CHAPTER 3 NBB. Students affected by NBB are real people struggling to do the best they can in life, and are referred to using person first language, such.

CHAPTER 3

NBB

Students affected by NBB are real people struggling to do the best they can in life, and are

referred to using person first language, such as “students with dyslexia.”

Neurological Based Behavior (NBB) indicates that much of behavior is outside student control,

and that students behave as they do because of the way their brain works.(based on National Institute of Mental Health 2005)

• Some of the categories of mental health diagnoses are accompanied by restlessness and short

attention span; others affect mood or feeling.• Most of these disorders are treated with medications, some of which may adversely affectstudents’ attention, concentration, and stamina.• Two major characteristics of NBB are inconsistency and unpredictability (Kranowitz,

1998).• Three NBB indicators:• behavior difficulties (especially if the behavior is atypical, inconsistent, perhapscompulsive, and immune to normal behavior management)• language difficulties (problems in understanding, processing, and expressinginformation verbally)• academic difficulties (compromised memory, and/or difficulties with fine and grossmotor skills, comprehension, and language and mathematic skills).

Facts:• Childhood mental health conditions now are very common.• On average, about one in five students have one or more mental health conditions that affectbehavior in school (DeAngelis, 2004).• One in ten students may suffer from a serious emotional disturbance (National Institute ofMental Health, 2005).• Only 20 percent of children with mental health disorders gets the kind of treatment they need(American Psychological Association, 2004).• ADHD is the most commonly diagnosed mental health disorder in children, affecting three tofive percent of school-age children (National Institute of Mental Health, 2005).• Suicide is the third leading cause of death for 15-to-24 year-olds, and the sixth leading causeof death for 5-to-14-year olds (American Academy of Child and Adolescent Psychiatry,2004).• Twenty-two percent of youths in juvenile justice facilities have a serious emotionaldisturbance, and most have a diagnosable mental disorder (U.S. Office of Juvenile Justice andDelinquency Prevention, 2001).• Often multiple mental health symptoms exist simultaneously (Feldman, 2004). Two or morediagnoses that exist simultaneously are called co-morbid diagnoses.• Mental health disorders are biological (not related to a person’s character or intelligence, orovercome through will power).• Serious mental illnesses now can be treated effectively, bringing a 70 to 90 percent reductionin symptoms (National Institute of Mental Health, 2005).

Brain Injuries are physical injuries to the brain that affect its ability to function.

• Traumatic injuries result from blows to the head incurred during events such as accidents,

sporting events, or assaults.• Non-traumatic injuries result from

disrupted blood flow to the brain (as in strokes), or from

tumors, infections, drug overdoses, and certain medical conditions (Acorn and Offer, 1998).

General Suggestions for Working with Students with Neurological

Based Behavior• Learn as much as you can about the condition, including

how individuals with the condition relate to each other, and how they relate to teachers and school in general.

• Use fewer words.• Increase wait time for compliance.• Make directions clear, concrete, and consistent.• If possible, physically show directions in addition to telling.• Ask students to repeat and show you what they are

supposed to do.• Differentiate instruction and use Gardner’s theory of

multiple intelligences to teach concepts.• Establish a positive, nurturing rapport with the students.• Modify the classroom to make it more sensory-friendly.• Provide a calm, structured, and nurturing environment.

• Add structure to time periods that ordinarily are unstructured, such as recess and free time.

• Use and teach humor.• Be careful of eye contact to avoid misinterpretation as a

challenge or threat.• Be careful how you react to situations.• When giving students choice, provide two alternatives

you can live with and let the students select the one they prefer.

• Be accepting of these students’ limitations—you cannot change them through repeated criticism.

• When appropriate to do so, work closely with diagnostic and support staff and utilize any special services and resources to their fullest extent.

More Specific Suggestions for Working with Certain Conditions

Sensory Integration Dysfunction (SID). Sensory integration refers to the automatic process we use to take information from our senses, organize, interpret, and respond to it.

Sensory Integration Dysfunction (SID) refers to when the process is flawed, and seems to be a major cause

of hyperactivity, inattention, fidgety movements, inability to calm down, impulsivity, lack of self control, disorganization, language difficulties, and learning difficulties.

Things to remember about students who are diagnosed with SID:

• Poor learning and inappropriate behavior may result when individuals do not receive

information properly or interpret it incorrectly because of flaws in the sensory integration

process.• Again, SID seems to be a major cause of hyperactivity,

inattention, fidgety movements,inability to calm down, impulsivity, lack of self control,

disorganization, languagedifficulties, and learning difficulties.

