GPC 355GPC 355

Special EducationSpecial Education

Dean Owen, Ph.D., LPCCDean Owen, Ph.D., LPCC

METU-NCCMETU-NCC

Spring 2014Spring 2014

Emotional and Emotional and Behavior Behavior Disorders Disorders

(EBDs)(EBDs)

Unit 8Unit 8

Emotional and Behavior Disorders (EBD)

This term does not refer to a single condition but to a group of conditions each of which has an emotional or psychological origin.

Each of these poses challenges not only to learning and school performance but to normal activities of daily living.

Emotional and Behavior Disorders (EBD)

All of the material in this presentation has been extracted from publications produced by

U.S. Department of Education

Office of Special Education and Rehabilitative Services

Emotional and Behavior Disorders (EBD)

Two Dimensions are important:

Severity (how bad are the symptoms?) Generally, to meet the definition the symptoms must be severe enough to represent Chronicity (How long have

the symptoms been exhibited?) Generally, to meet the definition of a disorder the symptoms must persist for at least 6 months.

Emotional and Behavior Disorders (EBD) Defined

Emotional and behavioral disorders (EBD) represent a group of emotional disabilities characterized by the following:

1. An inability to build or maintain satisfactory interpersonal relationships with peers and/or teachers. For preschool-age children, this would include other care providers.

2. An inability to learn which cannot be adequately explained by intellectual, sensory or health factors.

3. Consistent or chronic inappropriate type of behavior or feelings under normal conditions.

4. Displayed pervasive mood of unhappiness or depression.

5. Displayed tendency to develop physical symptoms, pains or unreasonable fears associated with personal or school problems.

EBD Defined….cont.

A student with an EBD is a student who exhibits one or more of these emotionally based characteristics of sufficient duration, frequency and intensity that it/they interfere(s) significantly with educational performance to the degree that provision of special educational services is necessary.

For preschool-age children, these characteristics may appear within the preschool environment or in another setting documented through an extended assessment period. The student's difficulty is emotionally based and cannot be adequately explained by intellectual, cultural, sensory or general health factors.

Emotional and Behavior Disorders

EBDs represent not only conditions but also a wide array of overt behaviors. As the result of these personal emotional and psychological events individuals frequently experience many feelings and reactions…..

Self-doubt

Anger

Loneliness

Depression

Frustration

Two Modes of Expression

Mode 1: Internalizing

Turning inward

Two Modes of Expression

Mode 2: Externalizing

Turning outward

Internalizing DisordersA child who internalizes their problems is said to be suffering from depression, and experience loss of interest in activities including social activities, work, and life. This goes with one part of the EBD federal definition; a general pervasive mood of depression of disturbed behavior.

Teachers of these children are asked to:monitor medications for side effects and behavioral fluctuationsassist with behavioral treatments in the classroomreinforce cognitive behavioral interventions related to classroom

Externalizing Disorders

Words and phrases that are commonly used with children who externalize are extroverted, under-controlled, and acting out. This includes attention deficit hyperactivity disorder (ADHD) and conduct disorder. These children act out their emotions instead of holding them in, exhibiting behaviors such as fighting, bullying, cursing, and other forms of violence.

Adjustment Disorders

Adjustment Disorders describe emotional or behavioral symptoms that children may exhibit when they are un-able to appropriately adapt to stressful events or changes in their lives. The symptoms, which must occur within threemonths of a stressful event or change, and last no more than six months after the stressor ends, are: marked distress, in excess of what would be expected from exposure to the event(s), or an impairment in social or school functioning. There are many kinds of behaviors associated with different types of adjustment disorders, ranging from fear or anxiety to truancy, vandalism, or fighting. Adjustment disorders are relatively common, ranging from 5% to 20%.

Adjustment Disorders

Adjustment Disorders

A chair for my friend……

Anxiety Disorders

Anxiety Disorders are a large family of disorders (school phobia, social phobia, generalized anxiety disorder, panic disorder.) where the main feature is exaggerated anxiety. Anxiety disorders may be expressed as physical symptoms, (headaches or stomach aches), as disorders in conduct (work refusal, etc.) or as inappropriate emotional responses, such as giggling or crying.

Anxiety occurs in all children as a temporary reaction to stressful experiences at home or in school When anxiety is intense and persistent, interfering with the child’s functioning, it may become deemed as an Anxiety Disorder.

