficult to
distinguish ADHD symptoms from age-appropriate behaviors in young,
active children (APA, 2000).
n
Symptoms are not due
to other disorders. Several other disorders may cause an individual
to exhibit difficulties in inattention, impulsivity, or
hyperactivity. In those cases, ADHD is not the diagnosis.
n
Some symptoms must
be present in two or more settings. If a teacher (school setting)
believes the child exhibits inattentive or impulsive/hyperactive
behaviors but the parents (home setting) do not see those same
behaviors, the problem most likely is differences in the environment
and not a function of the individual.
n
The inattentive or impulsive/hyperactive behaviors must cause
clinically signifi cant
impairment in academic
or social functioning. Students who exhibit behavioral symptoms of
ADHD but receive good grades and form solid relationships with
peers would not qualify for the diagnosis of ADHD.
Comorbidity.
Approximately 40 % to 60% of children with ADHD have at least one
coexisting disabilit y (Jensen et al., 2001). Although any disability
can coexist with ADHD, common disabilities are conduct disorder, mood
disorder, anxiety, tics,
Tourette’s
syndrome, and specific learning disabilities (Jensen, et al., 2001;
Mayes, Calhoun, & Crowell, 2000).
Developmental
differences. ADHD
affects individuals differently at different ages.
Children
may be initially identified as having hyperactive-impulsive subtype
and later identified as having the combined subtype as their
attention problems surface. Impulsiveness also manifests
differently in younger and older children. A preschooler may appear
fidgety, have a high energy level, have difficulty playing quietly,
and have difficulty taking turns, behaviors that tend to continue
Specific
learning disabilities: See page 430.
Characteristics of
ADHD.
Adolescents with ADHD
may show disorganized thinking and planning.
>><<
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ADHD Characteristics in School Settings
BOX 25.4
Module 25 :
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Inattentive behaviors in school settings:
n difficulty attending to instructions, explanations, or demonstrations
n missing important details in assignments
n daydreaming, difficulty sustaining attention
n avoidance or dislike of tasks requiring sustained mental effort
n procrastination about assignments
n misplacing needed items, difficulty organizing assignments
n lack of close attention to details, careless mistakes
n ignoring or disobeying teacher directions and school rules
Impulsivity/hyperactivity behaviors in school settings:
n attending only to activities that are entertaining or novel
n responding to questions without fully formulating the best answers
n moving from one task to another without finishing
n careless errors
n appearing fidgety, having difficulty staying seated or playing quietly
n verbal or physical disruptions in class, blurting out answers
n difficulty participating in tasks that require taking turns
n
a high energy level
often misperceived as purposeful noncompliance
Sources: Barkley, 2003; Cullinan, 2007; Schachar & Tannock, 2002; Weiss & Weiss, 2002; Zentall, 1993.
into elementary school as problems with impulsivity, aggression, and social adjustment (Campbell, Endman, & Bernfield, 1977; Campbell, Ewing, Breaux, & Szumowski, 1986). By the upper elementary grades, students with impulsivity may show disorganized thinking and planning, noncompliance, and academic failure and may become increasingly aggressive and be rejected by their peers (Cull-inan, 2007). Adolescents with impulsivity may make hasty, unreflective decisions, such a performing an academic task in a disorganized manner or making disrespectful comments without consideration of ramifications (Schachar & Tannock, 2002). They also tend to make friends with other unpopular adolescents, leading to detrimental choices with respect to peer groups, defiant and aggressive behaviors, delinquency, reckless behaviors, substance abuse, and illegal acts (Anastopoulos & Shelton, 2001; Barkley, 2003; Hinshaw & Blackman, 2005; Pelham & Molina, 2003; Weiss & Weiss, 2002).
Effect on school performance and relationships. Box 25.4 illustrates typical problems that students with inattentiveness or impulsivity may experience during school. Students with ADHD tend to have difficulties in reading, math, and writing and to have lower overall achievement than their peers (Frazier, Youngstrom, Glutting, & Watkins, 2007; Zentall, 1993). Working memory deficits may be partly responsible for poor academic achievement (Gathercole, Pinkering, Knight, & Stegman, 2004; Jarvis & Gathercole, 2003). Teachers can improve students’ classroom performance by providing frequent breaks between periods of concentration and structured work (Ridgway, Northup, Pellegrini, & Hightshoe, 2003).
