Emotional Behavioral Disorder: Accommodations and Modifications
Emotional Behavioral Disorder: Accommodations and Modifications forward this error screen to 64. Does My Child Have an Emotional or Behavioral Disorder? Does My Child Have a Mental Health, Emotional or Behavioral Disorder? What to look for Among all the dilemmas facing a parent of a child with emotional or behavioral problems, the first question — whether the child’s behavior is sufficiently different to require a comprehensive evaluation by professionals — may be the most troublesome of all.
Even when a child exhibits negative behaviors, members of a family may not all agree on whether the behaviors are serious. For instance, children who have frequent temper outbursts or who destroy toys may appear to have a serious problem to some parents, while others see the same behavior as asserting independence or showing leadership skills. Every child faces emotional difficulties from time to time, as do adults. Feelings of sadness, loss, or emotional extremes are part of growing up. These are normal changes in behavior due to growth and development. At times, however, some children may develop inappropriate emotional and behavioral responses to situations in their lives that persist over time. The realization that a child’s behavior requires professional attention can be painful or frightening to parents who have tried to support their child, or it may be accepted and internalized as a personal failure by the parent.
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Sometimes parents fear that their child may be inappropriately labeled. They have concerns that the array of medicines and therapies suggested are not always agreed upon by all professionals. While many parents will concede that they may need to learn new behavior management or communication techniques in order to provide a consistent and rewarding environment for their child, many also express deep anger about the blame that continues to be placed on families with children who behave differently. Where to start Before seeking a formal mental health evaluation, parents may have tried to help their child by talking to friends, relatives, or the child’s school. They may try to discover whether others see the same problems and to learn what others suggest. Parents may feel that they also need help in learning better ways of supporting the child through difficult times and may seek classes to help them sharpen behavior management or conflict resolution skills. If the problems a child is experiencing are seen as fairly severe and are unresponsive to interventions at school, in the community, or at home, a diagnostic evaluation by a competent mental health professional is probably in order.
Evaluations provide information that, when combined with what parents know, may lead to a diagnosis of a mental health, emotional, or a behavioral disorder. So what is that magical moment when parents should recognize their child’s behavior has surpassed the boundary of what all children do and has become sufficiently alarming to warrant a formal evaluation? It is often a gradual awareness that a child’s emotional or behavioral development just isn’t where it should be that sends most parents on a quest for answers. How much distress is your child’s problem causing you, the child, or other members of the family? If a child’s aggressive or argumentative behaviors, or sad or withdrawn behaviors are seen as a problem for a child, the school, or members of his or her family, then the child’s behaviors are a problem that should be looked at, regardless of their severity. While there is no substitute for parental knowledge, certain guidelines are available to help families make the decision to seek an evaluation.
Does it just go on and on with no sign that the child is going to outgrow it and progress to a new stage? While temper tantrums are normal in almost all children, some tantrums could be so extreme that they are frightening to parents and suggest that some specific intervention might be necessary. Some behavior might be quite normal for a two-year-old, but observation of other children that age may lead to the conclusion that the behavior in question is not quite right for a five-year-old. Not all children reach the same emotional milestones at the same age, but extreme deviations from age-appropriate behaviors may well be cause for concern. Attempts at self-injury or threats of suicide, violent behaviors, or severe withdrawal that creates an inability to carry on normal routines must be regarded as emergencies for which parents should seek immediate attention, through a mental health or medical clinic, mental health hotline, or crisis center. Young children Special consideration needs to be given to identifying behaviors of concern in very young children.
Their well-being is so connected with that of the family, that services must be developed with and directed to the family as a unit. The goal in evaluating and providing services to a young child should include helping families to articulate their own stresses and strengths. On the other hand, the earlier that parents and professionals can intervene in the life of a young child with delays in emotional and behavioral development, the better it is for both the child and the family. Early evaluation and intervention requires that parents be involved in both giving and receiving information about their child’s development. Interviews with families and observations of their child to assess how well he or she communicates, plays, relates to peers and adults, and is able to self-regulate behavior is useful in deciding whether the child has a developmental problem that needs attention.
Most often, the first indications that an infant may be experiencing significant problems will be delays in normal development. If parents have questions about their child’s development, they should call their child’s pediatrician or family physician. Many doctors who include young children in their practice will have materials available for parents on normal childhood development. Toddlers may have a tremendous range of behaviors that would be considered developmentally appropriate. Especially with a first child, parents may feel uneasy, uncomfortable, or even foolish about seeking an evaluation for their very young child. While sorting out problems from developmental stages can be quite tricky with infants and toddlers, early identification and intervention can significantly reduce the effects of abnormal psychosocial development.
