Understanding Emotional and Behavioral Disorders (EBD) in Education

Children represent the future, and their mental health and emotional well-being are crucial for their future success and happiness. However, some children face emotional and behavioral challenges that can significantly impact their ability to learn and thrive. Emotional and behavioral disorders (EBD) can manifest in early childhood and adolescence, leading to academic and behavioral difficulties.

Defining Emotional and Behavioral Disorders (EBD)

Emotional and behavioral disorders (EBD) are a range of mental health and behavioral challenges that can affect a student's ability to succeed in traditional classroom settings. However, there is no single, universally accepted definition of EBD. Medical specialists may have different classifications and categorizations. The Diagnostic and Statistical Manual of Mental Disorders (DSM), in its fifth edition, does not list EBD as a specific category but acknowledges diagnoses that fall within the range of such disorders.

The term EBD is generally used in reference to children and adolescents and its effects on education and socialization. While the onset of the disorder typically occurs during childhood or adolescence, adults may also experience EBD symptoms, often due to inadequate treatment or management in their younger years. According to the Centers for Disease Control and Prevention, approximately one in five children experiences a mental disorder in a given year.

Various terms have been used to describe irregular emotional and behavioral disorders, including mental illness and psychopathology, which were often used for adults with such conditions. However, these terms were avoided when describing children due to the associated stigma. In the late 1900s, the term "behaviorally disordered" emerged.

The term "EBD" includes students diagnosed with schizophrenia. IDEA's definition highlights the social and cognitive challenges individuals with emotional disturbance face daily. More often than not, when children have an emotional disturbance, these behaviors persist for a long time.

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Types of Emotional and Behavioral Disorders

EBD encompasses a wide spectrum of disorders, including:

Anxiety Disorders: Characterized by extreme anxiety that impairs a person's ability to function, leading to difficulties in school, work, and daily life. This can manifest as generalized anxiety disorder, panic disorder, separation anxiety, social phobia, specific phobias, or post-traumatic stress disorder (PTSD). Common manifestations of anxiety disorders include physical symptoms such as increased heart rate, shortness of breath, sweating, trembling, chest pain, abdominal discomfort, and nausea.
Depression: Occurs in children under stress, experiencing loss, or having attentional, learning, conduct, or anxiety disorders. It can also run in families.
Oppositional Defiant Disorder (ODD): Involves acting in opposition, often to a person of authority, in a defiant manner. Behavior often escalates from irritability and uncooperativeness to hostility. CYP with ODD are typically openly hostile, negativistic, defiant, uncooperative, and irritable. They lose their tempers easily and are mean and spiteful towards others. They are mostly defiant towards authority figures but may also be hostile to their siblings or peers. ODD is considered the mildest and commonest of the DBPs, with prevalence estimates of 6%-9% for pre-schoolers, and boys outnumbering girls by at least two to one.
Conduct Disorder (CD): Consists of aggressive behavior and violation of rules and social norms. CD refers to severe behavior problems, characterized by repetitive and persistent manifestations of serious aggressive or non-aggressive behaviors against people, animals, or property, such as being defiant, belligerent, destructive, threatening, physically cruel, deceitful, disobedient, or dishonest, excessive fighting or bullying, fire-setting, stealing, repeated lying, intentional injury, forced sexual activity, and frequent school truancy. Children with CD often have trouble understanding how other people think, sometimes described as being callous-unemotional. They may falsely misinterpret the intentions of other people as being mean. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. It also requires the presence of three symptoms from the list of 15 (above), and a duration of at least 6 months. CD is the commonest reason for CYP referral for psychological and psychiatric treatment. Roughly 50% of all CYP with a MHD have a CD. Majority of boys have an onset of CD before the age of 10 years, while girls tend to present mainly between 14 and 16 years of age.
Attention Deficit Hyperactivity Disorder (ADHD): Characterized by inattention, hyperactivity, and impulsivity. ADHD is the commonest neuro-behavioural disorder in children and adolescents, with prevalence ranging between 5% and 12% in developed countries. ADHD is characterized by levels of hyperactivity, impulsivity, and inattention that are disproportionately excessive for the child’s age and development.
Obsessive-Compulsive Disorder (OCD): Involves acting out repetitive compulsive behaviors, spurred on by extreme fears and irrational thoughts. What starts as an obsession becomes a compulsion. The person performs the behaviors as a means of relieving stress, but the relief is only temporary.
Autism Spectrum Disorder (ASD): A neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities.
Social (Pragmatic) Communication Disorder (SCD): Characterized by persistent difficulties with using verbal and nonverbal communication for social purposes, which can interfere with interpersonal relationships, academic achievement, and occupational performance, in the absence of restricted and repetitive interests and behaviors.

Factors Contributing to EBD

The reasons for a person's vulnerability to EBD can be varied. These may include:

Biological Factors: A biological cause or hereditary link within the family.
Brain Damage: An accident creating brain damage, a physical illness, or disability.
Environmental Factors: Aspects related to school or home life, such as a traumatic experience, excessive or inconsistent discipline, or a particularly pressurizing situation. Some environmental factors have been identified which are likely to increase the risk of challenging behaviour, including places offering limited opportunities for making choices, social interaction or meaningful occupation. Other adverse environments are characterized by limited sensory input or excessive noise, unresponsive or unpredictable carers, predisposition to neglect and abuse, and where physical health needs and pain are not promptly identified.

Characteristics and Identification

Students with EBD are a diverse population with a wide range of intellectual and academic abilities. Males, African-Americans, and economically disadvantaged students are over-represented in the EBD population, and students with EBD are more likely to live in single-parent homes, foster homes, or other non-traditional living situations. These students also tend to have low rates of positive social interactions with peers in educational contexts.