• Excess visual stimulation can overwhelm some students’ sensory processing systems.

• The sensory processing systems of some students seem to become easily overwhelmed by

excess visual and auditory limitations.

Advice from authorities

• Learn as much as you can about the condition, including how individuals with the condition relate to each other, and how they relate to teachers and school in general.

• For students with characteristics of SID, keep the classroom neat and tidy.

• Remove sources of loud unpredictable noise.• Enlarge printed questions or directions.• Stand in front of a solid white wall, board, or overhead screen

when giving instructions and directing lessons.• Give directions slowly and distinctly.• Check understanding by having students repeat information

and instructions.• Maintain calm in the classroom.• Be accepting of these students’ limitations—you cannot change

them through repeated criticism.

Attention Deficit and Hyperactivity Disorder (ADHD)

Based on Amen, 2001Facts:• ADHD is the most commonly diagnosed mental health

disorder in children.• ADHD can begin in infancy and extend into adulthood, with

negative effects on life at home, in school, and in the community.

• ADHD affects approximately 3-5% of school-age children.• The exact cause is unknown, but research suggests a

hereditary component.• Males are more likely than females to have the condition.• Among students with ADD/ADHD, males typically have ADD

with hyperactivity, while females typically have it without hyperactivity.

• ADHD very often is co-morbid with other diagnoses.

Things to remember about students who are diagnosed

with ADHD:

• ADHD is characterized by traits that inhibit learning and lead to misbehavior: short attention span, weak impulse control, and hyperactivity.

• • ADHD very often is co-morbid with other diagnoses.

Advice from authorities• Learn as much as you can about the condition, including how individuals with the

condition relate to each other, and how they relate to teachers and school in general.

• Maintain cordial relations with students with characteristics of ADHD.• Provide a calm, structured, positive learning environment that is uncluttered and

wellorganized to minimize distractions.• Seat students near you.• Establish clear standards of behavior, with realistic, predictable consequences for

infractions.• Model positive behavior.• Assign work that is within the student’s capabilities. The material may need to be

brokeninto tasks that can be accomplished in short amounts of time.• Make instructions clear and concise, giving only one direction at a time. Make eye

contactbefore giving instructions, and ask students to repeat instructions you give.• Develop consistent daily routines and prepare students for any change in the

procedure toavoid disorientation.

• Make sure homework can be completed easily and gets done. Communicate closely with caregivers and encourage their involvement in students’ homework.

• Use nods, smiles, pats on the back, and praise as frequent reinforcement. Use points or tangible items if stronger reinforcement is needed. Encourage student self-talk about how

good behavior is self-gratifying.• When students diagnosed with ADHD become upset, use

time-out to allow them to think quietly about the problem and resolve it on their own.

• Avoid fatigue, stress, and pressure, and provide opportunities for rest and relaxation.

• Coach students on how to make friends and relate to others.

• Avoid power struggles.• Be accepting of these students’ limitations—you cannot

change them through repeated criticism.

Oppositional Defiant Disorder (ODD)Based on The American Academy of Child and Adolescent

Psychiatry (AACAP), 2004)

Facts:• Five to 15 percent of all school-age

children have ODD.• The cause is unknown.• ODD can damage social, family,

and academic life.

Things to remember about students who are diagnosed with ODD:

• Oppositional defiant behavior is especially uncooperative and hostile.

• Symptoms include: frequent temper tantrums, excessive arguing with adults, active defiance

and refusal to comply with adult requests and rules, belligerent and sarcastic remarks made

when directly praised, deliberate attempts to annoy or upset people, blaming others for one’s

own mistakes or misbehavior, being touchy or easily annoyed by others, speaking hatefully

when upset, and seeking revenge.

Advice from authorities• Learn as much as you can about the condition, including how

individuals with the condition relate to each other, and how they relate to teachers and school in general.

• For students with characteristics of ODD, use positive reinforcement when they show flexibility or cooperation.

• Use indirect or earshot praise. (Student “overhears” adults talking positively about him/her,intentionally to be overheard.)

• Reduce the number of words you use when speaking to a student with ODD.

• Say and show what you mean, just once, and then do not explain yourself further. Students will ask if they need more information.

• If you need to, take personal time-out to calm down.• Be a good model for the student.• Be accepting of these students’ limitations—you cannot

change them through repeated criticism.