ADHD
also affects students’ social lives. Students with ADHD exhibit
several socially incompetent behaviors, such as (Cullinan, 2007;
Swanson, 1992; Waslick & Greenhill, 1997):
n lack of cooperation,
n unwillingness to wait their turn or play by the rules,
n defiance or opposition, and
n
aggression.
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The inability of children with ADHD, particularly boys, to control their behavior may lead to social rejection by peers and to relationships with parents and teachers characterized by conflict (Barkley, 1990; Erhardt & Hinshaw, 1994). As a result, students with ADHD are more likely to be suspended or expelled and to develop peer relationship problems in adolescence (Barkley, 1990; Melnick & Hinshaw, 1996; Stein, Szumowski, Blondis, & Roizen, 1995).
Examine
the characteristics of ADHD in school settings listed in Box 25.4.
Think of some ways you would handle these behaviors in the grade you
intend to teach.
CONDUCT DISORDER
Approximately
3% to 5% of U.S. children and adolescents exhibit aggressive patterns
typical of a conduct disorder (Connor, 2002; Hinshaw & Lee,
2003). An individual with a conduct
disorder shows
persistent behaviors such as (APA, 2000):
n aggression toward people and animals (e.g., bullying, fights, physical cruelty),
n destruction of property (e.g., setting fires),
n deceitfulness or theft (e.g., home burglary, conning others), and
n
serious violation of
rules (e.g., truancy, running away).
Individuals must show three or more symptoms over a 12-month period. The characteristic behaviors typically are evident at home, at school, and in the community (APA, 2000; Jensen, 2005). Also, these behaviors must be due to an underlying psychological disorder rather than to behavior patterns that children and adolescents acquire as protective strategies in threatening environments, such as neighborhoods with high poverty levels or high crime rates (APA, 2000).
Developmental differences. Conduct disorder may emerge as early as preschool (APA, 2000). Care-givers and early childhood educators often mistakenly assume that young children who show aggression will outgrow it (Jensen, 2005). Childhood onset of conduct disorder is identified when children demonstrate at least one characteristic behavior before age ten (typically fighting and hostility). Boys are more likely to develop the childhood-onset type and to display aggression through fighting, stealing, vandalism, and discipline problems in school (APA, 2000; Foster, 2005; Hinshaw & Lee, 2003). This type of conduct disorder generally is stable and resistant to change and predicts more severe antisocial, aggressive behaviors through adulthood (Walker, Colvin, & Ramsey, 1995; Webster-Stratton, Reid, & Hammond, 2001). Without early intervention, antisocial behaviors may escalate from childhood through adolescence to more deviant forms of behavior, such as stealing, property destruction, and victimizing others (Jensen, 2005; Walker et al., 1995).
Individuals with conduct disorder who do not show any characteristic behaviors before age ten develop the adolescent-onset subtype, more commonly found in females. Girls with this disorder typically engage in behaviors such as lying, running away, truancy, substance abuse, and sexual promiscuity (APA, 2000). Those with the adolescent-onset subtype are less likely to have persistent conduct disorders or to develop more serious antisocial disorders in adulthood than those with the childhood-onset type (APA, 2000).
Effect on school performance and relationships. Elementary and middle school students with conduct disorder tend to have lower verbal skills and lower academic achievement overall (APA, 2000; Gresham, Lane, & Beebe-Frankenberger, 2005). However, experts are not certain whether poorer academic achievement is one of several causal factors leading to conduct problems or an outcome of the conduct problems themselves.
Like students with ADHD, students who show highly aggressive and antisocial behaviors gradually become isolated from their peers. By fourth and fifth grades, children who are excluded by their peers may gravitate toward a negative peer group, leading to more serious behaviors in adolescence, such as delinquency, substance abuse, involvement with gangs, and other criminal activities (Jensen, 2005). Delinquent patterns of behavior that continue through adolescence are predictive of adult criminality and substantially limit future opportunities in education, employment, and social relationships (Jensen, 2005; Walker et al., 1995).
Students
with all types of disabilities need to learn how to function in the
general education classroom. Often, students are prescribed
medications by their physicians to reduce anxiety or depressive
symptoms and to increase attention and reduce impulsivity, which can
improve students’ academic
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module
twenty-five
emotional,
social, and behavioral disabilities 451
and
social functioning at school. Pharmacological interventions are
outside the teacher’s control and therefore are beyond the scope of
this text. However, teachers can play a central role in shaping
positive student behaviors in the classroom with several behavior
modification approaches.
