SEBD Flashcards
prevalence of SEBD
Sutton et al. (2004):
15 % of 5 year olds show behaviour that is oppositional and defiant
4 –10 % of children show persistent and pervasive behaviour problems
7.4% of boys between 5 and 15 were conduct disordered
3.2% of girls between 5 and 15 were conduct disordered
In disadvantaged neighbourhoods estimates as high as 20%
general charavcteristics of SEBD
Difficulty in forming friendships
Often preoccupied or find it difficult to get involved in activities
Difficulty keeping on task
Difficulty taking part in group activities and discussion
Low self-esteem and often become victims of bullies
Aggressive and disruptive
Difficult conforming to classroom rules and routines
Excessively attention-seeking through negative behaviour / clinginess
perception of SEBD
Warnock Report (1978):
Emotional and behavioural difficulties viewed as special educational needs
Difficulties viewed as an interaction between the child and his/her environment
Armstrong (2013):
Teachers often ill-equipped to deal with children with SEBD
Problematic behaviour by students is a source of teacher burnout, distress and attrition
Need for change in educational practice with children with SEBD, particularly in enacting inclusion
dev psy basis of SEBD
Family conversations that centre on emotional experiences can help toddlers achieve a better understanding of their own and others feelings
Denham et al. (2003): emotional competence (assessed at age 3-4) has implications for children’s emerging social abilities and patterns of social adjustment
Attachment theory (Ainsworth Strange Situation) – identified both secure and insecure attachment types. Caregiving hypothesis (Ainsworth) - aspects thought to promote secure attachments: sensitivity, attitudes, synchrony, mutuality, support and stimulation
risk factors (caregivers) for SEBD
Clinically depressed caregivers: ignore babies’ social signs, fail to establish relationship
Caregivers who were unloved, neglected, abused as children: sometimes withdraw affection, neglect or abuse, particularly if difficult babies
Unplanned pregnancies/unwanted babies: children more frequently hospitalised, have lower grades, less stable family and more irritable
Families with health related/legal/financial problems: incidence of insecure attachments is highest in poverty stricken families
Caregivers with a poor relationship with spouse: less favourable attitudes towards infants, less secure ties
attachment and later dev
Waters (1979):
Children with insecure attachment at 15 months.
At age 3.5 yrs - more likely to be hostile and aggressive and be socially and emotionally withdrawn.
This pattern emerged also when seen at age 11-12 and age 15-16
conduct disorder (DSM V Criteria)
A pattern of repetitive behaviour where the rights of others or the social norms are violated, as manifested by the presence of three (or more) of the following 15 criteria in the past 12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals (7 criteria): e.g. often bullies, threatens, or intimidates others
Destruction of property (2 criteria): e.g. has deliberately engaged in fire setting with the intention of causing serious damage
Deceitfulness or theft (3 criteria): e.g. has broken into someone else’s house, building, or car
Serious violations of rules (3 criteria): e.g. often stays out at night despite parental prohibitions, beginning before age 13 years
Behaviour causes significant impairment in social or academic functioning
conduct disorder (DSM V subtypes)
Onset:
Childhood-onset: at least one symptom prior to age 10
Adolescent-onset: no symptoms prior to age 10
Unspecified onset: criteria met, but not enough information to determine whether onset before 10 years
Severity:
Mild: few criteria, relatively minor harm to others (e.g. lying, truancy)
Moderate: intermediate number / effect of criteria (e.g. stealing without confrontation, vandalism)
Severe: high number or considerable harm to others (e.g. forced sex, physical cruelty, use of weapon, breaking / entering, stealing with confrontation)
DSM V specifiers of Conduct Disorder
CD with limited prosocial emotions - at least 2 of the following in multiple settings: Lack of remorse / guilt Callous – lack of empathy Unconcerned about performance Shallow / deficient affect
features, causes and prevalence of conduct disorder
Associated features: learning problems depressed mood hyperactivity addiction dramatic or erratic or antisocial personality Cause: poor parenting child abuse poverty children brought up in chaotic environments Prevalence: 6 to 16% of boys 2 to 9% of girls
DSM V criteria for ODD