Bipolar DisorderBased on University of Sheffield, 2004 and

Papolos and Papolos, 2002

Facts:• The cause is unknown.• The condition in children is

sometimes misdiagnosed as ADHD, depression, oppositional

defiant disorder, obsessive compulsive disorder, or separation anxiety disorder.

Things to remember about students who are diagnosed with Bipolar Disorder:

(based on University of Sheffield 2004 and Papolos and Papolos 2002)

• Bipolar is an affective disorder characterized by severe mood swings that occur in cycles of mania and depression, or highs and lows.

• Individuals can change abruptly from irritable, angry, and easily annoyed, to silly, goofy, giddy, and disruptive, after which they return again to low energy periods of boredom, depression, and social withdrawal.

• Abrupt mood and energy swings sometime occur several times a day.

• These swings often are accompanied by low tolerance to frustration, outbursts of temper, and oppositional defiant behavior.

• Students with bipolar disorder also frequently are diagnosed with sensory integration

• Indicators include: hysterical laughing for no evident reason; belligerence and argumentation followed by self recrimination; jumping from topic to topic in rapid succession when speaking; blatant disregard of rules because they think the rules do not pertain to them;

arrogant belief that they are exceptionally intelligent; belief they can do superhuman deeds without getting seriously hurt.

• Bipolar condition interferes with the quality of sleep.

• At school, students may show irritability and nebulous thinking during morning hours, but become able to function better in the afternoon.

Advice from authorities• Learn as much as you can about the condition, including

how individuals with the condition relate to each other, and how they relate to teachers and school in general.

• • Minimize visual and auditory distractions in the classroom for students who display characteristics of bipolar disorder.

• • Give directions slowly and distinctly.• • Check understanding by having students repeat

information and instructions.• • Avoid fatigue, stress, and pressure, and provide

opportunities for rest and relaxation.• • Maintain calm in the classroom.• • Be accepting of these students’ limitations—you

cannot change them through repeated criticism.

Learning Disabilities (LD)

Facts:(based on National Council for Learning Disabilities,

2005)• Some common learning disabilities are dyslexia,

which is difficulty in processing language;dyscalculia, difficulty with basic mathematics;

dysgraphia, difficulty with handwriting andspelling, and dyspraxia, difficulty with fine motor skills.• Because LD often is confused with other diagnoses, it

is useful to note that learning disabilities are not the same as attention disorders such as Attention Deficit/ Hyperactivity

Disorder, although the two may occur together.• Learning disabilities are not the same as mental

retardation, autism, hearing or visual impairment, physical disabilities, or emotional disorders.

• Learning disabilities are not caused by lack of educational opportunities, frequent changes of schools, poor school attendance, or lack of instruction in basic skills.

• Learning disabilities are difficulties in learning certain topics, especially in reading, writing, and mathematics.

• Specialized psychological and academic testing is needed to confirm diagnoses of LD.

• The law requires that a multidisciplinary team make the diagnosis: teacher, student, other school staff, family members, and appropriate diagnostic professionals.

• Based on assessment and availability of resources, special services may be provided.

Facts about Dyslexia:(based on U.S. National Institute of Health, 2002

and Levinson, 2000)

• Dyslexia is the most widespread and commonly recognized of all learning disabilities.

• It affects over 40 million American children and adults.

• It is characterized by difficulties in word recognition, spelling, word decoding, and occasionally with the phonological (sound) component of language.

• From a young age, students with dyslexia show deficits in coordination, attention, and reading.

• In the late 1960s, Levinson concluded that dyslexia is due to a signal-scrambling disturbance

involving the inner ear and the cerebellum.

Things to remember about students who are diagnosed with Learning Disabilities:

(based on the National Council for Learning Disabilities 2005)

• LDs are neurobiological disorders that interfere with learning in specific subjects or topics,

and are categorized by the academic areas in which difficulties are identified.• They affect students of above average intelligence, making it difficult for them to

receive and process information.• They appear to be inherited, and affect girls as frequently as boys.• Students never outgrow their particular LD, but with support and intervention can besuccessful in learning and life.• Indicators include: inability to discriminate between/among letters, numerals, or

sounds;difficulty sounding out words; reluctance to read aloud; avoidance of reading and/or

writingtasks; poor grasp of abstract concepts; poor memory; difficulty telling time; confusionbetween right and left; distractibility; restlessness; impulsivity; trouble following

directions;inappropriate responses; slow work pace; short attention span; difficulty listening andremembering; eye-hand coordination problems; poor organizational skills.