Acute or Chronic stress reaction…Neurologic Arousal

Anxiety DisordersSymptoms

Constant worrying or obsession about small or large concerns Restlessness and feeling keyed up or on edge Fatigue Difficulty concentrating or your mind "going blank" Irritability Muscle tension or muscle aches Trembling, feeling twitchy or being easily startled Trouble sleeping Sweating, nausea or diarrhea Shortness of breath or rapid heartbeat

Anxiety DisordersSymptoms

Children and adolescents

In addition to the symptoms above, children and adolescents may have excessive worries about: Performance at school or sporting events Being on time (punctuality) Earthquakes, nuclear war or other catastrophic events A child with the disorder may also: Feel overly anxious to fit in Be a perfectionist Lack confidence Redo tasks because they aren't perfect the first time Strive for approval Require a lot of reassurance about performance

Anxiety DisordersRisk FactorsBeing female. More than twice as many women as men are diagnosed with generalized anxiety disorder.

Childhood trauma. Children who endured abuse or trauma, including witnessing traumatic events, are at higher risk of developing generalized anxiety disorder at some point in life.

Anxiety DisordersRisk Factors

Illness. Having a chronic health condition or serious illness, such as cancer, can lead to constant worry about the future, your treatment and your finances. Stress. A big event or a number of smaller stressful life situations may trigger excessive anxiety.

Anxiety Disorders Risk Factors

Personality. People with some personality types are more prone to anxiety disorders than are others. In addition, some personality disorders, such as borderline personality disorder, also may be linked to generalized anxiety disorder.

Genetics. Generalized anxiety disorder may run in families.

Substance abuse. Drug or alcohol abuse can worsen generalized anxiety disorder. Caffeine and nicotine also may increase anxiety.

Panic disorder

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.

Panic attacks were once dismissed as nerves or stress, but they're now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment can be very effective.

Panic disorder

Panic attacks typically begin suddenly, without warning. They can strike at almost any time — when driving the car, at the mall, sound asleep or in the middle of a business meeting.

May last a few minutes or ½ hour or more.

Panic attacks typically include a few or many of these symptoms: Sense of impending doom or danger Fear of loss of control or death

Rapid heart rate Sweating Trembling Shortness of breath Hyperventilation Chills Hot flashes Nausea Abdominal cramping Chest pain Headache Dizziness Faintness Tightness in your throat Trouble swallowing

Panic disorderOne of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having a panic attack so much that you avoid situations where they may occur. You may even feel unable to leave your home (agoraphobia) because no place feels safe.

Obsessive-Compulsive Disorders

Obsessive-Compulsive Disorder (OCD) which occurs at arate of 2.5%, means a child has recurrent and persistent obsessions or compulsions that are time consuming or causemarked distress or significant impairment.

Obsessions are persistent thoughts, impulses, or images that are intrusive and inappropriate (repeated doubts, requirements to have things in a specific order, aggressive impulses, etc.).

Compulsions are repeated behaviors or mental acts (hand washing, checking, praying, counting, repeating words silently, etc.) that have the intent of reducing stress or anxiety. Many children with OCD may know that their behaviors are extreme or unnecessary, but are so driven to complete their routines that they are unable to stop

Obsessive-Compulsive DisordersOCD often centers around themes, such as a fear of getting contaminated by germs. To ease your contamination fears, some children may compulsively wash your hands until they're sore and chapped. Despite efforts to ignore or get rid of bothersome thoughts, the thoughts or urges keep coming back. This leads to more ritualistic behavior — and a vicious cycle that's characteristic of OCD.

Obsessive-Compulsive DisordersSymptoms

Obsessive-compulsive disorder symptoms usually include both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. About one-third of people with OCD also have a disorder that includes sudden, brief, intermittent movements or sounds (tics).

Obsession symptomsOCD obsessions are repeated, persistent and unwanted urges or images that cause distress or anxiety. You might try to get rid of them by performing a compulsion or ritual. These obsessions typically intrude when you're trying to think of or do other things.Obsessions often have themes to them, such as:Fear of contamination or dirtHaving things orderly and symmetricalAggressive or horrific thoughts about harming yourself or othersUnwanted thoughts, including aggression, or sexual or religious subjects

Obsessive-Compulsive DisordersSymptoms

Examples of obsession signs and symptoms include:Fear of being contaminated by shaking hands or by touching objects others have touched.Doubts that you've locked the door or turned off the stoveIntense stress when objects aren't orderly or facing a certain way.Images of hurting yourself or someone else.Thoughts about shouting obscenities or acting inappropriately.Avoidance of situations that can trigger obsessions, such as shaking handsDistress about unpleasant sexual images repeating in your mind