Types of Interventions
As part of their general classroom discipline, teachers can use contingency management techniques with their students with disabilities. Contingency management involves the use of consequences that are tied to specific behaviors exhibited by students. When shaping appropriate classroom behaviors, teachers are encouraged to use positive reinforcement—applying a positive consequence (praise, stickers, and so on)—for appropriate behaviors. They also should avoid positively reinforcing misbehaviors by paying attention to them. Calling on, or even reprimanding, a student who is blurting out an answer positively reinforces the inappropriate behavior. Teachers can implement positive reinforcement in a concrete way by using a token economy in which students earn tokens for good behavior and cash them in for a small toy or favored activity when they have accumulated a certain number. A student can lose tokens for inappropriate behaviors, a consequence known as response cost.
Negative consequences, or punishments, also can be used to maintain improvements in behavior in students with behavioral disabilities such as ADHD (Sullivan & O’Leary, 1990). Verbal reprimands, when given consistently and followed with time out and loss of privileges, are effective components of classroom discipline for students with behavioral disabilities (Abramowitz, O’Leary, & Futtersak, 1988; Acker & O’Leary, 1987; Pfiffner & O’Leary, 1987).
Psychologists also can train teachers to use cognitive-behavior management (CBM), a technique that teaches students to regulate their own behavior using a series of instructions that they memorize, internalize, and apply to different school tasks (Barkley et al., 2000; Miranda & Presentación, 2000; Miranda, Presentación, & Soriano, 2002). The goal of CBM is self-management through the development of new thinking patterns and good decision-making skills. CBM techniques include self-monitoring, self-assessment, self-evaluation, and self-reinforcement (Lee, Simpson, & Shogren, 2007). For example, if the goal is for the student to work independently and quietly at his desk on a worksheet, the student can periodically check on his behaviors, assess whether he is achieving the goal, and, if so, put a token in a jar. If not, he can evaluate what he needs to do to get back on track. As a result, students gain an ability to control their own behavior rather than having the behavior be controlled by an adult through consequences. CBM also helps students generalize their behaviors to other classroom settings (Koegel, Koegel, Harrower, & Carter, 1999).
School psychologists also may use systematic desensitization to reduce fears and anxieties in students with anxiety. Systematic desensitization—a technique based on the assumption that anxieties and fears are a conditioned (or learned) response to certain stimuli—combines relaxation training with gradual exposure to the anxiety-provoking stimulus. For example, a student who has anxiety about participating in class would engage in relaxation techniques as she moves from answering a question with a class partner to speaking in small groups to giving a response amid all her classmates.
Research
has also focused on multimodal
interventions,
interventions that combine more than one approach. For example,
students may receive both medication and CBM or both medication and
contingency management. Schools increasingly have implemented CBM to
augment pharmacological treatment of anxiety and depression. Because
medication is a common form of treatment for ADHD, students with ADHD
often are exposed to multimodal interventions consisting of
medication, behavior modification, and sometimes academic
interventions as well.
Effectiveness of Interventions
Because the nature and severity of students’ disabilities vary, no single intervention is universally effective for every student. Educators need to be aware of the efficacy of interventions for different types of disabilities so they can make informed decisions regarding which practices to implement in school settings.
Anxiety and depression. Systematic desensitization is effective in reducing a variety of fears in children and adolescents, including test anxiety, public speaking, and school phobia (Lane, Gresham, & O’Shaughnessy, 2002; Morris & Kratochwill, 1998). Contingency management techniques also can be used effectively to reduce students’ fears and anxieties (Lane et al., 2002; Morris & Kratochwill, 1983). Multimodal interventions consisting of CBM and pharmacological intervention are particularly beneficial in treating anxiety and depression because they help change the student’s thoughts, feelings, and behaviors (Harrington, 2002; Smith, Lochman, & Daunic, 2005; Weller, Weller, Rowan,
Classroom discipline: See page 344.
Module 25 :
Emotional, Social, and
Behavioral Disabilities
>><<
Applied
behavior analysis: See page 169.
Conditioning:
See
page 161.
>><<
>><<
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differences
& Svadjian, 2002). Research on adolescents with depression indicated that a combination of anti-depressant medication and CBM was more effective than either treatment alone (Treatment for Adolescents with Depression Study Team, 2004).