A pattern of angry / irritable mood, argumentative / defiant behaviour, or vindictiveness lasting at least 6 months, with at least four symptoms from any of the following categories, exhibited with at least one non-sibling individual (most days if under 5; at least weekly for 5+):
Angry / irritable mood: often loses temper; often touchy / annoyed; often angry / resentful
Argumentative / defiant behaviour: argues with authority figures / adults; defies / refuses to comply with requests; deliberately annoys others; blames others for mistakes / misbehaviours
Vindictiveness: spiteful / vindictive at least twice in last 6 months
Behaviour associated with distress in the individual / others, or impacts negatively on social / educational functioning
Not caused by substance use / psychotic / depressive / bipolar disorder
ODD severity
Severity:
Mild: symptoms confined to one setting (home / school / with peers)
Moderate: some symptoms present in at least two settings
Severe: Some symptoms present in three or more settings
Pervasiveness better predictor of functional impairment than number of symptoms
Virtually all with symptoms have them at least at home
Symptoms just at home demonstrated to be enough for clinical impairment
ODD features and causes
Associated features:
Learning problems
Depressed mood
Hyperactivity
Addiction
Dramatic or erratic or antisocial personality
Cause:
No systematic research into the causes of ODD
Genetic and environmental factors are probably combined
Children with oppositional defiant disorder are more likely to have family history of disruptive behaviour disorders, substance-use disorders, or mood disorders
intermittent explosive disorder
Recurrent outbursts demonstrating inability to control impulses: verbal / physical aggression twice weekly for three months or injury / destruction three times within a year
Must be disproportionate to stressors, not premeditated, cause distress / impaired functioning / legal / financial consequences, not explained by other mental / medical disorder / substance use
Cannot be diagnosed below age 6
Very small amount of research (~160 articles in past 30 years)
signs of depression in children
Frequent vague, non-specific physical complaints, such as headaches, muscle aches, stomach aches or tiredness
Frequent absences from school or poor performance in school
Talk of or efforts to run away from home
Outbursts of shouting, complaining, unexplained irritability, or crying
Being bored
Increased irritability, anger, or hostility
Reckless behaviour
Difficulty with relationships
major depressive disorder (DSM V criteria
Five or more of the following (must include 1 or 2), during a 2-week period, most of the time; change from previous functioning:
Depressed mood
Markedly diminished interest or pleasure in activities
Significant weight loss / gain or decrease / increase in appetite
Insomnia / hypersomnia
Psychomotor agitation / retardation
Fatigue / loss of energy
Feelings of worthlessness / excessive / inappropriate guilt
Diminished ability to think / concentrate / indecisiveness
Recurrent thoughts of death / suicidal ideation / suicide attempt / plan for committing suicide
Symptoms cause significant distress / impairment in functioning
Not attributable to substance use / medical condition / psychotic disorders
Seperation Anxiety Disorder
Excessive, age-inappropriate, fear about being apart from family members, especially parents; children fear being lost to their families or are sure something bad will happen to family members if they are separated from them
Prevalence: approximately 4% of children age 6-12 (no gender difference)
Symptoms:
Physical symptoms, such as headaches or stomach aches, particularly when they occur persistently in anticipation of separation from parents
Not wanting parents to be out of sight: following them around the house, requests to sleep in the parents’ bed at night
Nightmares about parents being gone or leaving
Causes and risk factors
A scary event that the child experiences personally (such as an earthquake) or hears about (e.g. a child abduction)
A serious separation (e.g. a parent’s service in the military)
Stress in the family or a significant change
Generalised Anxiety Disorder
Excessive, uncontrollable anxiety / worry about many events / activities most days
Symptoms: irritability, difficulty concentrating, lack of energy, difficulty falling asleep, restless sleep; may show physical symptoms (muscle tension, headaches, nausea)
May worry that things seen on TV will happen to them, expect worst possible outcome, underestimate ability to cope
Prevalence: approx. 2%; equally common in boys and girls, but slightly higher for older adolescent females
