Behaviour Disorders: Implications for Inclusion

From:  Caring and Safe Schools, Ministry of Education, Ontario (www.edu.gov.on.ca)

 Students with behavioural exceptionalities manifest an array of actions  in order to have their needs met.  In addition, students use different forms of expression in response to stimuli and to initiate and/or sustain relationships in the school environment.  Every behaviour communicates a need:  communication, medical, sensory, social, academic, emotional or physical or a combination of needs.  Additionally, students with behaviour disorders often experience deficits in other areas of development including but not limited to:  communication disorders, executive function (neurological) disorders and/or mental health problems.

The chart that follow illustrates the significance of each of the categories above as they relate to the inclusion of students with behavioural disorders:

 

Dimensions of BEHAVIOURAL DISORDERS

DIMENSIONS OF BEHAVIOURAL DISORDERS

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences.

Children or adolescents with conduct disorder may exhibit some of the following behaviors:

Aggression to people and animals

·      bullies, threatens or intimidates others

·      often initiates physical fights

·      has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun)

·      is physically cruel to people or animals

·      steals from a victim while confronting them (e.g. assault)

·      forces someone into sexual activity

Destruction of Property

·      deliberately engaged in fire setting with the intention to cause damage

·      deliberately destroys other's property

Deceitfulness, lying, or stealing

·      has broken into someone else's building, house, or car

·      lies to obtain goods, or favors or to avoid obligations

·      steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)

Serious violations of rules

·      often stays out at night despite parental objections

·      runs away from home

·      often truant from school

Copyright ©2010 - American Academy of Child Adolescent Psychiatry.

Socialized Aggression refers typically to youth with chronic patterns of cultural and social violations both within the school environment and community at large.  The bevaviours exhibited by youth in this category progress from less serious to more serious over time.  Many behaviours fall under delinquent, which is an illegal act committed by a juvenile.  Anti-social behaviours include aggression, non-compliance, bullying, intimidation, gang vandalism, stealing, fighting, sexual harassment, assault, rape and property destruction.  For youth in this category, the lack of distress or remorse shown makes for a vicious circle.  Anti-social behaviours result in reward from delinquent friends and within youth gangs, the behavior often is associated with prestige.  The level of aggressive then escalates as a result of the punitive intervention on the part of adults resulting in greater anger on the part of the young offenders.

Anxiety and Withdrawal currently encompasses 14 anxiety disorders including obsessive-compulsive disorder, separation anxiety disorder, post-traumatic stress disorder, generalized anxiety disorder and social phobia. 

Anxiety

·      a fear with a future reference; fear of events that have not yet occurred

·      feelings include distress, tension, uneasiness, fearfulness, worries

·      anxiety becomes abnormal when it occurs in situations most people can handle with little difficulty

·      with generalized anxiety, the symptoms are present most of the time

Phobias

·      persistent and irrational fears of a specific object, activity or situation

·      school phobia (social anxiety disorder) is one of the most common of the childhood phobias

Obsessive-Compulsive Disorders

• very serious and persistent
• recurrent obsessions and/or compulsions that are severe enough to interfere with the student’s daily life and cause significant distress

Obsessions

·      persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate

·      common obsessions include fear of contamination, fear of harm to self and others, aggressive or sexual themes, religiosity, forbidden thoughts, symmetry urges and a need to tell or confess things

Compulsions

·      repetitive behaviours or mental acts that serve to reduce anxiety or distress but do not serve to obtain pleasure or gratification

·      common compulsions include washing, repeating, checking, touching, counting, ordering, arranging, hoarding and praying

Depression

·      a mood disorder accompanied by cognitive, motivational and physical symptoms

·      primary symptom is an overall depressed mood or loss of interest in daily activities manifested over a two-week period

·      other symptoms include weight loss or gain, changes in sleep, activity and/or energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions, recurrent thoughts of death or suicidal plans

·      most extreme manifestation of depression is suicide; suicide is the second leading cause of death for adolescents today (after accidents); Canada has the 3^rd highest suicide rate in the world for people 15 to 24