Obsessive-Compulsive DisordersSymptoms

Compulsions are often believed to be attempts to gain relief from anxiety.As with obsessions, compulsions typically have themes, such as:Washing and cleaningCountingCheckingDemanding reassurancesFollowing a strict routineOrderlinessSelf-injurious behavior

Post-traumatic Stress DisorderPost-Traumatic Stress Disorder (PTSD) can develop followingexposure to an extremely traumatic event or series ofevents in a child’s life, or witnessing or learning about a deathor injury to someone close to the child. The symptoms mustoccur within one month after exposure to the stressful event.

Post-traumatic Stress DisorderSymptomsPost-traumatic stress disorder symptoms typically start within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not appear until years after the event.

PTDS Symptoms are generally grouped into three types:

Intrusive memories,

Avoidance and numbing, and

Increased anxiety or emotional arousal (hyperarousal).

Post-traumatic Stress DisorderSymptomsMemory problemsTrouble concentratingDifficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include: Irritability or angerOverwhelming guilt or shameSelf-destructive behavior, such as drinking too muchTrouble sleepingBeing easily startled or frightenedHearing or seeing things that aren't there

Post-traumatic Stress DisorderRisk Factors

Being female

Experiencing intense or long-lasting trauma

Having experienced other trauma earlier in life

Having other mental health problems, such as anxiety or depression

Lacking a good support system of family and friends

Having first-degree relatives with depression

Having been abused or neglected as a child

Women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.

Post-traumatic Stress DisorderTraumatic events

Kinds of traumatic eventsThe most common events leading to the development of PTSD include: Combat exposure RapeChildhood neglect and physical abuse Sexual molestationBeing threatened with a weapon Physical attack

But many other traumatic events also can lead to post-traumatic stress disorder, including fire, natural disaster, mugging, robbery, assault, civil conflict, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack and other extreme or life-threatening events.

Post-traumatic Stress DisorderTraumatic events

Selective Mutism DisorderSelective Mutism (formerly called Elective-Mutism) occurswhen a child or adolescent persistently fails to speak in specificsocial situations such as at school or with playmates, wherespeaking is expected. Selective mutism interferes with a child’seducational achievement and social communication. Onset: Before age 5 yearsVery Rare and usually lasts a few months but has been known to persist for years.

Attention deficit and hyperactivity disorder

Attention Deficit/Hyperactivity Disorder is a condition, affecting 3%-5% of children, where the child shows symptoms of inattention that are not consistent with his or her developmental level.

The essential feature of Attention Deficit HyperactivityDisorder is “a persistent pattern of inattention and/orhyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.”

Attention deficit and hyperactivity disorderA few doctors have written articles on ADHD inearly childhood, and some suggest that signs of the disordercan be detected in infancy. Most physicians prefer to wait untila clear pattern of inattentive behaviors emerge that affectschool or home performance before attempting to diagnoseADHD.

Ritalin or Dexedrine, or a combinationof these and other medicines have been very successfulin treating ADHD.

Attention deficit and hyperactivity disorderADHD

DefinitionAttention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Attention deficit and hyperactivity disorderSymptoms

Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.

Signs and symptoms of ADHD may include: Difficulty paying attentionFrequently daydreamingDifficulty following through on instructions and apparently not listeningFrequently has problems organizing tasks or activities

Attention deficit and hyperactivity disorderSymptoms

Frequently forgetful and loses needed items, such as books, pencils or toysFrequently fails to finish schoolwork, chores or other tasksEasily distractedFrequently fidgets or squirmsDifficulty remaining seated and seemly in constant motionExcessively talkativeFrequently interrupts or intrudes on others' conversations or gamesFrequently has trouble waiting for his or her turn

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

Attention deficit and hyperactivity disorderRisk Factors

Risk factors for ADHD may include: Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings Maternal drug use, alcohol use or smoking during pregnancy Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many things in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD.

Oppositional Defiant disorderOppositional Defiant Disorder. The central feature of oppositionaldefiant disorder (ODD), which occurs at rates of 2 to 16%, is “a recurrent pattern of negativistic, defiant, disobedientand hostile behaviors towards authority figures, lasting for atleast six months …”

The disruptive behaviors of a child or adolescent with ODD are of a less severe nature than those with Conduct Disorder, and typically do not include aggression toward people or animals, destruction of property, or a pattern of theft or deceit. Typical behaviors include arguing with adults, defying or refusing to follow adult directions, deliberately annoying people, blaming others, or being spiteful or vindictive.