Advice from authorities• Learn as much as you can about the specific learning disability, including how individuals

with the condition relate to each other, and how they relate to teachers and school in general.

• Minimize visual and auditory distractions in the classroom for students who are diagnosed

with learning disabilities.

• Provide a calm, structured, positive learning environment that is uncluttered and well

organized to minimize distractions.

• Differentiate instruction and student products to accommodate the specific area of difficulty

(reading, writing, or mathematics).

• Make instructions clear and concise, giving only one direction at a time. Make eye contact

before giving instructions, and ask students to repeat instructions you give.

• Assign work that is within the student’s capabilities. The material may need to be broken

into tasks that can be accomplished in short amounts of time.

• Make sure homework can be completed easily and gets done. Communicate closely with

caregivers and encourage their involvement in students’ homework.

• Be accepting of these students’ limitations—you cannot change them through repeated

criticism.

• Work closely with diagnostic and support staff and utilize any special services and resources

to their fullest extent.

Autism Spectrum Disorder (ASD)Based on Faraone, 2003

Facts:• About 1.5 million American children and adults

are thought to have some form of autism.• It occurs in every ethnic and socio-economic

group and affects four times as many males asfemales.

Things to remember about students who are diagnosed with Autism Spectrum

Disorder:

• ASD includes various diagnoses of abnormal development in verbal and non-verbalcommunication, along with impaired social development and restricted, repetitive, andstereotyped behaviors and interests.• ASD also includes pervasive developmental disorder (delays in the development ofsocialization and communication skills).• Asperger Syndrome is a pattern of behavior among students of normal intelligence andlanguage development who also exhibit autistic-like behaviors and marked deficiencies insocial and communication skills.• In its milder form, autism resembles a learning disability.• Indicators include: self-stimulation, spinning, rocking, and hand flapping; compulsivebehaviors; repetitive odd play for extended periods of time; insistence on routine andsameness; difficulty dealing with interruption of routine schedule and change; monotonevoice and difficulty carrying on social conversations; inflexibility to thought and language.• Sensory integration dysfunction also is common in students with ASD, and sensory

overload can lead to behavior problems.

Advice from authorities• Learn as much as you can about the condition, including how individuals with the

condition relate to each other, and how they relate to teachers and school in general.• Maintain cordial relations with students who are diagnosed with ASD.• Because SID also is common in students with ASD, modify the physical environment tominimize distractions and stimuli.• Remove sources of loud unpredictable noise.• Enlarge printed questions or directions.• Stand in front of a solid white wall, board, or overhead screen when giving instructions

anddirecting lessons.• Give directions slowly and distinctly.• Check understanding by having students repeat information and instructions.• Assign work that is within the student’s capabilities. The material may need to be

brokeninto tasks that can be accomplished in short amounts of time.• Develop consistent daily routines and prepare students for any change in the

procedure toavoid disorientation.• Maintain calm in the classroom.• Be accepting of these students’ limitations—you cannot change them through

repeatedcriticism.

Fetal Alcohol Spectrum Disorder (FASD)

Facts:(based on the Centers for Disease Control and Prevention

(CDC), 2004, and Institute of Medicine, 1996).• FASD is a group of neurobehavioral and developmental

abnormalities: fetal alcohol syndrome (FAS), alcohol related neurodevelopmental disorder (ARND), and partial fetal alcohol syndrome (pFAS).

• The spectrum affects about one percent of the U.S. population.

• Alcohol is the most toxic and damaging substance to which unborn children are normally exposed, and it is the leading cause of mental retardation in the western world.

Things to remember about students who are diagnosed with FASD:

(based on Institute of Medicine 1996)• Symptoms and characteristics appear in a

variety of combinations, with the overall condition

ranging in severity from mild to extreme.• Most individuals with FAS and FASD diagnoses

have normal intelligence.• At the same time they may have compromised

adaptive and social skills: poor impulse control, poor judgment, tendency to miss social cues, lack of common sense, learning difficulties, and difficulty with daily living tasks.

• ADHD usually is co-morbid with FASD.

Advice from authorities• Learn as much as you can about the condition, including

how individuals with the condition relate to each other, and how they relate to teachers and school in general.

• Maintain cordial relations with students with characteristics of FASD.

• Provide a calm, structured, positive learning environment that is uncluttered and well organized to minimize distractions.

• Assign work that is within the student’s capabilities. The material may need to be broken into tasks that can be accomplished in short amounts of time.

• Develop consistent daily routines and prepare students for any change in the procedure to avoid disorientation.

