17-EBDC

Synopsis

Introduction

Anorexia nervosa is a serious eating disorder defined by a refusal to maintain minimal body weight.

The Impact of Media and Consequences of Anorexia Nervosa

One possible cause of anorexia is cultural pressure. Many television shows often depict characters with desirable physical attributes such as slimness. Teenage girls, being at an impressionable age, are extremely susceptible to such influences from the media and may develop anorexia by dieting and/or exercising excessively or even resort to laxatives or starvation in order to reach the ideal figure, to the point that it becomes an obsession. The consequences of anorexia include social problems such as an increased likelihood of being socially excluded, as well as health problems such as jaundice and brittle bones, and in severe cases even death.

Behavioral Signs and Symptoms of Anorexia Nervosa

Typically, anorexic patients tend to be secretive in their behavior and also display signs of withdrawal from people. Another sign of someone who could possibly be suffering from anorexia is a drastic change from someone who was pleasant to someone who is:

1. irritable

2. easily annoyed by his/her parents

3. frequently squabbling about “not-so-important” things, and

4. unhappy all the time

What teachers can do to help students suffering from Anorexia Nervosa

In the case of suspected anorexic cases, teachers can advise parents to send their child for diagnosis and encourage the child to get treatment if he/she is indeed suffering from anorexia. However, teachers need to be sensitive when raising this issue due to the possible defensiveness and denial involved. A good approach a teacher can take is to gently express his/her concerns and let the child know that he/she is always there to lend a listening ear.

Other steps a teacher can take to help an anorexic student include

· seeking help from other members of the teaching community such as special needs officers.

· being a good role model for healthy eating, exercising, and body image by refraining from making negative comments about your own body or anyone else’s.

· maintaining an open channel of communication.

· using peer support systems to create an awareness of anorexia within the student’s peers.

Bibliography

1. DPA. (2007). Anorexia cases up in Singapore as teens compete for thinness. In Earth Times. Retrieved on February 8th, 2010 from http://www.earthtimes.org/articles/show/92658.html

2. National Alliance on Mental Illness. Mental Illnesses. Retrieved on February 8th, 2010 from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=65838

3. Roxanne Dryden-Edwards, M. (2010). Anorexia Nervosa, symptoms, signs, causes, diagnosis and treatment by medicine. Retrieved February 8, 2010, from http://www.medicinenet.com/anorexia_nervosa/article.htm

- End of Synopsis -

Emotional Behavioural Difficulties (covert)

