Ch+3+notes

= NBB: The Special Challenges of Neurological Based Behavior = Chapter 3 presents information to help teachers better serve students with behavioral, emotional, and psychiatric disorders, or with mild to moderate cognitive impairment. The overall type of behavior is referred to as // neurological based behavior // (NBB), indicating that much of the student’s behavior is out of his or her control. As you read, it is important to remember that the students we describe are real persons who have real challenges in life. Consequently, all references are made in person-first language, such as “students with visual impairments” rather than “blind students.” Authoritative input for this chapter comes from Paula cook, a teacher specialist in NBB. While most students can control their behavior when they wish to do so, a few cannot or have great difficulty doing so. For these students, their overall behavior, referred to as // neurological based behavior // (NBB), is outside their control, unresponsive to normal behavior management techniques, and leaves teachers feeling powerless. Students with NBB may misbehave erratically or inconsistently for no apparent reason, and their behavior does not respond reliably to normal discipline tactics. This puzzling condition seems to result from difficulties students experience in processing information, due to compromised cerebral functioning resulting from chemical imbalances, congenital brain differences, brain injuries, or brain diseases. Resulting diagnoses are considered to be // mental health issues // (American Academy of Child and Adolescent Psychiatry, 2004). Because neurological differences and mental health issues can be difficult to diagnose, they sometimes are not identified until several years after individuals experience the onset of symptoms (Papolos & Papolos 2002), even though teachers know something is producing behavior that is erratic and unpredictable. Students with these diagnoses behave as they do because of the way their brain works. They usually show high degrees of inattention, hyperactivity, impulsivity, excess emotionality, anxiety, inconsistent emotional responses, unpredictable intense mood swings, withdrawal, and episodes of rage (Kranowitz, 1998; Greene, 2001; Papolos and Papolos, 2002; Hall and Hall, 2003; Cook 2004). NBB diagnoses include attention deficit hyperactivity syndrome (ADHD), learning disabilities (LD), sensory integration dysfunction (SID), bipolar disorder, oppositional defiant disorder (ODD), autism spectrum disorder (ASD), fetal alcohol spectrum disorder (FASD) and brain injuries. Rage is an extreme behavior sometimes exhibited by students with NBB. Brain injuries are physical injuries to the brain that affect its ability to function. The incidence of brain injuries has increased dramatically in recent years. // 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). NBB can be signaled by // behavior difficulties // (especially if the behavior is atypical, inconsistent, perhaps compulsive, and immune to normal behavior management), // language difficulties // (problems in understanding, processing, and expressing information verbally), and/or // academicdifficulties // (compromised memory, and/or difficulties with fine and gross motor skills, comprehension, and language and mathematic skills). // 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 (Kranowitz, 1998 and Cook, 2004). ** Attention Deficit and Hyperactivity Disorder (ADHD)— ** characterized by short attention span, weak impulse control, and hyperactivity, all of which inhibit learning and can lead to misbehavior (Amen, 2001). ** Oppositional Defiant Disorder (ODD)— ** behavior that is especially uncooperative and hostile, with symptoms such as: frequent temper tantrums, excessive arguing with adults, active defiance and refusal to comply with adult requests and rules, deliberate attempts to annoy or upset people, blaming others for one’s own mistakes or misbehavior, speaking hatefully when upset, and seeking revenge (The American Academy of Child and Adolescent Psychiatry (AACAP) 2004). ** Bipolar Disorder ** —an affective disorder characterized by severe mood swings that occur in cycles of mania and depression, or // highs and lows // (University of Sheffield, 2005; Papolos and Papolos, 2002). ** Learning Disabilities (LD) ** —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 (National Council for Learning Disabilities, 2005). ** Dyslexia ** —the most widespread and commonly recognized of all learning difficulties, characterized by difficulties in word recognition, spelling, word decoding, and occasionally with the phonological (sound) component of language (Levinson, 2000). ** Autism Spectrum Disorder (ASD) ** —includes various diagnoses of abnormal development in verbal and non-verbal communication, along with impaired social development and restricted, repetitive, and stereotyped behavior and interests (Faraone, 2003). ** Fetal Alcohol Spectrum Disorder (FASD) ** —a group of neurobehavioral and developmental abnormalities, resulting from exposing the fetus to alcohol from the mother’s blood, that includes fetal alcohol syndrome (FAS), alcohol related neurodevelopmental disorder (ARND), and partial fetal alcohol syndrome (pFAS) (The Centers for Disease Control and Prevention, 2004). ** Rage ** —an extreme kind of behavior sometimes exhibited by students with NBB, displayed as an explosion of temper that occurs suddenly with no real warning, and may turn violent (Packer, 2005). 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 affect students’ 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, perhaps   compulsive, and immune to normal behavior management) • // language difficulties // (problems in understanding, processing, and expressing   information verbally) • // academic difficulties // (compromised memory, and/or difficulties with fine and gross   motor 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 of Mental 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 to five 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 cause of 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 emotional disturbance, and most have a diagnosable mental disorder (U.S. Office of Juvenile Justice and Delinquency Prevention, 2001). • Often multiple mental health symptoms exist simultaneously (Feldman, 2004). Two or more diagnoses that exist simultaneously are called // co-morbid diagnoses //. • Mental health disorders are biological (not related to a person’s character or intelligence, or overcome through will power). • Serious mental illnesses now can be treated effectively, bringing a 70 to 90 percent reduction in 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). • 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.
 * Chapter 3 **
 * Sensory Integration Dysfunction (SID), also called Sensory Processing Disorder.  **
 * __ Working with Students with Neurological Based Behavior (NBB)  __**
 * __ General Suggestions for Working with Students with Neurological Based Behavior __**