Oppositional Defiant disorderSymptoms

Signs of ODD generally begin before a child is 8 years old. Sometimes ODD may develop later, but almost always before the early teen years. When ODD behavior develops, the signs tend to begin gradually and then worsen over months or years.

A child may be displaying signs of ODD instead of normal moodiness if the behaviors:

Are persistentHave lasted at least six monthsAre clearly disruptive to the family and home or school environment

Oppositional Defiant disorderSymptoms The following are

behaviors associated with ODD:

NegativityDefianceDisobedienceHostility directed toward authority figures

Oppositional Defiant disorderSymptoms

These behaviors might cause your child to regularly and consistently:

Have temper tantrumsBe argumentative with adultsRefuse to comply with adult requests or rulesAnnoy other people deliberatelyBlames others for mistakes or misbehaviorActs touchy and is easily annoyedFeel anger and resentmentBe spiteful or vindictiveAct aggressively toward peersHave difficulty maintaining friendshipsHave academic problemsFeel a lack of self-esteem

Oppositional Defiant disorderCauses (not entirely clear)

There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

A child's natural disposition

Limitations or developmental delays in a child's ability to process thoughts and feelings

Lack of supervision

Inconsistent or harsh discipline

Abuse or neglect

An imbalance of certain brain chemicals, such as serotonin

Oppositional Defiant disorderRisk factors

ODD is a complex problem involving a variety of influences, circumstances and genetic components. There's no single factor that causes ODD. Possible risk factors include: Being abused or neglectedHarsh or inconsistent disciplineLack of supervisionLack of positive parental involvementHaving parents with a severely troubled marriageParents with a history of ADHD, oppositional defiant disorder or conduct problemsFinancial problems in the familyFamily instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequentlyStressful changes that disrupt a child's sense of consistency — such as divorce or changing child care — increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it.

Conduct disorderConduct Disorder, which affects between 6% and 16% of boys and 2% to 9% of girls, has as the essential feature “a repetitive and persistent. pattern of behavior in which the basic rights of others or major age-appropriate social norms or rules areviolated.”

Children with Conduct Disorder often have a patternof staying out late de-spite parental objections, running away from home, or being truant from school.

Children with Conduct Disorder may bully or threaten others or may be physically cruel to animal and people. Conduct Disorder is oftenassociated with an early onset of sexual behavior, drinking, smoking, and reckless and risk-taking acts.

Anorexia nervosaAnorexia Nervosa can be thought of as a “distorted body image”disorder, since many adolescents who have Anorexia seethemselves as overweight and unattractive.

In Anorexia Nervosa,the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and has no realistic idea of the shape and size of his or her body. Signs of anorexia nervosa include extremely low body weight, dry skin, hair loss, depressive symptoms, constipation, low blood pressure, and bizarre behaviors, such as hiding food or binge eating.

Anorexia nervosa

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.

Anorexia (an-oh-REK-see-uh) nervosa isn't really about food. It's an unhealthy way to try to cope with emotional problems. When you have anorexia nervosa, you often equate thinness with self-worth. Anorexia nervosa can be difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

Anorexia nervosa SymptomsSome people with anorexia lose weight mainly through severely restricting the amount of food they eat. They may also try to lose weight by exercising excessively. Others with anorexia binge and purge, similar to bulimia. They control calorie intake by vomiting after eating or by misusing laxatives, diuretics or enemas. No matter how weight loss is achieved, anorexia has a number of physical, emotional and behavioral signs and symptoms.

Anorexia nervosa SymptomsPhysical anorexia symptomsPhysical signs and symptoms of anorexia include: Extreme weight loss Thin appearance Abnormal blood counts Fatigue Insomnia Dizziness or fainting A bluish discoloration of the fingers Hair that thins, breaks or falls out Soft, downy hair covering the body Absence of menstruation Constipation Dry skin Intolerance of cold Irregular heart rhythms Low blood pressure Dehydration Osteoporosis Swelling of arms or legs

Anorexia nervosa SymptomsEmotional and behavioral anorexia symptomsEmotional and behavioral characteristics associated with anorexia include: Refusal to eat Denial of hunger Afraid of gaining weight Lying about how much food has been eaten Excessive exercise Flat mood (lack of emotion) Social withdrawal Irritability Preoccupation with food Reduced interest in sex Depressed mood Possible use of laxatives, diet aids or herbal products

Anorexia nervosa Risk FactorsBeing female. Anorexia is more common in girls and women. However, boys and men have been increasingly developing eating disorders, perhaps because of growing social pressures.

