Academic Performance of Students with Emotional and Behavioral Disorders Served in a Self-Contained Setting

This study describes the academic, social, and behavioral performance of elementary and secondary students with emotional and behavioral disorders (EBD) receiving services in a self-contained school for students with serious behavior problems, with an emphasis on how school adjustment and problem behavior patterns predict academic performance. Results revealed that elementary and secondary group scores were well below the 25th percentile on reading, math, and written expression measures. Further, a seven variable model representing academic, social, and behavioral domains was able to differentiate between age groups explaining 54% of the variance and correctly classifying 78.26% (n = 18) of the elementary students and 84.21% (n = 16) of the secondary students. Findings also suggested that behavioral variables (e.g., school adjustment, externalizing, and internalizing) were predictive of broad reading and broad written expression scores, with school adjustment (a protective factor) accounting for the most variance in the three-variable model. Limitations and recommendations for future research are addressed.     

Inclusion and Students with Emotional/Behavioral Disorders

Summary

This article presents a point/counterpoint approach to the issue of full inclusion of all students with emotional/behavioral disorders. To set the stage for the discussion that follows, the academic, social, and behavioral characteristics of these students pertinent to classroom performance are reviewed. The pros and cons of these four issues are then presented: (a) appropriateness of the general education curriculum for students with EBD; (b) social acceptance and other social competence issues; (c) mental health interventions and supports in general education settings; and (d) legality of full inclusion. Under the legality issue, case law on full inclusion pertaining to students with EBD is briefly reviewed. The basic premise of the authors who are full inclusion opponents is that a continuum of placements, including full-time placement in general education classrooms, should be preserved so that decisions about appropriate settings can be made on an individual basis. The basic premise of the author who is a full inclusion proponent is that, rather than maintaining two separate systems, we should direct our energies toward correcting the inadequacies of the general education classroom for the benefit of all students, including those with EBD.     

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.     

Recognition of Facial Expressions of Emotion by Children with Emotional and Behavioral Disorders

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.     

A Comparison of Results and Acceptability of Functional Behavioral Assessment Procedures with a Group of Middle School Students with Emotional/Behavioral Disorders (E/BD)

There is currently controversy over the validity and applicability of functional behavioral assessment (FBA) procedures with students with emotional/behavioral disorders (E/BD). A set of FBA procedures, including teacher and student interviews and direct classroom observations, were carried out with eight students with disabilities (7 classified E/BD, one classified LD). Results indicated that when all three methods (teacher/student interviews, classroom observations) yielded a ranking for a function they agreed 64% of those occasions. For those situations in which there was overall disagreement there was agreement between teacher interview and classroom observations most of the time. Social validity data indicated that both students and teachers felt that the assessment procedures were a useful and productive process.     

Quality of Work Life as a Mediator Between Emotional Labor and Work Family Interference

Purpose  We adopted the conservation of resources model (COR, Hobfoll Am Psychol 44:513–524, 1989; Hobfoll in Stress, culture, and community: the psychology and philosophy of stress, Plenum, New York, 1998) to examine the associations among emotional labor, work family interference, and quality of work life. Design/Methodology/Approach  Cross-sectional, self-reported data were obtained from 442 Hong Kong Chinese service employees. Findings  Correlation and hierarchical regression analyses showed that surface acting was a salient correlate of work-to-family interference, even when organizational display rules and employees’ demographic information were controlled. Furthermore, quality of work life had partially mediated the relationship between surface acting and work-to-family interference. However, deep acting and expression of naturally felt emotion did not relate to work-to-family interference. Finally, we found that family-to-work interference was a salient correlate of the use of surface acting in workplace. Implication  This study provided useful information of how adopting different emotional labor strategies related to work family interference. Based on our results, the use of deep acting should be promoted in workplace because it related positively to quality of work life and it did not amplify the work-to-family interference. Originality/value  While past studies often explored the role of emotional labor as the precursor of work family interference, our study is among the first attempt to examine family-to-work interference as the antecedent of emotional labor. Additionally, we had also confirmed the role of quality of work life as an important mediator between emotional labor-work-to-family interference.     