Autism. Because individuals with autism experience multiple deficits, they often need a variety of interventions, such as speech and language therapy, social-skills training, occupational therapy, and behavior modification techniques. Intensive contingency management techniques have led to improved overall functioning of children with autism (Eikeseth, in press). Teachers can improve the social skills of students with autism by including such students in activities with nondisabled peers, providing multiple opportunities to practice social skills in varied settings, and positively reinforcing attempts at appropriate social skills (Kohler, Anthony, Steighner, & Hoyson, 2001; Strain & Danko, 1995). Preschool children, older children, and adolescents with autism have also improved their social skills through cognitive-behavior management (Lee et al., 2007). In short, there is no single effective intervention for individuals with autism. What may be more important than the type of intervention is the timing and length of the intervention. Children with autism benefit from early and intensive interventions—those begun between ages two and four and involving 15 or more hours per week of treatment over a one- to two-year period with low adult-to-child ratios (Filipek et al., 1999; Rogers, 1996).
Behavioral disorders. Preschool prevention programs have significantly improved behaviors and delayed the development of more serious behavior problems of children at risk for behavioral disabilities (Serna, Lambros, Nielsen, & Forness, 2002; Serna, Nielsen, Mattern, & Forness, 2003). Token economies and response cost have reduced the number of aggressive and disruptive behaviors in pre-school children with ADHD or aggressive tendencies (McGoey & DuPaul, 2000; McGoey, Eckert, & DuPaul, 2002; Pelham & Gnagy, 1999).
Contingency
management techniques, parent training of contingency management, and
CBM all have been found to reduce the incidence of disruptive
behaviors among school-age children and adolescents with ADHD and
other behavioral disorders (Pelham & Fabiano, 2001; Pelham &
Hoza, 1996; Pelham, Wheeler, & Chronis, 1998). Students with ADHD
respond positively to a combination of academic interventions,
behavior management, and modifications of the classroom environment
(McInerney, Reeve, & Kane, 1995). Research findings include
these:
n
In one study, a
combination of contingency management and academic intervention was
more effective than only CBM in reducing disruptive behaviors of
students with ADHD (DuPaul & Eckert, 1997).
n In the Multimodal Treatment Study of Children with ADHD—the longest and most thorough study of the effects of ADHD multimodal interventions—a combination of medication and behavioral interventions (e.g., parent training, school-based interventions, and summer treatment) improved academic performance, school behaviors, and parent-child interactions and reduced oppositional behavior (MTA Cooperative Group, 1999a, 1999b). The combined medication/ behavior treatment and the medication-alone treatment were significantly more effective in reducing the symptoms of ADHD than behavior modification alone (Conners et al., 2001; Swanson et al., 2001). The combined treatment also was effective in improving students’ social skills and academic outcomes (Chacko et al., 2005; MTA Cooperative Group, 1999a, 1999b).
Imagine the grade level you intend to teach. Think of some ways you could use contingency management to reduce anxieties and disruptive behaviors and to increase appropriate classroom behaviors in students with disabilities.
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key concepts 453
Describe how students with emotional, social, and behavioral disabilities are identified and served under IDEIA and Section 504. Students with emotional, social, or behavioral problems may be eligible for special education or related services under IDEIA. They must present symptoms to a marked degree that exist over a long period of time and significantly impair educational performance. Section 504 provides more flexible criteria for eligibility, but eligibility is not guaranteed. Both laws require placement in the least restrictive environment.
Explain how anxiety and depression affect students’ academic and social functioning. Students with anxiety perform below their ability, earn lower grades, avoid peer interactions, and may appear less competent in social interactions because of a heightened state of arousal in academic and social situations. Students with depression tend to have lower academic performance and are more likely to be isolated by peers, to have suicidal behaviors, and to drop out of school during adolescence.
Describe the characteristics of autism, and explain how these affect academic and social functioning. Autism includes deficits in social interaction, communication, and behavior. Because many individuals with autism have some degree of intellectual disability, they face major academic challenges in the general education classroom. Their problems in communication and social interaction present added challenges to learning and to the development of peer relationships. Few
individuals with autism are able to function independently in society.
Explain how ADHD and conduct disorder affect students’ academic and social functioning. Students with ADHD display many behaviors that impair school performance, such as fidgeting and excessive activity in younger children and problems with organization, planning, and decision making in older children. These problems lead to difficulties in reading, math, and writing and to lower overall achievement. Impulsive and hyperactive behaviors may lead to conflicting relationships with adults and social rejection by peers, especially in adolescence. Children with conduct disorder tend to have lower levels of verbal skill and academic achievement, gradually become excluded by their peers, and develop delinquent patterns of behavior in adolescence.
