The Special Challenges of Neurological-Based Behavior
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Transcript of The Special Challenges of Neurological-Based Behavior
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The Special Challenges of The Special Challenges of Neurological-Based Neurological-Based
BehaviorBehavior
The Special Challenges of The Special Challenges of Neurological-Based Neurological-Based
BehaviorBehaviorTimothy J. SmithTimothy J. Smith
EDUC 531EDUC 531Dr. WilliamsDr. Williams
February 3, 2010February 3, 2010
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Use people first language
• Students are real people living with a condition, not defined by the condition.
“A child with dyslexia” not
“a dyslexic child”
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Introduction toNeurological-Based Behavior
• All students misbehave at times; for some it is beyond their control
• Some erratic or inconsistent behavior is inexplicable and unresponsive to standard discipline strategies
• Behavior could be due to compromised cerebral functioning
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Compromised Cerebral Function
• Can be due to• Chemical imbalance, congenital brain
differences, brain injuries, or brain diseases
• Students can exhibit:• High degree of inattention, hyperactivity,
impulsivity, emotionality, anxiety, inconsistent emotional responses, unpredictable mood swings, withdrawal, or episodes of rage
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Identifying & diagnosing…
• Difficulties identifying typically cause lag between onset and diagnosis
• Without formal diagnosis, students untreated
• Brain, not background, causes difficulties
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Major characteristics of Neurological-Based Behavior
• Inconsistency
• Unpredictability
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Conduct disorder
Posttraumatic stress disorder
Anxiety disorders
Affective disorders
Attention-deficit hyperactivity disorder
What are some mental health diagnoses that are prominent in the literature ?
Miss 1
Miss 2
Miss 3
Oppositional defiant disorder
Autism spectrum disorder
Fetal alcohol spectrum disorder
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Students by the numbers…
• 1 in 5 have a mental health condition that affects behavior
• 1 in 10 suffer from serious emotional disturbance
• 1 in 5 who need help get treatment
• 1 in 20 are diagnosed with ADHD
• Suicide is– 3rd leading cause of death in 15-24 year olds
– 6th leading cause of death in 5-14 year olds
• Treatment can reduce symptoms by 70-90%
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Brain Injuries• Traumatic
– Blows to the head from events• Sporting• Accidents• Assaults
• Nontraumatic• Disrupted blood flow to brain (stroke)• Tumor• Infection• Drug overdose• Other medical condition
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Indicators• Behavior difficulties
– Can be atypical, inconsistent, compulsive– Immune to typical behavior management
• Language difficulties– Problems in understanding, processing, or
expressing information verbally
• Academic difficulties– Memory can be compromised– Could have difficulties with motor skills,
comprehension, language/math that add to problem
Note what special teachers do and adapt for your classroom.
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Sensory Integration Dysfunction
• Sensory integration– the ability to take in information, organize
it, interpret it, and react to it– Any disruption is SID– SID could be a cause of
• Hyperactivity• Inattention• Fidgetiness• Impulsivity• Inability to calm down• Lack of self control• Disorganization• Language difficulties• Learning difficulties
– Excess information is overwhelming
Keep room neat and tidy, quiet, minimize distractions, simplify.