An Analysis of the Status and Stability of the Behaviors of Students with Emotional and Behavioral Difficulties

Students with emotional and behavioral problems are placed in a variety of classroom settings, presumably where their needs can be best served. Little attention, however, has been dedicated to monitoring their behavioral progress in these settings. This study analyzed data on student engagement, disruption, and destruction during 10 types of instructional activities. Data were collected at two times across one academic year in Pennsylvania and California in 90 classrooms, ranging from grades 1 to 12. Tests of mean comparisons (i.e., independent samples and paired t-tests) and the association between variables (i.e., bivariate correlation analysis) were conducted to address a number of concerns regarding the status and stability of classrooms for students with EBD. Independent paired sample t-tests showed a lack of significant improvement in behaviors across time, and the correlational data reflect a significant relationship between student engagement and classroom activity. Findings are discussed in light of limitations and directions for future research. In addition, practical implications are noted.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Providing Ongoing Skill Development and Support for Educators and Parents of Students with Emotional and Behavioral Disabilities

Target six of the national agenda to improve outcomes for students with or at risk of emotional disturbance is reviewed. Having discussed this target with multiple stakeholders, the authors present four underlying themes that support ongoing skill development of providers and parents alike. These include building capacity of providers, decreasing isolation of school staff, gaining commitment of all school staff to support students with challenging behavior, and including parents and family members in staff development activities. The four underlying themes are discussed and recommendations given for ensuring ongoing skill development and support in education.     

Increasing Anger Log Use During School Among Middle School Students with Emotional/Behavioral Disorders

ABSTRACT

Although anger management programs often promote the use of anger logs as an alternative to aggressive behavior, researchers have not studied whether or not these programs actually increase anger log use. Thus, this study examines the impact of In Control, a classroom-based curriculum with 10 weekly 30-minute sessions, on the frequency of anger log use between sessions. Study participants were all of the students attending a middle school for emotional/behavioral disorders. Twenty-seven students received the In Control program, and 19 equivalent students did not. While anger logs were visibly available in all of the classrooms, the students who received the In Control program completed significantly more logs between sessions than did the nonprogram students. During a 4-month follow-up, the 19 program students who received monthly booster sessions continued to fill out significantly more logs than did the nonprogram students. These findings suggest that In Control can increase the use of a log to record anger-provoking episodes by middle school students with serious emotional/behavioral disorders, both in between training sessions and during follow-up, if booster sessions are provided.     

Reducing Time-Out Assignments for Students with Emotional/Behavioral Disorders in a Self-Contained Classroom

This study assessed the impact of a class-wide time-out/re-directing strategy on (a) the frequency of teacher-assigned time-outs and (b) the time students spent in disciplinary sanctions. Twelve students with emotional/behavioral disorders, enrolled in a self-contained elementary classroom were taught an alternative time-out strategy (Active Response Beads-Time Out), while teachers were taught a re-directing strategy, in an attempt to decrease the amount of student's time spent in time-out (TO) and the number of TO assigned by staff. Using a multiple baseline design across academic classroom periods, results showed that Active Response Beads Time-Out (ARB-TO) and teacher re-directions decreased the total time spent in time-out and number of TO assigned across the three class periods. Results maintained at one, two and four week follow-up sessions.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Anger Management Effects on Middle School Students with Emotional/Behavioral Disorders: Anger Log Use,Aggressive and Prosocial Behavior

ABSTRACT

This study examined the impact of a classroom-based, 10-week, cognitive-behavioral, anger management program plus booster sessions on middle school students with emotional disorders attending a therapeutic day school. Forty-five students were in the study; 20 received the program. The program group completed significantly more anger logs compared to the nonprogram group in both program and follow-up periods. Program students were observed to exhibit significantly more prosocial behaviors toward their teachers and showed a trend toward exhibiting fewer negative behaviors toward peers than nonprogram students at the end of the program. Program students also showed a trend toward fewer aggressive incidents than their nonprogram peers during follow-up. Findings may suggest mechanisms of change in anger management.     