A young age. Anorexia is more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in people older than 40. Teenagers may be more susceptible because of all of the changes their bodies go through during puberty. They also may face increased peer pressure and may be more sensitive to criticism or even casual comments about weight or body shape.

Genetics. Changes in certain genes may make people more susceptible to anorexia nervosa.

Family history. Those with a first-degree relative — a parent, sibling or child — who had the disease have a much higher risk of anorexia nervosa.

Weight changes. When people lose or gain weight — on purpose or unintentionally — those changes may be reinforced by positive comments from others if weight was lost, or by negative comments if there was a weight gain. Such changes and comments may trigger someone to start dieting to an extreme.

Anorexia nervosa Risk FactorsTransitions. Whether it's a new school, home or job, a relationship breakup, or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia nervosa.

Sports, work and artistic activities. Athletes, actors and television personalities, dancers, and models are at higher risk of anorexia. For some, such as ballerinas, ultrathinness may even be a professional requirement. Sports associated with anorexia include running, wrestling, figure skating and gymnastics. Professional men and women may believe they'll improve their upward mobility by losing weight, and then take it to an extreme. Coaches and parents may inadvertently raise the risk by suggesting that young athletes lose weight.

Media and society. The media, such as television and fashion magazines, frequently feature a parade of skinny models and actors. But whether the media merely reflect social values or actually drive them isn't clear-cut. In any case, these images may seem to equate thinness with success and popularity.

Bulimia nervosaBulimia Nervosa is characterized by episodes of “binge andpurge” behaviors, where the person will eat enormous amountsof food, then induce vomiting, abuse laxatives, fast, or followan austere diet to balance the eff ects of dramatic overeating.Essential features are binge eating and compensatory methodsto prevent weight gain. Bulimia Nervosa symptoms include theloss of menstruation, fatigue or muscle weakness, gastrointestinalproblems or intolerance of cold weather. Depressive symptomsmay follow a binge and purge episode.

Bulimia nervosaBulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge — eating large amounts of food — and then purge, trying to get rid of the extra calories in an unhealthy way. For example, someone with bulimia may force vomiting or do excessive exercise. Sometimes people purge after eating only a small snack or a normal-size meal. Bulimia can be categorized in two ways:

Purging bulimia. You regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.

Non-purging bulimia. You use other methods to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

However, these behaviors often overlap, and the attempt to rid yourself of extra calories is usually referred to as purging, no matter what the method.

Bulimia nervosa SymptomsBulimia signs and symptoms may include: Being preoccupied with your body shape and weight Living in fear of gaining weight Feeling that you can't control your eating behavior Eating until the point of discomfort or pain Eating much more food in a binge episode than in a normal meal or snack Forcing yourself to vomit or exercise too much Misusing laxatives, diuretics or enemas after eating Using dietary supplements or herbal products for weight loss

Bulimia nervosa Risk Factors

Being female. Girls and women are more likely to have bulimia than boys and men are.

Age. Bulimia often begins in the late teens or early adulthood.

Biology. People with first-degree relatives (siblings or parents) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. It's also possible that a deficiency in the brain chemical serotonin may play a role.

Psychological and emotional issues. People with eating disorders may have psychological and emotional problems that contribute to the disorder. Examples include low self-esteem, perfectionism, impulsive behavior, anger management problems, depression, anxiety disorders or obsessive-compulsive disorder. In some cases, traumatic events may be a contributing factor.

Societal pressure. Peer pressure and what people see in the media may fuel a desire to be thin, particularly among young women. People who are in the public eye, such as actors, dancers and models, are at higher risk of eating disorders.

Performance pressure in sports. Eating disorders are particularly common among athletes, such as gymnasts, runners and wrestlers. Coaches and parents may unknowingly contribute to eating disorders by encouraging young athletes to lose weight, maintain a low weight and restrict eating for better performance.

Bipolar Disorder

Bipolar Disorder

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.

Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.

Bipolar Disorder

Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern.