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Common pediatric/adolescent
mental health diagnoses
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Attention deficit hyperactivity disorder
(ADHD)
• Characterized by– Short attention span– Weak impulse control– Hyperactivity
• Cause is unknown• 3 to 5% school age population• XY > XX; XY also exhibit
hyperactivity
Often comorbid with other conditions
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Oppositional defiant disorder
• Excessively uncooperative and hostile
• Symptoms– Frequent temper tantrums– Excessive arguing with adults– Active defiance and refusal to comply– Belligerent and sarcastic– Deliberately annoy or upset others– Blame others for mistakes or behavior– Touch/ easily annoyed– Speak hatefully when upset– Vengeful
• 5-10% have ODD
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Oppositional defiant disorder
• Use positive reinforcement– Especially when cooperating or
show flexibility
• Use earshot or indirect praise• Do not repeat unless needed• Take a personal timeout to
avoid conflict (model behavior)
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Bipolar disorder• Affective disorder
– Cyclic depression and mania• Silly, goofy, giddy, or disruptive• Irritable, angry, and easily annoyed
– Cause unknown– Often misdiagnosed as ADHD, ODD,
etc.– Can be treated with drugs, therapy,
and counseling
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Bipolar disorder• Students exhibit
– Hysterical laughter for no reason– Belligerence and argumentation followed
by recrimination– Jumping from topic to topic in rapid
succession when speaking– Blatant disregard of rules because they do
not pertain to them– Arrogant belief in superior intellect– Belief they are superhuman– Can be tired from lack of sleep; sometimes
performing better in afternoon
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Learning Disabilities
• Neurobiological disorders– Affect students of average or above average
intelligence
• Dyslexia– Difficulty processing language
• Dysgraphia– Difficulty with handwriting and spelling
• Dyscalculia– Difficulty with basic math
• Dyspraxia– Difficulty with fine motor skills
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Learning Disabilities• Indicators
– Inability to discriminate between/among letters, numerals, or sounds
– Difficulty sounding out words, reluctance to read aloud, avoid writing or reading tasks
– Poor grasp of abstract concepts; poor memory; difficulty telling time
– Confusion between left and right– Difficulty being disciplined; distractible; restless;
impulsive; trouble following directions– Say one thing but mean another; respond inappropriately
for situation– Slow work; short attention span; difficulty listening and
remembering– Poor eye-hand coordination; poor organization
Special testing is needed to confirm
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Autism Spectrum Disorder
• Includes Autism, pervasive developmental disorder, and Asperger syndrome.– Various abnormal development in verbal
and nonverbal communication, impaired social development, restricted repetitive and stereotyped behaviors and interests
• Varies in range of intelligence and language development
• ~1.5M in US
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Autism Spectrum Disorder
• Indicators– Self-stimulation, spinning, rocking, and
hand flapping– Obsessive compulsive behaviors, such as
lining up evenly– Repetitive odd play for extended periods– Insistence on routine and sameness– Difficulty dealing with interruption of
routine schedule and change– Monotone voice and difficulty carrying on
social conversations– Inflexibility of though and language
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Autism Spectrum Disorder
• Varies in intensity across spectrum• SID often comorbid• Some need around the clock care
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Fetal alcohol spectrum disorder
• Leading cause of mental retardation in western world, though most have normal intelligence
• Group of disorders– Fetal alcohol syndrome (FAS)– Alcohol related neurodevelopmental disorder (ARND)– Partial fetal alcohol syndrome (pFAS)
• 1% in US population• Ranges from mild to severe• Behavior can differ drastically even with same
condition• Compromised social and adaptive skills
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Rage• Not neurological but behavioral
– Exhibited by some NBB students
• Traumatic for all• Student has little control• Rage cycle consists of five phases
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Rage• Phase I
– Precedes rage and trigger• Phase II
– Triggering Phase• Phase III
– Escalation – can be mild or rapid• Phase IV
– Rage• Phase V
– Post-rage event
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Rage-Phase II• Recognize rage is coming and you may not be
able to prevent• Understand this is neurological, and is not
intentional or personal• Stay calm, quiet, non-adversarial• Use short, direct, and emotionless language• Do not question, scold, or be too wordy• Be careful of body language• Be empathetic verbally, do not make it
personal• Be calm, quiet, and succinct – use logical
persuasion to provide alternative
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Rage-Phase III• Stay calm• Ensure safety of others• If threatened, walk away• Calmly direct to safe place• Use short, direct language• Use care in body language• Use empathy to acknowledge students feeling• Calmly provide student with alternative• Praise student if they respond• Do not address language or behavior for now.
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Rage-Phase IV
• Allow student space• Do not restrain unless threat• Do not bully, question, or otherwise escalate• Do not try to make student understand• Support other in room
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Rage-Phase V• Reassure the student that all is OK now• Do not talk about consequences• When student is ready help to put language to
event• Help the student plan action plan for next
event• Take care of yourself – this was stressful
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Medications for Students with Behavioral Issues
• Most NBB are treatable with medication• Be aware of school policies on
medication•Vyvanse•Adderall XR•Concerta•Daytrana•Focalin XR•Metadate CD•Ritalin LA
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Summary• Be proactive in dealing with NBB• Establish positive and nurturing environment• Modify environment to be more friendly• Provide calm structured environment• Add structure where needed• Use humor• Use eye contact carefully; do not challenge or
threaten• Think before you react• Always provide a choice