A Review of Occupation-Based Life Skills Interventions for Adults with Neurodevelopmental Disorders

Adults with neurodevelopmental disorders are at a higher risk for poverty, unemployment, and difficulties in relationships. Instrumental activities of daily living deficits often go unaddressed and minimal research has explored interventions to address them. The purpose of this study was to synthesize findings about occupation-based life skills interventions for adults with neurodevelopmental disorders. Ten articles met inclusion criteria and the American Occupational Therapy Association level of evidence and quality ratings were identified. Results indicate that occupation-based life skills interventions effectively address limitations experienced by adults with neurodevelopmental disorders but the overall quantity and quality of evidence-based interventions are lacking.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Health-Related Quality of Life in College Undergraduates with Learning Disabilities: The Mediational Roles of Anxiety and Sadness

Little research has examined health-related quality of life (HRQoL) in adults with learning disabilities in post-secondary settings and the potential relationship between a learning disability and anxiety or sadness. This study examined HRQoL in 68 undergraduate students: 34 students who reported having been diagnosed with a “learning disability” were compared to 34 students who indicated they had not been diagnosed with a learning disability. Participants completed an online survey of anxiety, sadness, and HRQoL, including the SF-36. ANCOVAs on the Emotional Well-Being and Role Limitations Due to Emotional Problems scales from the SF-36 revealed that students reporting a diagnosis of a learning disability were significantly more impaired in Emotional Well-Being. Regression analyses suggested that impairment in Emotional Well-Being was mediated by separate ratings of both anxiety and sadness. Results indicated that those undergraduates reporting learning disabilities suffered from an impaired sense of well-being associated with anxious and sad feelings. A portion of these data were presented at the 2005 annual meetings of the Association for Behavioral and Cognitive Therapies (ABCT).     

Academic Processing Speed Mediates the Influence of Both Externalizing Behavior and Language Skills on the Academic Skills of Students with Emotional Disturbance

The results from previous research suggest that there is a relatively small (albeit statistically significant) relationship between the externalizing behavior and academic skills of students with emotional disturbance (ED). Researchers have also found that the majority of these students have language deficits that hinder their academic performance. The purposes of this study were to investigate the mediating role of academic processing speed (i.e., academic fluency) on the relationship between: (a) The externalizing behavior and academic skills of K-12 students with ED; and (b) language skills and academic skills of students with ED. Results indicate that academic processing speed mediated the influence of both language skills and externalizing behavior on academic skills of this population. The findings, limitations, and implications were discussed.     

Using a Behavioral Treatment Package for Sleep Problems in Children With Autism Spectrum Disorders

This study investigated the effectiveness of a behavioral treatment package for sleep problems in children diagnosed with Autism Spectrum Disorders. Treatment consisted of four behaviorally based components: circadian rhythm management, positive bedtime routines, white noise, and graduated extinction. A multiple-baseline design across three participants was used. Families completed a baseline of various lengths followed by 1 month of intervention. Results indicated the treatment package was effective in decreasing sleep onset latency and the frequency of night awakenings. A week of follow-up data showed continued improvement. Parents reported their children slept better and satisfaction with the four intervention components.     

Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach

Given the relationship between internalizing disorders and deficits in emotion regulation in youth, the emotion science literature has suggested several avenues for increasing the efficacy of interventions for youth presenting with anxiety and depression. These possibilities include the identification and addition of emotion-regulation skills to existing treatment packages and broadening the scope of those emotions addressed in cognitive-behavioral treatments. Current emotion-focused interventions designed to meet one or both of these goals are discussed, and the developmental influences relevant to the selection of emotion-focused treatment goals are explored using the framework of a modal model of emotion regulation. These various lines of evidence are woven together to support the utility of a novel emotion-focused, cognitive-behavioral intervention, the Unified Protocol for the Treatment of Emotional Disorders in Youth, a transdiagnostic treatment protocol that aims to treat the range of emotional disorders (i.e., anxiety and depression) simultaneously. Avenues for future directions in treatment outcome and assessment of emotion regulation are also discussed.