• Be accepting of these students’ limitations—you cannot change them through repeated criticism.

Rage

Facts:• Rage is not a type of neurological disorder, but rather an

extreme kind of behavior sometimes exhibited by students with NBB.

• The rage process is traumatic for everyone and should be understood as a neurological event that leads to behavior over which the student has little control.

• It differs from tantrum, which is goal-directed with the purpose of getting something or getting somebody to do something.

• Rage is a release of built up tension or frustration.• Once a rage episode begins, there is little one can do to stop it.

It may last for a few minutes or continue for hours.• The Rage Cycle has five distinct phases.

Things to remember about students who are diagnosed with Rage:

(based on Greene, 2001; Echternach and Cook, 2004; Cook, 2005; Hill, 2005; and Packer, 2005)

• Rage is not a type of neurological disorder, but rather an extreme kind of behavior sometimes exhibited by students with NBB. It is manifested as an explosion of temper that occurs suddenly with no real warning, and may turn violent.

• The process is traumatic for everyone and should be understood as a neurological event that leads to behavior over which the student has little control.

• The Rage Cycle has five distinct phases:1. Pre-Rage—time preceding the rage just before something triggers the

event and sets it in motion.2. Triggering—precipitating events that provoke episodes of rage,

apparently by stimulating neurochemical changes in the brain that greatly heighten the self-protective responses of flight/flight/freeze.

Triggering conditions seem to be associated with work transitions, sensory overload, being told “No,” fatigue, frustration, confusion, hunger, central nervous system executive dysfunction, anxiety, and mood swings.

Students may appear angry, confused, frustrated, dazed, tense, or flushed, and they may use crude language and swear.

3. Escalation—after triggering, the episode may be mild or rapid.Mild escalation: begin to get angry; call names; swear; exhibit startled

verbal or physical responses; talk rapidly; increase volume and speech cadence; show tension in arms, hands, and body.

Rapid escalation: violent temper, hostility, aggressive comments; profanity; flushed face and clammy body; show fists; throw objects or furniture.

4. Rage or meltdown—when the student is caught up in the rage.5. Post-rage or post-meltdown—a low point for the student who may or

may not remember the behavior or the triggering causes. The student will be tired, passive, headachy, and sometimes remorseful and apologetic.

Advice from authorities(based on Greene, 2001; Echternach and Cook, 2004; Cook, 2005; Hill, 2005; and

Packer, 2005)• Learn as much as you can about the condition, including how individuals with

the condition relate to each other, and how they relate to teachers and school in general.

During Phase 2 Triggering:• Recognize that an episode may be eminent and that you may be unable to

prevent it.• Understand that this is a neurological event, that the student’s

flight/fight/freeze responses are strongly activated, and that the rage is not intentional or personal.

• Stay calm; use a quite voice tone; do not become adversarial.• Use short, direct phrases and non-emotional language.• Do not question, scold, or become verbose.• Use non-threatening body language; stand off center and at least one long

stride away; make sure the student can see your hands.• Use empathetic verbal support.• Deflect control elsewhere.• Use calm, quiet, and succinct logical persuasion to provide an alternative

behavior.

During Phase 3 Escalation:

• Stay calm.• Ensure safety of others. Remove others or support them to ignore

the escalation.• Walk away if student threatens.

• Calmly direct the student to a safe place to allow the energy to dissipate.

• Use short, direct phrases and non-emotional language.

• Use non-threatening and non-confrontational body language.• Use supportive empathy to acknowledge the student’s feelings.

• Use calm, quiet, and succinct logical persuasion to provide an alternative behavior.

• Praise student as soon as s/he begins to respond to your direction.

• Do not address the student’s inappropriate language, threats, or other behavior at this time.

The student cannot process the information and may only become further inflamed.

During Phase 4 Rage or Meltdown:

• Allow student space to go through the physical manifestations.

• Do not restrain the student unless there is an immediate threat to physical safety.

• Do not bully, question, make sarcastic comments, yell, scream, or try to talk the student out of the rage.

• Do not try to make the student understand instructions.• Support others in the room, and help ensure that their

interpretations of the rage event are correct.

During Phase 5 Post-Rage or Post-Meltdown

• Reassure the student that s/he is all right now.• Do not talk about consequences or punishments.• When the student is ready, help him/he put language to

the event.• Help him/her plan what to do the next time rage occurs.• After the rage event and when student is calm, take care

of yourself, document observations, hold debriefing conferences.