DNE: Lecture 6**

• Emotional symptoms


  • Easily annoyed or nervous
  • Appear angry
  • Blame others
  • Refusing to follow rules; question authority
  • Arguing or throwing tantrums
  • Difficulty handling frustrations
• Causes: Internal factors


  • Physiological factors (brain injury, genetic, brain function disorders, prenatal drug exposure; mood disorders, depression, schizophrenia, ADHD may be genetic)
  • Psychological factors (low self-esteem, mental disorders, weak moral sense)
  • Intellectual factors (low intelligence, reading, learning difficulties or other low capacity weak and so on)
• Causes: External factors


  • Social-economic factors (poverty, social class, race, gender)
  • Family factors (History of physical, sexual abuse, poor parenting, coercion from parents, inconsistent or unhealthy discipline style, etc.)
  • School factors (academic advancement, intellectual-oriented teaching and discipline improper, inadequate education, environment, etc.)
  • Social and cultural factors (culture, television, film, advertising, news media reports or demonstrations bad, or improper entertainment, etc.)
• Characteristics of students with emotional disorders

  • Dishonest: lying, cheating, stealing
  • Lazy: lack of motivation, does not want to participate or follow instructions from authority
  • Withdrawal: do not like to talk with others or avoid opportunities to interact with others, retreat back to their own circle, lack of the necessary relationships
  • Fatigue: poor spirit, lack of energy, lack of balance between activity and rest
  • Absent: health problems, may be from emotional issues; frequent truancy or running away from home, criminal related activities, associated with bad habits
  • No respect for authority: often feel unjust in relation to authority or laws and regulations, resist rules and instructions
  • Attention-deficit and hyperactivity: short attention span, impulsive, overactive, cannot exercise self-restraint
  • Social difficulties: Can not get along with peers, no meaningful or long lasting relationships (often become the object of bullying, defiant, hostile to authority, or narcissistic, refused to participate in any group activities)
  • Emotional immaturity: physical development in many ways are the same as typical peers, or may even exceed it, but significantly behind in emotional development, they have more childish emotional response, such as crying, easily frustrated, and get angry easily
  • Learning difficulties: Emotional distress makes students with EBD more difficult to learn in school (poor attention span, mind wandering, or the melancholy of learning activities, led to difficulties in reading and writing and communication, and lack of curiosity and motivation, may not engage in any creative activity)
• Schizophrenia


  Diagnostic criteria must be met over much of the time of a period of at least 1 month (Delusion, hallucination or disorganized speech, Severely disorganized or catatonic behavior, Negative symptoms)
• Disruptive mood dysregulation disorder


  Severe recurrent temper outbursts manifested verbally (e.g. verbal rages) and/0r behaviorally (e.g. physical aggression towards people or property) that are grossly out of proportion in intensity, duration to situation, frequency 3 or more per week, Irritable, angry; present for 12 or more months, Diagnosis restricted to 7-18yrs
• Major depressive disorder


  5 or more: depressed mode most of the day, diminished interests or pleasure, significant weight lost or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation; fatique or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, recurrent thought of death
• Separation Anxiety Disorder


  Developmentally inappropriate and excessive fear or anxiety concerning separation from those whom individual is attached, Three of the following: excessive distress when anticipating of experiencing separation, persistent and excessive worry about losing or harm to figure of attachment, worry about experiencing an untoward event, reluctant or refusal to go out, fear of being alone, fear of sleep without being near attachment figure, nightmares, complaints of physical symptoms
• Selective Mutism


  Consistent failure to speak in specific social situation despite speaking in other situations, Interferes with educational or occupational achievement, Duration of 1month or longer, Failure to speak not due to lack of knowledge or comfort with spoken language, Disturbance not better explained by communication disorder
• Anxiety Disorder