1. The nature of area of special needs/ disability

• General definition (proposed by National Mental Health and Special Education Coalition) In Kavale, Forness & Mostert (2005). pp 48.
  • i. A disability characterised by behavioural or emotional responses in school programs so different from appropriate age, cultural, or ethnic norm that the responses adversely affect educational performance, including academic, social, vocational, and personal skills. Such a disability
  • o is more than a temporary, expected response to stressful events in the environment
  • o is consistently exhibited in two different settings, at least one of which is school-related; and
  • o is unresponsive to direct intervention in general education, or the child’s condition is such that general education interventions would be insufficient.
  • ii. Emotional and behavioural disorders can co-exist with other disabilities.
  • iii. This category may include children or youth with schizophrenic disorders, affective disorder, anxiety disorder, or other sustained disorders of conduct or adjustment where they adversely affect educational performance in accordance with (i).
• Range of conditions (if any)
  • Anxiety Disorders
    • Young people who experience excessive fear, worry, or uneasiness may have an anxiety disorder. Anxiety disorders are among the most common of childhood disorders. According to one study of 9- to 17-year-olds, as many as 13 of every 100 young people have an anxiety disorder (U.S. Department of Health and Human Services, 1999). Anxiety disorders include:
      • Phobias, which are unrealistic and overwhelming fears of objects or situations.
      • Generalized anxiety disorder, which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience.
      • Panic disorder, which causes terrifying "panic attacks" that include physical symptoms, such as a rapid heartbeat and dizziness.
      • Obsessive-compulsive disorder, which causes children to become "trapped" in a pattern of repeated thoughts and behaviors, such as counting or hand washing.
      • Post-traumatic stress disorder, which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness of violence, or exposure to other types of trauma such as wars or natural disasters.
    • Severe Depression
    • Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Studies show that two of every 100 children may have major depression, and as many as eight of every 100 adolescents may be affected (National Institutes of Health, 1999). The disorder is marked by changes in:
      • Emotions—Children often feel sad, cry, or feel worthless.
      • Motivation—Children lose interest in play activities, or schoolwork declines.
      • Physical well-being—Children may experience changes in appetite or sleeping patterns and may have vague physical complaints.
      • Thoughts—Children believe they are ugly, unable to do anything right, or that the world or life is hopeless.
    • It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide.
    • Bipolar Disorder
    • Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (sometimes called manic depression). Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder (about one in 100) often experienced their first symptoms during their teenage years (National Institutes of Health, 2001).
    • Attention-deficit/Hyperactivity Disorder
    • Young people with attention-deficit/hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Attention-deficit/hyperactivity disorder occurs in up to five of every 100 children (U.S. Department of Health and Human Services, 1999). Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet. Symptoms must be evident in at least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed.
    • Learning Disorders
    • Difficulties that make it harder for children and adolescents to receive or express information could be a sign of learning disorders. Learning disorders can show up as problems with spoken and written language, coordination, attention, or self-control.
    • Conduct Disorder
    • Young people with conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism. Current research has yielded varying estimates of the number of young people with this disorder, ranging from one to four of every 100 children 9 to 17 years of age (U.S. Department of Health and Human Services, 1999).
    • Eating Disorders (Our case study on Celine)
    • Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Eating disorders can be life threatening. Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys (National Institutes of Health, 1999).
    • Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food in one sitting). After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates of bulimia vary from one to three of every 100 young people (National Institutes of Health, 1999).
    • Autism
    • Children with autism, also called autistic disorder, have problems interacting and communicating with others. Autism appears before the third birthday, causing children to act inappropriately, often repeating behaviors over long periods of time. For example, some children bang their heads, rock, or spin objects. Symptoms of autism range from mild to severe. Children with autism may have a very limited awareness of others and are at increased risk for other mental disorders. Studies suggest that autism affects 10 to 12 of every 10,000 children (U.S. Department of Health and Human Services, 1999).
    • Schizophrenia
    • Young people with schizophrenia have psychotic periods that may involve hallucinations, withdrawal from others, and loss of contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia occurs in about five of every 1,000 children (National Institutes of Health, 1997).
• Characteristics
  • Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. These problems, often called "disorders," are sources of stress for children and their families, schools, and communities.
  • (Federal ED definition in the Individuals with Disabilities Education Act (IDEA)) In Kavale, Forness & Mostert (2005). pp 46.
    • o An inability to learn which cannot be explained by intellectual, sensory, and health factors.
    • o An inability to build or maintain satisfactory relationships with peers and teachers.
    • o Inappropriate types of behaviour or feelings under normal circumstances.
    • o A general pervasive mood of unhappiness or depression.
    • o A tendency to develop physical symptoms or fears associated with personal or school problems.

http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/default.asp

2. Causes of disability (if any)

• Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person.

http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/default.asp

3. The general impact of the special need or disability on a student in terms of development and learning

• can have detrimental effects on cognitive development in children;
• has a negative impact on student behavior and school performance;
• makes students feel irritable, decreases ability to concentrate and focus, decreases ability to listen and process information, may cause nausea, headache, and makes students feel fatigued and have lack of energy;
• makes students with disordered eating behaviors less able to perform tasks as well as their adequately nourished peers;
• leads to deficiencies in specific nutrients, such as iron, which has an immediate effect on students’ memory and ability to concentrate;
• can make students become less active and more apathetic, withdrawn, and engage in fewer social interactions;
• can impair the immune system and make students more vulnerable to illnesses; and
• increased absenteeism in affected students because of the above impairments.
• perfectionist attitude may compel them to maintain a high level of academic performance, which is even more difficult given their compromised physical and mental status.
• preoccupation with food often dominates the life of a student

http://www.nationaleatingdisorders.org/uploads/file/toolkits/NEDA-TKE-A04-ImpactInSchool.pdf

