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Children Behaving Badly -- Helping Students with Emotional Disorders

By Carolyn Cosmos

They are the least likely to succeed and the most likely to not have friends, the most likely to drop out," says Eleanor Guetzloe, professor emerita at the University of South Florida in Tampa. She's speaking of children with emotional and behavioral disabilities, and she's concerned.

"School districts are getting rid of special services" with the focus on inclusion, and "general education teachers need to be well informed about the needs of children with emotional disturbance and how to manage classrooms with these children in them," she observes. "Yet most regular education teachers will tell you 'I am not trained to deal with this'" - that is, difficult behavior stemming from an emotional disability or disorder (EBD). (Terminology use and definitions vary widely.)

Robert Horner, professor at the University of Oregon in Eugene, has similar concerns.

"Schools are in a bind," he says. "Some are seeing more truancy, vandalism, and drug use, and, in some cases, schools are, in effect, "taking the most difficult kids and moving them into the juvenile justice system." Agrees Guetzloe, "These children are very difficult. People have just been throwing them out of school."

However, Horner says, when it comes to children who are behaving badly, "we know more than we ever have before how to assist these kids" - a clear cause for celebration.

The challenge lies in translating our collective special education expertise into action. The first challenge is society's "lack of political will" to commit resources to the effort. Secondly, referring too many children to intensive support services will "implode the system," Horner observes.

Taking the "big picture" into account can contribute to solutions, he believes. "Schools no longer are a reflection of a common social culture. There's greater diversity than there's ever been before." This can foster behavior problems in any child, not to mention the emotionally disturbed, because "kids need a very clear message about what's okay and not okay to do" - and that no longer automatically exists in our richly diverse but fragmented-culture schools.

Solutions

Use School-wide Positive Behavioral Support
Consensus can, however, be created. It can be developed school by school, district by district, through school-wide positive behavioral support (PBS) systems.

With these systems, "the goal is to place first-grader Alisha in a social culture where she knows what's expected of her and everyone around her knows it too. Every single child walking into that school is taught 'This is what we expect of children here,'" Horner explains.

In these school-wide positive systems - and over 800 schools in 20 states are now using them, Horner says - all children learn three to five locally defined rules, such as "Be respectful," "Be safe," or "Be Your Best." These rules are modeled and taught in a variety of locations throughout the campus, hung on the walls inside and out, and taught and reinforced by every adult entering the school.

"About 80 percent" of entering school children typically "come ready and willing to be socially appropriate; 15 percent are at risk, confused but needing only a little targeted support; and 3 to 5 percent need high intensity, wrap-around support," he observes.

In schools with PBS, "we believe that fewer [EBD] kids will be in special education. If you intervene early... they will not show up in fifth grade," Horner says. And children who need extra support through special education services can be better served.

Develop a District Collaborative
A number of school districts are taking a similar proactive, preventive, and positive approach to the handling of intensive support services for students challenged by emotional and behavioral problems. Using its resources in new and cost-effective ways, Mt. Diablo Unified School District near San Francisco, Calif., is one of them.

Mt. Diablo is developing a district-wide "Mental Health Collaborative" where the focus is on positive behavioral and mental health support. The idea is to address student needs before they reach crisis level and serve even those with severe disabilities within the school system itself "so students don't need to go out of the county," says Connie Cushing, the school district's program specialist for special education.

The district, school administrators, and school psychologists have taken the new Mental Health Collaborative through a pilot phase and "all special ed staff will receive training this fall," Cushing explains. The Collaborative uses designated consulting agencies and works with Contra Costa County Mental Health to provide, as needed, individual counseling, medication management, group counseling, crisis management, and case management services.

The Collaborative has set up special classes and centers in the schools at all levels - an elementary center for students who have less severe behavioral problems, an elementary day treatment program providing intensive support, and a "dual diagnosis class for young students with mild cognitive impairment and behavioral issues, Cushing explains.

For middle school children, the Collaborative deploys a mental health "enhanced" program at one school and day treatment at another. High school programs include a special mental health enhanced program and intensive day treatment.

The idea is to meet the needs of a range of children, including those whose problems are severe. While addressing "a myriad of different diagnoses, the whole gamut," Cushing comments that "we're seeing a lot of children with the extreme end of ADHD and many students with post traumatic stress syndrome, often as a result of abuse. There will be one or two children in each school who are extreme challenges, who may cut themselves, threaten suicide, or be very aggressive to staff. We do work with them," Cushing says.