  • Specific Phobia (Fear or anxiety about specific object or situation, Phobic object or situation always provokes immediate fear or anxiety, Phobic object or situation actively avoided, Fear or anxiety is out of proportion to actual danger posed by specific object or situation, Fear is persistent, lasting for 6+ months, Fear causes clinically significant distress or impairment in social or other important areas of functioning, Disturbance not better explained by symptoms of other mental disorder)
  • Social Anxiety Disorder (Fear or anxiety to one or more social situation in which individual is exposed to possible scrutiny by others; e.g. social interactions, being observed, performing in front of others)
  • Panic Disorder (Recurrent unexpected panic attack, Panic attack: palpitation, accelerated heart rate, sweating, shaking, choking, shortness of breath, chest pain, nausea, dizzy, chills, numbness, unreality, losing control, fear of dying)
  • Agoraphobia (Fear of public transportation, open space, enclosed space, crowded area, home alone)
  • Generalized Anxiety Disorder (Excessive anxiety on events or activity; difficulty controlling worry)
• Oppositional Defiant Disorder


  Pattern of angry/irritable mood, argumentative/defiant behavior, vindictiveness lasting at least 6 months by at least 4 symptoms, Disturbance in behavior associated with distress in individual or others in immediate social context, Do not occur exclusively during course of psychotic/substance abuse, depression, Often comorbid with ADHD, ODD is less severe than conduct disorder (in which aggression, destruction of property, theft/deceit is involved)
• Intermittent Explosive Disorder


  Recurrent behavioral outbursts representing failure to control aggressive impulses (Verbal aggression or physical aggression – 2 times per week for 3 months, Magnitude of aggressiveness is out of proportion, Recurrent aggressive outbursts are not premeditated, not to achieve tangible objective, Distress in individual or impairment in occupational or interpersonal functioning, associated with financial or legal consequences, Age 6 years or older, Not better explained by other disorders)
• Conduct Disorder


  Repetitive and persistent pattern of behavior which basic rights of others or major age-appropriate societal norms or rules are violated (Aggression to people or animals, Destruction of property, Deceitfulness or theft, Serious violations of rules, Maybe childhood, adolescent onset, May have: Lack of remorse or guilt; callous – lack of empathy; unconcerned about performance, shallow or deficient affect)
• Short term and long term effects of EBDs


  • Student may get into trouble for acting out (e.g. suspension, expulsion, fighting, bulling, arguing)
  • Poor academic achievements
  • Longer delays in employment after graduation (part-time work, frequent change of jobs, earn less)
  • Adults may lose their jobs
  • Failed marriages
  • Serious criminal offences (e.g. abusing others, threatening, aggression towards self/others/animals)
• Assessing Children with EBDs


  • Parent/ Caregiver Interviews (Family relationships, Cognitive and school functioning, Peer relationships, Physical development, Child medical and psychiatric history, Family medical and psychiatric history, Emotional development and temperament, Interests and talents, Strengths, Unusual circumstances and Prior testing etc.)
  • Teacher/ Daycare Worker Interviews (Can provide a wealth of information about the child outside of the home setting. Instead information relate to child's relations with peers and adults, the child's mastery of beginning key concepts/ academic skills, and the child's ability to meet expectations of the school or daycare setting)
• Interview with Young Children


  • Rapport Building/ Initial Information Gathering (e.g. Drawing, express feelings and concerns, helping the child feel more comfortable and engaged)
  • Suggested Play materials for Free-play Sessions (e.g. Doll family, Doll house, Clay, Toy-telephone, Crayons, Puppets, Toy soldiers, Toy cars)
• Direct Observation


  The interviewers' observations may provide important information about the child's ability to adapt to new situations, his/her thoughts and fantasies, his/her ability to solve problems, his/ her degree of spontaneity and creativity, and any interpersonal problems and the quality of interpersonal interactions
• Assessments


  • Pre-school behavior checklist (children aged 2-5 years)
  • Pediatric symptom checklist
  • Revised Behavior problem checklist (indivduals aged 5-18 years)
  • Rorschach Psychodiagnostic Plates
  • Children Apperception Test (children aged 3-10 years- personality traits, attitudes)
  • Draw a person
• Supporting Children with EBDs (Anxiety Disorders)