Average onset in early adolescence; symptoms increase with age; persistent over time
medical model of SEBD
Research over the past 15 years has demonstrated a steady increase in the use of psychopharmacology (medication) to treat children and adolescents with EBD
The medical model suggests that psychopharmacological interventions needed to be added to existing behavioral or psychosocial treatment for management of children with EBD, rather than treated as a distinct, separate alternative
There have been overall increases in the prescription of psychopharmacological medicines with as many as 2-4% of children in general education, 15-20% of children in special education and 40-60% of children in residential facilities receiving medication
educational model of SEBD
Social inclusion: Pupil support guidance (Charles Clarke, Secretary of State for Education, 1999):
“Even in the most difficult areas, schools can and do make a difference to the behaviour and attitudes of their pupils, especially when they are effectively supported by other agencies”
Estelle Morris, Minister of State for Schools, 1999:
“Good teaching, sound behaviour management, effective anti bullying policies, clear rewards, consistently applied sanctions and imaginative use of the curriculum all make a difference, and reinforce the message that all young people can achieve their potential”
child related factors explaning behaviour
Personality Cognitive ability Social skills Specific difficulties, e.g. dyslexia, ADHD, ASD Self-image
home, family and community factors explaining behaviour
Family finances Parental expectations Parental experiences Lifestyle Peer pressure Parenting styles Out of school activities
teacher and classroom factors explaining behaviour
Classroom management Curriculum Communication Rules and routines Rewards and consequences
whole school factors explaining behaviour
Behaviour policy Curriculum planning Quality of teaching and learning Pastoral, SEN and academic departments Teaching groups Extra curricular activities
procedure and general assessment of SEBD
Consultation / structured discussions with parents / carers, key staff
Observation: structured / unstructured; ABC analysis
Rating scales: e.g. Strengths and Difficulties Questionnaire (SDQ), Connors Comprehensive Behaviour Rating Scales (Conners CBRS)
ABC analysis of behaviour
Antecedents: things that come before the behaviour (triggers)
Behaviours: behaviours displayed by the child
Consequences: positive or negative consequences of the behaviour
Specific assessments for SEBD
Strengths and Difficulties Questionnaire (SDQ): 3-16; emotional symptoms, conduct problems, hyperactivity / inattention, peer relationship problems, prosocial behaviour
Conners’ CBRS: 6-18; parent / teacher / self-report (8+); includes emotional distress, academic difficulties, separation fears / anxiety, violence potential, defiant / aggressive behaviours, physical symptoms, GAD, CD, ODD, MDD and more
Reynolds Depression Scale: 7-13; self-report; maps depressive disorders in DSM-V
Beck Youth Inventories: 7-18; self-report; 5 inventories:
Beck Depression Inventory
Beck Anxiety Inventory
Beck Anger Inventory
Beck Disruptive Behaviour Inventory
Beck Self-concept Inventory
whole school level interventions for SEBD
Prioritising work on social emotional development, not just behaviour, e.g. SEAL programme
Work on underlying causes
Promote staff competence and well being
Implement whole school programmes
class/teacher level interventions for SEBD
Class environment / practice
Teacher strategies and skills
-Use of encouragement and rewards (e.g. Token system)
-Providing firm boundaries, limits and structure
-Reminders about consequences
-Consistent use of sanctions when necessary
Curriculum planning
Working with parents/carers
Working with other agencies
individual/group level interventions for SEBD
Social skills training Mentoring Stress management, therapeutic and counselling programmes Learning Support Units Circle of friends
SEBD interventions: support strategies
Ensure a consistent approach to the child’s behavioural difficulties
Encourage the provision of a positive classroom environment
Have group and class discussions (circle time) to focus on problems
Set up small social skills groups for children who have difficulties
Develop social interaction through games and problem-solving activities
Give short, clearly-defined tasks
Provide activities that encourage the building of self-esteem
Give the child opportunities to express their feelings
early intervention for SEBD
Start really early Promote attachment Parent training Strong school ethos and school programmes Family therapy Involvement in community