Bipolar DisorderManic phase of bipolar disorderSigns and symptoms of the manic or hypomanic phase of bipolar disorder can include:EuphoriaInflated self-esteemPoor judgmentRapid speechRacing thoughtsAggressive behaviorAgitation or irritationIncreased physical activityRisky behaviorSpending sprees or unwise financial choicesIncreased drive to perform or achieve goalsIncreased sex driveDecreased need for sleepEasily distractedCareless or dangerous use of drugs or alcoholFrequent absences from work or schoolDelusions or a break from reality (psychosis)Poor performance at work or school

Bipolar DisorderDepressive phase of bipolar disorderSigns and symptoms of the depressive phase of bipolar disorder can include:SadnessHopelessnessSuicidal thoughts or behaviorAnxietyGuiltSleep problemsLow appetite or increased appetiteFatigueLoss of interest in activities once considered enjoyableProblems concentratingIrritabilityChronic pain without a known causeFrequent absences from work or schoolPoor performance at work or school

Major Depressive Disorder

Major Depressive Disorder occurs when a child has a seriesof two or more major depressive episodes, with at least a two month interval between them. Depression may be manifestedin continuing irritability or inability to get along with others,and not just in the depressed affect.

In Dysthymic Disorder, the depressed mood must be present for more days than not over a period of at least two years. Dysthymic Disorder and Major Depressive Disorder are differentiated based on severity, chronicity, and persistence.

Usually, Major Depressive Disorder can be distinguished from the person’s usual functioning, whereas Dysthymic Disorder is characterized by chronic, less severe depressive symptoms that have been present for many years.

Reactive vs Endogenous

Major Depressive Disorder

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness, nor is it something that you can simply "snap out" of. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychological counseling or both. Other treatments also may help.

Major Depressive Disorder Symptoms

Although depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, emptiness or unhappinessAngry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in normal activities, such as sexSleep disturbances, including insomnia or sleeping too muchTiredness and lack of energy, so that even small tasks take extra effort

Major Depressive Disorder Risk Factors

Depression that started when you were a teen or child

History of anxiety disorder, borderline personality disorder or post-traumatic stress disorder

Abuse of alcohol or illegal drugs

Certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimisticSerious or chronic illness, such as cancer, diabetes or heart disease

Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Traumatic or stressful events, such as physical or sexual abuse, the loss of a loved one, a difficult relationship or financial problems

Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide

Autistic Spectrum DisorderAutistic Disorder is a Pervasive Developmental Disorder,characterized by the presence of markedly abnormal or impaireddevelopment in social interaction and communication, and amarkedly restricted level of activities or interests.

Children with Autism may fail to develop relationships with peers of the same age, and may have no interest in establishing friendships.

The impairment in communication (both verbal and nonverbal) issevere for some children with this disorder.

Autistic Spectrum Disorder

Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms and severity vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, children with severe autism have marked impairments or a complete inability to communicate or interact with other people.

Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired.

Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:

Autistic Spectrum DisorderSocial skillsFails to respond to his or her name Has poor eye contact Appears not to hear you at times Resists cuddling and holding Appears unaware of others' feelings Seems to prefer playing alone — retreats into his or her own world Doesn't ask for help or request things

Autistic Spectrum Disorder

LanguageDoesn't speak or has delayed speech Loses previously acquired ability to say words or sentences Doesn't make eye contact when making requests Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech Can't start a conversation or keep one going May repeat words or phrases verbatim, but doesn't understand how to use them Doesn't appear to understand simple questions or directions

Autistic Spectrum Disorder

BehaviorPerforms repetitive movements, such as rocking, spinning or hand-flapping

Develops specific routines or rituals and becomes disturbed at the slightest change

Moves constantly

May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the "big picture" of the subject

May be unusually sensitive to light, sound and touch, and yet oblivious to pain

Does not engage in imitative or make-believe play

May perform activities that could cause self-harm, such as head banging

Tourette’s SyndromeTourette’s Disorder occurs in approximately 4-5 individuals per 10,000. The disorder includes both multiple motor tics andone or more vocal tics, which occur many times per day, nearly every day, or intermittently throughout a period of more thanone year. During this period, there is never a tic-free period of more than 3 consecutive months. Chronic Motor or Vocal TicDisorder includes either motor ties or vocal tics, but not both as in Tourette’s Disorder. Transient Tic Disorder includes eithersingle or multiple motor tics many times a day for at least four weeks, but for no longer than 12 months. This can occur as either a single episode or as recurrent episodes over time.

http://www.youtube.com/watch?v=oFoVIC8e9lE

Wiley Coyote is off this week on vacation but Bill the Cat is here to wish you a great week. Class is now officially over for the day.