mODULE 3: BEHAVIOUR EXCEPTIONALITIES
GOOD INFORMATION
Ministry Definition of Behaviour ExceptionalityA learning disorder characterized by specific behaviour problems over such a period of time, and to such a marked degree, as to adversely affect educational performance, and that may be accompanied by one or more of the following:
Disruptive, Impulse-Control and Conduct Disorders
Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors. While other disorders in the DSM-5 may also involve problems in emotional and/or behavioral regulation, the disorders in this category are unique in that these problems are manifested in behaviors that violate the rights of others (e.g., aggression, destruction of property) and/or that bring the individual into significant conflict with societal norms or authority figures. Disorders in this category include the following:
Communication includes any verbal or nonverbal behavior (whether intentional or unintentional) that influences the behavior, ideas, or attitudes of another individual. The following are two of the communication disorders with behavioural symptomology:
Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. The following are only some of the anxiety disorders, however any of the disorders in this category will show the internalizing characteristics discussed previously.
The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed etiology. The DMS-V has also introduced a new diagnosis to address concerns for over diagnosis of bipolar disorder in children. Disruptive mood dysregulation disorder, refers to the presentation of children with persistent irritability and frequent episodes of extreme behavioral dyscontrol. This categorization has been added to the depressive disorders for children up to 12 years of age. Its placement in this chapter reflects the finding that children with this symptom pattern typically develop unipolar depressive disorders or anxiety disorders, rather than bipolar disorders, as they mature into adolescence and adulthood.
- inability to build or to maintain interpersonal relationships
- excessive fears or anxieties
- a tendency to compulsive reaction
- inability to learn which cannot be traced to intellectual, sensory, or health factors, or any combination thereof
Disruptive, Impulse-Control and Conduct Disorders
Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors. While other disorders in the DSM-5 may also involve problems in emotional and/or behavioral regulation, the disorders in this category are unique in that these problems are manifested in behaviors that violate the rights of others (e.g., aggression, destruction of property) and/or that bring the individual into significant conflict with societal norms or authority figures. Disorders in this category include the following:
- Conduct Disorder: the child exhibits behaviours that are highly disruptive, antisocial, aggressive, lack guilt, or remorse, refusal to do work and follow rules, has temper tantrums, and a very short attention span. Violence and cruelty towards animals are also noted. The behaviour pattern typically is present in the home, at school, with peers, and in the community. This problem causes significant impairment in social, academic, and occupational functioning. The essential feature of conduct disorder is that it is a repetitive and persistent pattern of behaviour where the basic rights of others or major age-appropriate social norms or rules are violated.
- Oppositional Defiant Disorder: the child repeatedly argues with authority figures, resents people and surroundings, throws temper tantrums, often deliberately annoys others, blames others for his/her mistakes, and is often spiteful and vindictive. The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning. ODD behaviours are classified as less severe than those with conduct disorder, and have the central feature of negativistic, defiant, disobedient, and hostile behaviours towards authority figures lasting at least six months.
- Intermittent Explosive Disorder: the child repeatedly has behavioural outburst that may be seen in the forms of verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights), or physical aggression (toward property, animals or other individuals) even in the case where destruction/damage or injury does not occur. The outbursts are often out of proportion to the stressor and tend to not be committed to achieve some tangible objective (money, power, intimidation).
Communication includes any verbal or nonverbal behavior (whether intentional or unintentional) that influences the behavior, ideas, or attitudes of another individual. The following are two of the communication disorders with behavioural symptomology:
- Social (Pragmatic) Communication Disorder: The child has difficulty using communication for social purposes (like greeting or sharing information) appropriately. They may have difficulty changing communication to match their audience and environment. They may also have difficulty understanding things not explicitly stated (like inferences) and nonliteral or ambiguous language (e.g., idioms, humour, metaphors, and words that have multiple meanings depending on context). These difficulties result in further challenges in social relationships and academic achievement.
- Attention-Deficit/Hyperactivity Disorder: the child shows a consistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than what is typically observed in children of a comparable level of development.
Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. The following are only some of the anxiety disorders, however any of the disorders in this category will show the internalizing characteristics discussed previously.
- Separation Anxiety Disorder: the child shows developmentally inappropriate or excessive fear or anxiety concerning separation from those the child is attached. This may be seen in distress from anticipation or the experience of being separated from an attachment figure, or worrying about losing this attachment figure (e.g. from illness, injury, disaster or death). The child may complain of headaches, stomach aches, or nausea when separated from attachment figure (or in anticipation of separation).
- Selective Mutism: the child persistently fails to speak in specific social situations such as at school or with playmates, where speaking is expected. Selective mutism interferes with a child’s educational achievement and social communication.
- Social Anxiety Disorder: The child shows fear or anxiety when faced with social situations in which they may be exposed to possible scrutiny by others (having conversations, meeting new people), being observed (eating or drinking) or performing in front of others (giving a speech). Social situations may invoke crying, tantrums, freezing, clinging, shrinking or failing to speak.
The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed etiology. The DMS-V has also introduced a new diagnosis to address concerns for over diagnosis of bipolar disorder in children. Disruptive mood dysregulation disorder, refers to the presentation of children with persistent irritability and frequent episodes of extreme behavioral dyscontrol. This categorization has been added to the depressive disorders for children up to 12 years of age. Its placement in this chapter reflects the finding that children with this symptom pattern typically develop unipolar depressive disorders or anxiety disorders, rather than bipolar disorders, as they mature into adolescence and adulthood.
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