  Try to help the child learn problem-solving techniques, Develop routines that foster independence, Keep the child engaged and involved in activities, Respect his issues, but don't "play into" them by allowing the child to constantly discuss them, Be consistent, yet patient, with the child and remember that progress may be slow
• Assessments


  • Pre-school behavior checklist (children aged 2-5 years)
  • Pediatric symptom checklist
  • Revised Behavior problem checklist (indivduals aged 5-18 years)
  • Rorschach Psychodiagnostic Plates
  • Children Apperception Test (children aged 3-10 years- personality traits, attitudes)
  • Draw a person
• Supporting Children with EBDs


  • Try to help the child learn problem-solving techniques
  • Develop routines that foster independence
  • Keep the child engaged and involved in activities
  • Respect his issues, but don't "play into" them by allowing the child to constantly discuss them
  • Be consistent, yet patient, with the child and remember his anxiety is very real
• Children with Oppositional Defiant disorder (ODD)


  • Keep routines simple
  • Make sure the rules are clear, specific and consistently enforced
  • Deal with behaviors as they occur and work closely with the child's family and therapist to monitor her progress
  • Make sure you and the child's family have a specific and consistent method to communicate with each other
  • Try to keep the child actively engaged in daily activities as much as possible
• Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Keep rules simple and enforce them consistently
  • Provide guides, such as picture cards to help the child remember classroom rules
  • Practices specific social skills, such as waiting for a turn or asking for a toy
  • Help the child learn to organize his materials
  • Keep in constant communication with the child's family
  • If the child is on medication, make sure you know when he is to receive it and how it will be administered
  • Praise the child when he completes a task or activity
  • Provide an avenues for the child to let you know when he needs to get up and move around
  • Work with the child's family to develop a systematic method for rewarding positive behavior
• Teacher attitude


  • Respond without anger
  • Be clear and consistent
  • Do not take things personally
  • Set limits and be consistent
• Self-observation skills

  • 1. Identify behaviors for change
  • 2. Goal setting and positive reinforcement
  • 3. Self-recording and graphing
  • 4. Self-defined management and goals
• Play Therapy


  An approach to counseling young children in which the counselor uses toys, art supplies, games, and other play media to communicate with clients using the "language" of children – the "language" of play
• Who needs Play Therapy?

  • Anger management
  • Grief and loss
  • Divorce and family dissolution
  • Crisis and trauma
  • Modification of behavioral disorders
  • Anxiety
  • Depression
  • Attention deficit hyperactivity (ADHD)
  • Autism or pervasive developmental
  • Academic and social developmental
  • Physical and learning disabilities
  • Conduct disorders
• Play Therapy Toys


  • Family/nurturing toys
  • Scary toys
  • Aggressive toys
  • Expressive toys
  • Pretend/fantasy toys
• Art Therapy


  The use of creative techniques such as drawing, painting, collage, coloring, or sculpting to help people express themselves artistically and examine the psychological and emotional undertones in their art
• Who needs Art Therapy?

  • Chronic Health issues
  • Anxiety, depression, other mental and emotional problems
  • Substance abuse and addictions
  • Family and relationship issues
  • Abuse and domestic violence
  • Trauma
  • Grief and loss
  • Physical, cognitive, and neurological problems
  • Psychosocial difficulties
• How does Art Therapy work?

  • Used for assessment and treatment
  • Work with individuals, couples, and groups in a variety of settings
  • Artistic talent is unnecessary for art therapy
  • Seek for connections between the creative choices made and a child's inner life
• Benefits of Art Therapy

  • Become more aware of self and others
  • Able to cope with symptoms, stress, and traumatic experiences
  • Further improve cognitive abilities
  • Enjoy the life-affirming pleasures of making art
• Tips and tricks


  • Build on positives, not negatives
  • Pick your battles
  • Seat student near teacher and away from high traffic areas
  • Clearly post and frequently review classroom rules
  • Highly structured classroom with little down time
  • Behavior prevention program; positive behavior support
  • Integrate lessons that have to do with social interactions; conflict resolution
  • Create a quiet or calm corner
  • Model how to deal with feelings
  • Involve physical activities (odd, adhd, depression)
  • Deep breathing exercises