3 through 21 who have disabilities. The section of the law that covers children birth through 2 is called Part C and recognizes the importance of families in meeting the needs of their young children. As of this writing, all states are receiving funds to provide services to infants and toddlers. Parents who have questions related to preschool or early intervention programs should call their local school district offices or their state Department of Education or Department of Health or Human Services for guidance. Cultural considerations Evaluation of a child’s mental or emotional status is the key to developing appropriate school or mental health services. For children who are from diverse cultures, parents will want to know how, or if, those differences will affect evaluation results. Tests, by their very nature, have been developed to determine differences between one child and another.
If everyone taking a test scored the same, then the test would be of no use. What’s important, though, is that tests are used only in those areas they were designed to measure — such as depression or anxiety. If the professional who is responsible for evaluation is not of the same cultural background as the child, parents should feel free to ask what his or her experiences have been in cross-cultural assessment or treatment. Professionals who are sensitive to issues of bias related to language, socioeconomic status, or culture in formal evaluation tools should willingly share such information with parents. Do the data and conclusions from various professionals agree?
Did the professionals use family information about the child’s functioning at home and in the community to aid in making a diagnosis? Does the family believe the evaluation is accurate? When a multidisciplinary approach is not practical or available, the person providing the evaluation should give the battery of tests following the procedures to reduce the effects of bias when making a determination that a child needs mental health services. If children from specific ethnic or cultural groups appear to be overrepresented in a school or treatment program that has been selected or recommended for a child, parents should carefully examine the procedures for determining their child’s placement.
If parents decide that the placement decision was not influenced by racial or cultural bias, that perspective can increase confidence in the program selected for their child. Seeking a diagnostic evaluation from a medical professional Once parents have decided that their child or adolescent has behaviors that deserve at least a look by a medical professional, the question then becomes where to turn for a diagnostic evaluation. A family doctor can rule out physical health issues, perform a basic mental health screening, and refer families to an appropriate child or adolescent psychologist, or psychiatrist. Also, many hospitals and most community mental health centers offer comprehensive diagnostic and evaluation programs for children and adolescents. School districts also do mental health screenings during kindergarten roundup, and the results from that screening might help you decide to move forward with contacting your child’s pediatrician or another medical provider for a diagnostic evaluation. Evaluations can be costly, but there are some supports available for families. Under the Affordable Care Act, marketplace health plans must cover preventative services for children at no charge, which includes behavioral assessments.
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Under EPSDT, a screening is a comprehensive health evaluation, including the status of a child’s emotional health. Check with your state Medicaid office to get current information about the services under the EPSDT program. Other parents, particularly those in rural areas, may want to first approach their county’s public health nurse, or family and human services agency. Either may be able to direct them to an evaluation program available in their area.
Community mental health centers are also a good source of help, and can be less expensive than seeking out a private doctor or mental health professional. Parents will want to ask for professional staff with experience in evaluating the mental health needs of children. If in doubt, ask for the credentials and expertise of the professional who is assigned to work with the child. Credentials should be offered and displayed in the professional’s workplace. Seeking a free comprehensive special education evaluation for services at school There are federal and state laws that require certain services in school for children who have disabilities.
The process of evaluation starts with Child Find, a process that requires schools to identify, locate, and evaluate students with disabilities who may need special education services and supports. An evaluation for special education is not the same as a diagnostic evaluation. If the child is not determined to meet the criteria as a child with a disability under IDEA, parents may want to consider a 504 Plan. Section 504 of the Rehabilitation Act of 1973 is a federal civil rights law that says it is not legal to discriminate against people with disabilities in any program receiving federal funds. In school, Section 504 can help children and youth who have a mental health or emotional disorder but are not eligible for special education.
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Schools must first determine whether the child’s impairment substantially limits their ability to learn, and then provide accommodations for that child. Accommodations can include such things as giving extra time to complete work, using headphones or going to a quiet place to help screen out noise. PACER is the Minnesota Parent Training and Information Center, funded by the U. Social Skills Deficits in Learning Disabilities: The Psychiatric Comorbity Hypothesis By: Stephanie K. This meta-analysis makes it clear that most studies on social skills deficits of children with learning disabilities do not provide sufficient data to determine the prevalence of social skills deficits within this population. Just as there are no clear prevalence data on social skills deficits in children with learning disabilities, the exact nature of the relationship between social skills deficits and learning disabilities is a matter of speculation.
This article explores the hypothesis that social skills deficits among children with learning disabilities are associated with high rates of undetected psychiatric diagnoses. In order to explore the psychiatric comorbidity hypothesis, information on ADHD and depression or dysthymia and each disorder’s co-occurrence with learning disabilities will be briefly reviewed. Second, data will be presented from a study in which a number of children are characterized by a combination of a learning disability and a related behavioral difficulty or depression. Learning disabilities and ADHD can coexist with other emotional or behavioral disorders. Whether learning disorders predispose a person to other disorders. As a result, the origin of social skills deficits sometimes seen in individuals with learning disabilities is unclear. ADHD describes a syndrome with the following principal symptoms: inattention, impulsivity, and hyperactivity.
In all likelihood, this variability results from differences in selection criteria, sampling and measurement variations, as well as discrepant definitions of learning disabilities and ADHD in various studies. In a review of the school performance of children with ADHD, Biederman et al. Thus, there is considerable evidence of a small but significant sample of children with learning disabilities whose social skills deficits may result not from learning disabilities per se, but from ADHD. Learning disabilities and depression A scheme depicting the general diagnostic features of major depression and dysthymia is presented in Table 1. 15 epidemiologic studies on childhood depression.
While the reviewed studies relied on more objective and replicable measures, considerable variability was found in the percent of samples who were depressed, often because of diagnostic criteria and instrumentation. Prevalence of depression in the normal population tends to increase with age. Special populations tend to demonstrate an even higher prevalence rate. 53 public school elementary children aged 8 through 11 identified as learning disabled by state standards. Studies on the course of depression provide information on depression and the school and psychosocial functioning of youth with learning disabilities. Overlap in these percentages reflects the fact that major depression was superimposed on dysthymia. As with ADHD, there is also evidence that depression is a significant comorbid diagnosis in children with learning disabilities.
Note as well from Table 1 that certain cognitive symptoms characteristic of children with depression may overlap those of children with learning disabilities. Axis II diagnoses of learning disorders in addition to affective disorder. A few of the children in the third group also had some conduct disorder or ADHD. As shown in Table 2, only about two in five subjects had a diagnosis of depression or dysthymia alone. In turn, about one in three had such a diagnosis accompanied by a secondary diagnosis, typically ADHD or conduct disorder.
The remaining subjects demonstrated a high degree of comorbidity as well, but were differentiated from the first two groups by having a learning disability diagnosis in addition to their depressive or disruptive behavior disorder. Outpatient evaluations were completed and the children were followed to determine their school placement. In contrast to the first and second groups, students in the third group were much more often found to be eligible for special education, typically a resource room placement. In short, comorbidity with conduct disorders or ADHD seemed to produce a higher rate of special education services than the single disorder. However, “trimorbidity,” that is, the addition of a learning disability diagnosis seemed the surest guarantee of such services. Adapted from information in “Adaptive behavior of subtypes of learning disabled individuals,” by C.
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Strawser, 1987, Journal of Special Education, 21, pp. Undoubtedly, when depression, attention deficit disorder or another problem occurs concurrently with a learning disability, the need for increased special education support comes to the fore. The goal of subtyping research is to divide heterogeneous samples of youngsters with learning disabilities into homogeneous groups based on patterns of performance across a variety of tests or other measurements thought to be critical to the development of learning disabilities. Although a detailed review of learning disabilities subtypes is beyond the scope of this article, Table 3 depicts “consensus” subtypes arrived at by researchers in this area.
The first column presents the five consensus subtypes that have been found. Indeed, Weller and Strawser asserted that the five subtypes are clearly identifiable by their differences in adaptive behavior and ability to cope with the environment. Specifically, these authors provide a comprehensive review of the subtypes and the related adaptive capabilities related to coping mechanisms, adaptive language skills, compensatory behaviors, and behaviors that impact transition from school to community and employment. The study of the adaptive behavior of subtypes of individuals als with learning disabilities has allowed for a clearer understanding and appreciation of individual strengths and limitations in terms of social competence. However, it is possible that more specific research is needed in this area beyond the general notion of social competence. Such research might also focus on developmental psychopathology with reference to specific psychiatric disorders that undergird social skills deficits.
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There is apparently only one study that directly explores this hypothesis to date. 60 children with LD in the primary grades on a social skills rating scale. There were, however, no significant differences in IQ or achievement. What are the educational placement and treatment implications of the psychiatric comorbidity hypothesis? When ADHD, depression or dysthymia, or another psychiatric disorder occurs concurrently with a learning disability, there appears to be a need for increased special education support. In turn, the most effective form of treatment merits careful consideration. It is unfortunate that previous studies in learning disabilities have largely ignored the potential for comorbidity between learning disabilities and specific psychiatric disorders.
Resident in Psychology, Senior Staff Counselor, Counseling Center, University of Virginia. Professor of Psychiatry, University of California. Professor of Special Education, University of Iowa. References Click the “References” link above to hide these references. Journal of Learning Disabilities, 17, 540-543. A handbook for diagnosis and treatment.
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