The cost savings are substantial. "It may take $35,000 a year to send a student out to a non-public school, but a little more than half that, $19- $20,000" to treat them through the Collaborative. The program draws on a "braided funding stream" from multiple sources, including the district, county mental health services, and California's version of Medicaid. (Suggestions for ways you can start a collaborative in your own district are included later in this article.)

Try the Agency Assist
Public and private agencies providing this proactive, preventive, and positive support to schools vary but share a common devotion to avoiding aversive techniques.

"You can't use zero tolerance and work with kids," says Terry Johnston, director of one such private agency set up in 1997, PEP Assist, based in Cleveland, Ohio. "We accentuate the positive and help kids understand what they're doing right."

PEP, the longer-established parent agency, is a "positive education" consulting organization specializing in, but not limited to, children who are severely emotionally disturbed. It has been recognized for excellence and innovation by the U.S. Department of Education.

PEP runs a variety of community programs for troubled children in Ohio and several other states. They include a home-visiting program for infants and toddlers at risk, early intervention centers for children to the age of six, and day treatment centers for school children.

PEP Assist, Johnston explains, provides one-time or ongoing training and consultation for special and general education programs and teachers in public schools. It conducts functional behavior assessments, for example, or works with specific parents - whatever the school needs.

A state-wide collaborative approach has been deployed in New York since 1948, when its education department set up a system of cooperatives called Board of Cooperative Educational Services (BOCES) [pronounced BOW-sees]. These service-management cooperatives, or agencies, help school districts pool funds and programs in many areas of educational life, including, but not limited to, special education.

BOCES are public consulting agencies that attend to local needs. The Southern Westchester BOCES headquartered in Rye Brook, N.Y., for example, serves 35 school districts. It offers a variety of special education programs including one that helps gifted students who have emotional and behavioral problems. The BOCES gifted program conducts staff training and sets up and conducts classes in public schools.

Similarly providing statewide public support, Illinois, through its State Board of Education, has created a "Positive Behavior Interventions and Supports Network" for children who have emotional and behavioral disabilities. Since 1991 it has deployed 11 community-based sites that provide support and services for these youth. The goal, the board says, is to reduce the number of students placed "outside of their homes and communities."

Do It Yourself
Even without a district or state initiative, there are still things individual sites or teachers can do. For example, in Spokane, Wash., Shannon Lea Espinoza has set up an alternative middle school program for children who have significant behavioral difficulties and yet are not getting referred to special education because, in part, the school district "can't pay for it. None of my students qualifies for special ed," Espinoza explains.

Her alternative program (see Espinoza profile on page 2), started in the year 2000, has had good results so far. Start-up costs were supported by a grant from the state through her school district. The program is now self supporting and all costs are covered through standard student funding.

The program is deeply collaborative. As is the case in Mt. Diablo Unified School District in California, Espinoza has linked to public mental health services. Spokane Mental Health provides twice-weekly counseling services on site and trains Espinoza and other staff. She has strong collaborative ties with a university that feature faculty, student interns, and student volunteers. In addition to herself, there will typically be five other professional workers in her classroom when you walk in.

And here are some other initiatives that start with the "power of one."
Start a District Collaborative. Where do you begin? "I would suggest working with the highest special education person in your district," says Cushing. "Talk about the benefits to the students and families. Secondly, see if you and this person can come up with cost savings figures. Combine the costs of benefits to the families and cost benefits to the district. Look at annual per-pupil figures." Third, begin working with your county mental health and potential helper agencies.

In order to develop a program like this, you will need start-up funds to cover initial costs, but the long-term savings can be convincing to a superintendent and a school board, Cushing emphasizes.
Help General Education Teachers Help You. If your school needs to help general education teachers deal with their children who are difficult and emotionally challenged, there are Department of Education training funds to do that, Guetzloe observes. They flow through school districts. "Where you have skilled teachers, research shows, problems subside," she says. And that should make your own professional life a little less stressed.

What can you do for your general education colleagues right now? Every teacher faced with a challenging child, says Cushing, needs to know three things:

The nature of a functional analysis and how to informally figure out some of the functions of a student's challenging behaviors.
Resources available within a school such as the school psychologist and special education staff with particular expertise.
Community resources for mental health, public and private, and how to connect to an outside expert if needed.
Special education teachers can help themselves if they also help general education colleagues do the following five things, Cushing advises:
Modify a child's curriculum if needed. "First, fix that."
Examine the classroom environment to see if anything needs to change.
Identify missing student skills that need teaching and teach them.
Appreciate the power of reinforcement.
Develop, in advance, a plan for handling bad behavior.

Dealing with the Passive-Aggressive or Defiant Child
The child with emotional disabilities who is noncompliant or showing signs of oppositional defiance disorder (ODD) can drive any teacher to wit's end, many experts observe. Such a child may be exhibiting "passive-aggressive" behavior, seeking attention, and expressing anger indirectly through manipulative behavior that can include cruelties and stubborn refusals to cooperate.

"They can be the child who just doesn't do anything all day long, who sits there and says 'I'm not going to do it and you can't make me.' Teachers do get angry with these youngsters!" says Eleanor Guetzloe emphatically.

"These children are avoiding something, not being aggressive, getting what they want without acting out," she observes. "People will avoid something if they fear they can't be successful. If you asked me to play golf with Tiger Woods, you would find me pleasant but noncompliant."

So the first thing that must be done, Guetzloe emphasizes, is to make sure the child can do the work assigned. "To comply, it's got to be worth the child's while. It's got to get him or her something."

Then reward signs of effort. "It's terribly important with children with emotional and behavior disorders to get rewards for participation and that there are also rewards for work completion," she says.

However, don't go overboard. "If the child does a little bit, reward a little bit," she advises. "If the assignment is to write a paragraph and he puts his name on the paper and stops, you can say, 'Good! You've begun.' But don't give the child a good grade if the work isn't completed." A good reward tactic: Establish clear rules and let the child see other children getting attention for following these rules.

Another helpful strategy, she explains, is to make sure you are not rewarding the child for the problem behavior. There should be "no attention given for doing nothing. Attention is a powerful reinforcer."

For example, if the child has a puzzle on a desk and dumps it on the floor, "ignore it. Give no reward. Pick it up and walk away. Don't try the puzzle again." And if you are rewarding or penalizing an entire group, do not include a child with this disorder in the group.

Another strategy is to avoid punishment, she advises. "Don't take away. The child's account is in the red already...

They can be so tired of aversive treatment and taking too much punishment from other people." As difficult as it can be with these children, "Don't do anything in anger. Plan ahead."

Here are some other strategies you can use. They were developed by the University of Minnesota College of Education in Minneapolis and Kareen Smith of the university's Institute on Community Integration.

Give the child some brief, friendly attention each day to let him or her know you care.
Make a list of the child's behaviors that you find most annoying and list alternative behaviors that you find acceptable.
Keep calm. Plan in advance ways of keeping yourself calm when you are dealing with this child. Ask another teacher to "spell" you if necessary.
When you are setting limits, make interactions brief. The gifted child. The child with emotional disabilities who is gifted has special needs, learning disabilities, or suffer from both. But these too can be addressed with positive strategies, says Lois Baldwin, supervisor of a New York state BOCES program for gifted students who are emotionally disabled. As is the case with defiant and noncompliant kids, the place to start is with the learning task. "Many of these children are extremely bored. Differentiation of the curriculum is crucial," she observes, adding that it's important to not give them busy work if they completed other tasks. "That's punitive to these children." She also advises:
Let them work from their strengths. Research shows that if gifted children with behavioral disorders are allowed to do this "many of them will pull it together on their own."
Make one of their rewards free time to develop and work on their own projects. This could be working at a computer, constructing a messy model, organizing a community service project, developing a science or art project, or just reading a book they select themselves.
Look for learning disabilities that may not be apparent. "They're so smart they can mask it. They don't necessarily know it themselves."
Use cognitive strategies to address behavioral problems. "Talk it through with them. We don't use what we call 'M &M' reinforcers with these kids. They figure it out. They'll outwit you. Talk to them about their behaviors and discuss with them ways they can get what they really want. Teach them what they're doing right."
Help your general education colleagues learn how they can provide appropriate and positive reinforcements to gifted children who respond appropriately.

CEC Today thanks our online Discussion Group participants and survey respondents. Their comments helped guide this article.