Students with EBD are often categorized as "internalizers" (e.g., have poor self-esteem or are diagnosed with an anxiety disorder or mood disorder) or "externalizers" (e.g., disrupt classroom instruction or are diagnosed with disruptive behavior disorders such as oppositional defiant disorder and conduct disorder). Male students may be over-represented in the EBD population because they appear to be more likely to exhibit disruptive externalizing behavior that interferes with classroom instruction. Females may be more likely to exhibit internalizing behavior that does not interfere with classroom instruction, though to what extent this perception is due to social expectations of differences in male and female behavior is unclear.

A person with EBD with "internalizing" behavior may have poor self-esteem, have depression, experience loss of interest in social, academic, and other life activities, and may exhibit non-suicidal self-injury or substance abuse. Students with internalizing behavior may also have a diagnosis of separation anxiety or another anxiety disorder, post-traumatic stress disorder (PTSD), specific or social phobia, obsessive-compulsive disorder (OCD), panic disorder, and/or an eating disorder.

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Students with EBD that show externalizing behavior are often diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, autism spectrum disorder and/or bipolar disorder; however, this population can also include typically developing children that have learned to exhibit externalizing behavior for various reasons (e.g., escape from academic demands or access to attention). These students often have difficulty inhibiting emotional responses resulting from anger, frustration, and disappointment. Students who "externalize" exhibit behaviors such as insulting, provoking, threatening, bullying, cursing, and fighting, along with other forms of aggression.

Teachers are more likely to write referrals for students that are overly disruptive.

Impact on Cognition and Emotion Regulation

Emotional disorders can significantly impact cognitive processes and emotion regulation. Research has shown a relationship between emotional disorders and cognition. Specific cognitive processes (e.g., attention) may be different in those with emotional disorders. Emotional disorders can also alter the way people regulate their emotions, leading to the use of maladaptive emotion regulation strategies.

Strategies for Supporting Students with EBD

Students with EBD have unique learning needs and struggle differently compared to their peers without such challenges. Instructional strategies for students with behavioral problems must prioritize their unique needs and challenges. These strategies include:

Providing Choices: Offer the student up to three options and ask them to choose just one. Then, offer them time to decide and wait for their response.
Encouraging Reflection: Engage students with thought-provoking questions that encourage reflection.
Using Visual and Acoustic Cues: Associate visual or acoustic cues with the concepts being taught. For example, associating actions or hand signals with lesson concepts.
Accommodating Different Learning Styles: Recognize that students learn differently and tailor instruction accordingly.
Regular Assessment and Monitoring: Regularly assess and monitor student progress to identify areas of difficulty and adjust instruction.
Breaking Down Tasks: These students exhibit shorter attention spans and difficulty focusing. Break the reading time into shorter intervals. Stop in between sessions to ask questions, encourage self-reflection, and clarify some points.
Addressing Aggressive Tendencies: Understand the root of the incident and allow the student to take responsibility by adopting Life-Space Interviewing. This repair and rebuild strategy can bring balance back into the classroom and provide support to students with emotional and behavioral challenges.
Utilizing Story Maps: A story map is a graphic organizer of the elements of a story, such as the settings, characters, plot, and theme. This tool benefits the students and helps the teacher facilitate the discussion and ensure the student’s understanding of key story elements.
Reinforcing Positive Behavior: Use rewards and positive language to reinforce positive behavior. A classroom positive behavior chart can help track students’ behavior improvement. Model these rules as a teacher to further reinforce positive behavior.

Treatment Approaches

When a child or adult displays emotional behaviors, or there is a hint of an underlying emotional dynamic to the behavior, it is essential to seek help. A family doctor can refer to a mental health professional or psychiatrist specializing in emotional and behavioral disorders. Early intervention is crucial to prevent potential negative outcomes such as substance abuse, violent abuse of others, dropping out of school, job instability, legal issues, and suicide.

Treatment approaches may include:

Medication: Medication may be prescribed for managing the behavioral aspect of the disorder. Examples include Ritalin for ADHD to induce calmness, focus, and control impulsivity and restlessness, and antidepressants for anxiety disorder and OCD. However, prescription medication is not without risk, and dependency is possible.
Therapy: Talking therapies, such as psychotherapy, are recommended for dealing with the emotional issues often at the base of the disorder. Cognitive behavioral therapy (CBT) is often utilized for disorders such as OCD or ODD. Therapy treatments may involve individual therapy, family therapy, and sometimes group therapy. It is important to ensure that the therapist is a fully trained and licensed professional.
Healthy Lifestyle: A healthy diet and exercise are significant components to supplementing or controlling behavior or emotional health.
Applied Behavior Analysis (ABA): Uses ABA principles with person-centred values to foster skills that replace challenging behaviours with positive reinforcement of appropriate words and actions.
Self-Management Strategies: Uses interventions to help individuals learn to independently regulate, monitor, and record their behaviours in a variety of contexts and reward themselves for using appropriate behaviours.
Fading Prompts: Gradually decreases the use of prompts during instruction over time.

Historical Context

Historically, mental illnesses were often misunderstood and attributed to demonic possession or witchcraft. In the early to mid-1800s, asylums were introduced in America and Europe, where patients were often treated cruelly. In 1963, the Community Mental Health Centers Construction Act was passed, providing federal funding to community mental health centers and changing the way mental health services were handled. In 1978, Public Law 94-142 required free and public education for all disabled children, including those with EBDs.

The Role of Educators

Teaching in an EBD classroom requires compassion, resilience, and patience. Educators play a vital role in helping students regulate their emotions, build trust, and gain the social tools they need to succeed. EBD teachers require specialized training to effectively support their students.

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