__ More Specific Suggestions for Working with Certain Conditions __
** Sensory Integration Dysfunction (SID), also called Sensory Processing Disorder ** Based on Kranowitz, 1998 and Cook, 2004. ** 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, language difficulties, 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. • 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, 2001 **// Facts //** : • 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. • 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 well organized 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 broken into tasks that can be accomplished in short amounts of time. • 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. • Develop consistent daily routines and prepare students for any change in the procedure to avoid 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. 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.    • 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. Based 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 dysfunction. • // 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. • 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. **// 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 and spelling, 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 be   successful 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 writing tasks; poor grasp of abstract concepts; poor memory; difficulty telling time; confusion between right and left; distractibility; restlessness; impulsivity; trouble following directions; inappropriate responses; slow work pace; short attention span; difficulty listening and remembering; eye-hand coordination problems; poor organizational skills. • 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 as females. ** Things to remember about students who are diagnosed with Autism Spectrum Disorder ** : • ASD includes various diagnoses of abnormal development in verbal and non-verbal communication, along with impaired social development and restricted, repetitive, and stereotyped behaviors and interests. • ASD also includes pervasive developmental disorder (delays in the development of   socialization and communication skills). • Asperger Syndrome is a pattern of behavior among students of normal intelligence and language development who also exhibit autistic-like behaviors and marked deficiencies in   social and communication skills. • In its milder form, autism resembles a learning disability. • // Indicators include //** : ** self-stimulation, spinning, rocking, and hand flapping; compulsive behaviors; repetitive odd play for extended periods of time; insistence on routine and sameness; difficulty dealing with interruption of routine schedule and change; monotone voice 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. • 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 to   minimize 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 and directing 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 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. • Maintain calm in the classroom. • Be accepting of these students’ limitations—you cannot change them through repeated criticism. **// 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. • 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. **// 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. 3. // Escalation // —after triggering, the episode may be mild or rapid. 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. (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.
 * Advice from authorities **
 * Advice from authorities **
 * Oppositional Defiant Disorder (ODD) **
 * Advice from authorities **
 * Bipolar Disorder **
 * Advice from authorities **
 * Learning Disabilities (LD) **
 * Advice from authorities **
 * Advice from authorities **
 * Fetal Alcohol Spectrum Disorder (FASD) **
 * Advice from authorities **
 * Rage **
 * // 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.
 * // 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.
 * Advice from authorities **

//__ 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. (based on U.S. National Institute of Mental Health 2003) • Most childhood mental health problems are treatable with medication. • Because medication is controversial, the decision to use it or not ultimately is made by the parents or caregivers. • If medication is used at school, established policies stipulate where it must be stored, who is responsible for administering it, and what teachers and other educators are allowed to say about the medication. • Monitoring the effects of medication usually is a shared responsibility among parents, school, and the medical practitioner, with school personnel asked to watch for any unusual behavior or symptoms during the school day.
 * Medications for Students with Behavioral Issues **
 * Things to remember about medications **