C. FOR YOUR GROUP PRESENTATION ASSIGNMENT: IMPLICATIONS FOR TEACHING AND LEARNING*

1. What would I expect of the student with the chosen area of special needs:

· he/she will want to be part of the class and activities in school

· he/she will want to have friends

· he/she may need extra support in terms of…

· CHARACTERISTICS

· low self-esteem

· difficulty building/maintaining interpersonal relationships

· compulsive behaviour

· withdrawn behaviour

· verbal and/or physical aggression

· excessive fear or anxiety

· depression

· poor social skills

· academic problems

· inappropriate crying

· temper tantrums

· non-compliant behaviour

· low motivation

· inattention and impulsivity

· poor self-control

· difficulty solving social and academic problems

· difficulty categorizing and organizing information in a logical format

(Special needs technology assessment resource support team, 1996)

• A general inability to cope with the routine of daily tasks
• Obsessive and repetitive behaviours
• Attention-seeking behaviour, such as negative interactions or a poor attitude towards work, peers or teachers
• Depressed behaviour, such as withdrawal, self-injurious behaviour or eating disorders.

(Emotional or behavioural difficulties)

2. How will this affect the other students in my class? How do I work with them to understand their peers and to create an inclusive classroom?

3. What would I suggest in terms of provisions/accommodations to meet the student’s needs? (suggest only in areas which are appropriate)

· learning environment (physical and socio-emotional)

· behaviours (look also into the reasons for inappropriate behaviours)

· instruction

· Ensure student knows what is expected of him, establish expectations and rules.

· Post established rules in a location where student can easily see.

· Come to prior agreement with the student on consequences for broken rules and apply these consistently.

· Praise appropriate behaviour as it occurs.

· When using tangible reinforcers to improve student behaviour, ensure they are age

appropriate and motivating for the student.

Help student to develop social skills, self-control and self-esteem. (Special needs technology assessment resource support team, 1996)

· collaboration (school, home, agencies)

· it is important that supportive links be established.

· This would include family and parents.

· In serious cases, a formal diagnosis involves assessment by psychologist and a psychiatrist.

(Emotional or behavioural difficulties)

Strategies for students classified with EBD

1. Routine:

Let there be a structured routine, possibly with a visual time clock. Sound cues may provide addition aid to help students manage their time efficiently. Schedules could be posted and referred to on a regular basis.

1. Changes in Routine: Convey any changes of routine to students as soon as available. This provides the students ample time to adjust to the new routine. Classroom Jobs
2. Chart/Classroom Order Chart: Classroom assignments could provide an opportunity for students to demonstrate responsibility. It would be beneficial for students to experience various jobs. Eg. Having a duty allocation chart with a rotational basis. Students with EBD tend to be competitive and require specific procedures.
3. Logical Consequences: Students must be held responsible for their doings. Consistency with consequences enable students to know what is expected of them.
4. Target Behaviors: After knowing the students observable behavior, determine which behavior or behaviors could be used to direct attention. Cooperate with student to develop a plan to replace undesirable behavior with a more suitable behavior.
5. Small Flexible Grouping: Students with EBD may have difficulty establishing relationships with their peers. Inappropriate language and other behaviors may interfere with learning. Smaller groups decrease distractions and student-to-teacher ratio. Differentiation of instruction is more manageable with smaller groups.
6. Audience: During a serious behavior episode, the most effective strategy may be to remove the audience. The audience typically is other peers but may be other adults. The audience can be removed by moving taking the student aside.
7. Calm spot: Have a designated area of the classroom for students to calm down. This spot can be used pro actively to prevent behaviors. Alternatively, the spot may be used after a behavior occurs to give the student a chance to refocus.
8. Choices: Students may frustrate easily when doing work. Giving students an option of when to complete the work is a powerful tool.