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder characterized by inattentiveness, impulsiveness, and hyperactivity resulting in significant impairment in functioning at home, school, or with peers.  The current and most widely used criteria for ADHD are defined by the American Psychiatric Association  (DSM IV) as follows:

A. Either (1) or (2) as well as B, C, and D below.

1) Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:

Inattention

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. often has difficulty sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure of comprehension)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. often loses things necessary for tasks or activities at school or at home (e.g. toys, pencils, books, assignments)
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities

2) Six or more of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:

Hyperactivity

1. often fidgets with hands or feet or squirms in seat
2. often leaves seat in classroom or in other situations in which remaining seated is expected
3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. often has difficulty playing or engaging in leisure activities quietly
5. often talks excessively
6. often on the go or often acts as if driven by a motor

Impulsivity

7. often has difficulty awaiting turn in games or group situations
8. often blurts out answers to questions before they have been completed
9. often interrupts or intrudes on others, e.g. butts into other children’s games

B. Onset before the age of 7.

C. Some impairment from the symptoms is present in more than two or more settings (e.g. at school or work or at home)

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.       Dr. Saul Greenberg, Ontario Association of Pediatricians, University of Toronto

Psychosis can be defined as the presence of disruptions in thinking, accompanied by delusions or hallucinations, along with an alteration in thought processes.   Early signs and symptoms of childhood psychosis include:

• language delays
• late or unusual crawling
• late walking
• other unusual motor behaviours such as rocking and arm flapping
• seeing or hearing things that don’t exist (hallucinations)
• having beliefs not based in reality (delusions)
• lack of emotion
• emotions inappropriate for the situation
• social withdrawal
• poor school performance
• decreased ability to practice self-care
• strange eating rituals
• incoherent speech
• illogical thinking
• disorganized thoughts (break from reality)
• agitation

When psychosis begins early in life, symptoms may build up gradually and may be so vague that they are difficult to diagnose.  However, the symptoms become more severe as the child ages.

Mayo Clinic

Behaviour Disorders - Developmental Consequences

Developmental Consequences of Behavioural Disorders
Because the behaviours and the population are so heterogeneous, a profile of a typical child with behavioural disorders cannot be drawn. Each child is unique.   However, every child diagnosed with a behavioural disorder experiences other developmental consequences as a result.  Most commonly, the developmental consequences of behavioural disorders includes:

Cognitive Development - Many students with behavioural disorders may be slightly below the norm in cognitive development.

Academic Achievement - Children with behavioural disorders do not achieve well academically. They usually lag behind in reading, arithmetic, and spelling. The behaviour often hinders efficient learning in conduct-disordered children. Anxious children develop a defeatist attitude that hinders social development. The timid and passive behaviour of anxious and withdrawn children interferes with the adequate utilization of potential.

Communication – Problems such as speech and language disorders are often found as co-occurring disabilities in children with behavioural disorders.

Social and Emotional Development - Socialization is the means by which individuals become acceptable members of their society. Many children with behavioural disorders do not have social competence and lack social skills. They may show deficits in social cognition-the knowledge and cognitive activities used by people in dealing with the social world-and in prosocial behaviour-voluntary behaviour intended to aid or benefit others. Highly aggressive children have few friends and probably meet school failure. Children with personality disorders develop strategies to cope with anxiety. In doing so, they forego assertive, independent behaviour and instead exhibit low self-concept, poor self-esteem, and withdrawn behaviours.

Co-Occurring Disabilities  - Together with speech and language disorders, children with behavioural problems may have learning disabilities, anxiety, mood disorders, or Tourette syndrome.

Family Variables - Raising a child who is behaviourally disordered brings great stress to families.

Cultural and Linguistic Differences - Today, a high proportion of students served under the categories of behavioural disorders or serious emotional disturbance are from culturally and linguistically diverse groups. Misdiagnosis is often a culprit; equally important are the ideologies and expectations of school systems, which can have an immediate and profound effect on behaviour. Behaviour considered normal and adaptive in a subculture may be looked upon as deviant or inadequate by members of the dominant group.

Winzer, M.  Children with Exceptionalities in Canadian Classrooms.