Describe
interventions that are effective in treating anxiety, depression,
autism, and behavioral disorders. Systematic
desensitization and contingency management techniques are effective
strategies for reducing students’ fears and anxieties. Children
with autism need a variety of interventions and benefit most from
early and intensive therapies. They respond positively to intensive
contingency management and cognitive-behavior management.
Cognitive-behavior modification and contingency management
techniques also work well for reducing disruptive behaviors.
Students with ADHD respond most positively to a combination of
interventions.
ADHD anxiety disorder autism cognitive-behavior management
(CBM)
conduct disorder contingency management emotional disturbance inclusion Individualized Education Plan (IEP) Individuals with Disabilities Education
Improvement Act of 2004 (IDEIA) least restrictive environment (LRE) mainstreaming major depressive disorders multimodal interventions Section 504 of the Rehabilitation Act of 1973 Section 504 plan systematic desensitization
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454
case
studies: reflect and evaluate
Early Childhood: “Letter P Day”
These questions refer to the case study on page 388.
1. Based on the information given in the case, is it likely that Peter has ADHD? Why or why not? If Peter were a girl, would that change your decision?
2.
What behaviors should Anita look for to determine whether Peter may
have ADHD? How might these symptoms differ from those students might
show in higher grades?
3.
What specific strategies based on contingency management can Anita
use to keep Peter on task?
4. Imagine that Devin is a student with conduct disorder in Anita’s class. Using the information presented in the module, describe how Devin might behave during the language arts activity.
5. Does Nolan exhibit symptoms of depression? Why or why not? Use Box 25.3 and the research discussed in the module to support your answer.
6.
Why wouldn’t you expect to see many anxiety problems in
kindergarten? Compare this situation to middle school or high school.
What factors might contribute to the development of anxiety in middle
school or high school?
Elementary School: “Cheetahs, Lions, and Leopards”
These questions refer to the case study on page 390.
1. Assume that Travis has autism. What challenges might Mrs. Fratelli face in addressing Travis’s learning and social needs?
2. Based on Box 25.2 and the information presented in the module, evaluate whether Denise might have an anxiety disorder.
3. Several days this week, one of the students in Mrs. Fratelli’s class has come into school very sullen.
She’s not eating very much or paying attention like she normally does. What factors does Mrs. Fratelli need to consider to help her determine whether this student has symptoms of a major depressive disorder? What additional information would she need to gather?
4. Based on information in the module, give Mrs. Fratelli specific suggestions for adapting the science experiment so that it helps Travis improve his social functioning.
5. Based on information in the module, give Mrs. Fratelli specific suggestions for easing Denise’s anxiety about reading aloud.
6.
This case does not include any students with ADHD. Using information
in the module, create and describe an elementary school student with
ADHD for this case.
Middle School: “Math Troubles”
These questions refer to the case study on page 392.
1. Use the characteristics in Box 25.2 to evaluate whether Lindsey could have an anxiety disorder. What additional information would you need to have to help you decide? If Lindsey were a boy, would that make a difference?
2. Use the characteristics in Box 25.4 to evaluate whether Sam could have ADHD. What additional information would you need to have to help you decide?
3. Did you assume Sam was a boy? How did that affect your evaluation in question 2?
4. Assume that Sam is African American. How might that affect your evaluation in question 2? What does the research say about identification of emotional and behavioral disabilities in students from minority and lower-socioeconomic backgrounds?
5. How can Elizabeth address Sam’s disruptive behaviors? Give specific strategies based on contingency management.
6. How can Elizabeth prevent students like Jessie and Lindsey from developing anxiety about math?
Give specific suggestions based on information discussed in the module.
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case studies: reflect and evaluate 455
High School: “NSS”
These questions refer to the case study on page 394.
1. How might anxiety affect a student’s performance in Beau’s class? Think of specific examples that relate to in-class performance, performance on assignments, and peer interactions.
2. Beau regularly uses student presentations in his class but finds that several students have severe anxiety about public speaking. What specific methods discussed in the module are used to reduce anxiety? Brainstorm additional strategies for reducing student anxiety that Beau can use with his students.
3. Why would you expect to find few students with autism in a ninth-grade history class?
4. Use Box 25.4 to evaluate whether Jason could have ADHD. What additional information would you need to have to help you decide?
5. This case does not include any students with conduct disorder. Using information discussed in the module, create and describe a high school student with conduct disorder for this case. Specifically, provide behaviors that Beau would see in class or information he would be given from the school administration.
6. Give Beau specific suggestions based on contingency management for how to increase homework completion in students like Jason, Anthony, and Sarah.
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