(wikipedia)

4. Do I have the skills to meet the student’s needs?

· knowledge of basic principles of effective learning and teaching

· need to know more about…

References

1. Kenneth A. KAVALE, Steven R. FORNESS and Mark P. MOSTERT (2005). Defining Emotional or Behavioral Disorders: The Quest for Affirmation. In Peter Clough, Philip Garner, John T. Pardeck & Francis K. O. Yuen (2005). Handbook of Emotional & Behavioral Difficulties. pp 45 to 58. Sage Publications

2. Emotional or behavioural difficulties. (n.d.). Retrieved December 13, 2009, from http://www.scoilnet.ie/article.aspx?id=3263

3. Special needs technology assessment resource support team. (1996). Meeting the Needs of Students with emotional/behavioural difficulties. Retrieved December 13, 2009, from Meeting the Needs of Students

4. wikipedia. (n.d.). Emotional and behavioral disorders. Retrieved december 13, 2009, from http://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders

Suggested Presentation

Scene 1: Ms. Lim slumped into her chair as she joined a group of other teachers in the school cafeteria. (Counsellor, Discipline Master and Senior Teacher? We can decide who is who next time)

Teacher 1: "Bad day?"

Ms. Lim nodded and sighed. "I don't know what to do with my class anymore..."

Teacher 2: "C'mon, it's not that bad..."

Ms. Lim looked at her with bewildered eyes. "Not bad? You had no idea. I was..." (dim lights and video starts on what happened in her class earlier.)

Teacher 3: "Well, what do you think could you have done differently?"

Ms. Lim (say something and conversation would revolve on the first three questions... DM giving advise on how to handle rowdy students, Senior Teacher on maybe some class rules and routines and Counsellor on building students' rapport? or something like that...)

Ms. Lim then brings out her concerns with Celine. Turning to the school counsellor, Ms. Lim asks, "You know, I have this student, she isn't fat but she likes to watch her figure a lot. I kind of suspect that she has eating disorder. What do you know about eating disorders?"

Counsellor: "What makes you think she has eating disorder?"

Ms. Lim: (Share "signs and symptoms of eating disorder: Celine's case study.)

Counsellor: "I can only tell you so much but there's this "Eating Disorder Awareness Talk" happening on (fill in the details*). Maybe you'll find it helpful. Drop by my room when later and I'll give you the brochure..."

Scene 2:

Narrator: Ms. Lim decided to go for the talk... (The narrator will inform the rest of the class that they are also going to be participants in the "talk" and that after a short video presentation, there will be a discussion... Note: Use split screen; the other screen will be to remind them the things that they can look out for)

>> Video Presentation (video from youtube)

After the video, a "facilitator" will consolidate what they've discussed.

Facilitator: "Alright, I hope you have now a better understanding of Anorexia Nervosa. Before I proceed, do you have any questions**?"

(We can choose to cater this discussion such that the audience will be made to suggest ways on what they think could've been done to not just cure Anorexia but to actually create an inclusive environment for students with eating disorder. Of course, we have to ask them what they got from the video and knowing those things, how will they think they'll be able to help Celine overcome her eating disorder... something like that)

>> End

footnotes: *wink*

- *Different participants like health practioners, teachers and parents? or, to make it more relevant, do we just cater the talk to "teachers"?

- **Are we planting questions?

Remark: Erm, the conversations are not set in stone. This is but an "outline" of what I thought a way in which we can conduct our presentation. Feedback, modifications and suggestions are very much welcome. Enjoy your weekend guys! ^_^

I think planting questions is good... to ensure we cover all the different 'technical' aspects of anorexia nervosa. i think assigning them with 'characters' is interesting. like wat czarina said... health practitioners, teachers, parents, even principals, reps from orphanages etc... how about having an "ex-patient"? to share his/her experience?

Possible questions to plant among the audience: