Biological Disorders Related to Emotional/Behavioral Disorders

Tourette's Disorder

Individuals with Gilles de la Tourette's disorder demonstrate tics or repetitive, recurring, and involuntary movements or sounds. Motor tics range from eyeblinks to complex muscular patterns, and vocal tics include grunts, barks, screams, or throat clearing (Anderson, 1993). These tics occur many times during the day. Generally tic-free periods are no longer than three months. In about one half of the individuals with Tourette's disorder, the tics usually begin with a single tic such as eye blinking (American Psychiatric Association, 1994). Tics occur as early as two years of age, and because Tourette's disorder is a developmental disability, must occur before the individual is 18 years of age. The "vulnerability"-or receiving genetic basis for developing a condition-to Tourette's disorder is transmitted in a dominant pattern, and the range in which this vulnerability is expressed could be from Tourette's disorder, motor or vocal tics, obsessive-compulsive disorder, or Attention Deficit/Hyperactivity Disorder.

Burd, Kauffman, and Kerbeshian (1992) reported that slightly more than half of the clinical files of students with Tourette syndrome they reviewed reported learning disabilities. Tourette syndrome may be highly disruptive in the classroom, and learners frequently have difficulties in social relationships. For individuals with moderate or severe tics, medication is frequently used.

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder is one of the most frequently diagnosed and researched disorders among school-age children.

Reid, Maag, Vasa, and Wright (1994) examined the educational treatment of children clinically diagnosed as having Attention Deficit Hyperactivity Disorder. Among the children in the large sample, more than half were receiving special education services, with most receiving services as learners with emotional/behavioral disorders and learning disabilities. The most common special education placement was general education classrooms with resource room support. More than 90% of the students were taking medication.

One of the major controversies regarding the use of medication with learners diagnosed with Attention Deficit Hyperactivity Disorder involves the impact of medication on learning, In a study of the clinical effects of medication on behavior and cognition, Swanson, Cantwell, Lerner, Pfiffner, and Kotkin McBurnett, (1992) reported that the effects of stimulant medication on academic performance is minimal compared to its effects on behavior. They found no evidence of beneficial effects of medication on learning or academic achievement.

The dominant paradigm applied to explain Attention Deficit Hyperactivity Disorder has been psychiatric (neurological and biological). As a consequence, according to Maag and Reid (1994), other efforts to explain the disorder, such as a functional approach to assessment and treatment, have been hampered. For the purpose of the learner's education, the usefulness of accepted conceptualizations of Attention Deficit Hyperactivity Disorder should be judged from an educational perspective, that is, the conceptual model's implications for classroom intervention (Maag & Reid, 1994).

Depression

The characteristics of depression for children are similar to those for adults. A "Major Depressive Episode" for both adults and children is described as a period of at least two weeks during which there is either depressed mood or the loss of interest or pleasure in most activities. The Diagnostic and Statistic Manual of Mental Disorders (American Psychiatric Association, 1994) notes that in children, depression is often seen as irritation, crankiness, and sadness. The duration of symptoms required for identification is also shorter among children. Children and youth who are depressed have low self-esteem, poor social skills, and are pessimistic.

In a study of 8- to 11-year-old children identified as learning disabled, Wright-Strawderman and Watson (1992) found that more than a third scored in the depressed range on the Children's Depression Inventory. Females with learning disabilities may be even more likely to demonstrate symptoms related to depression (Maag, Behrens, & DiGangi, 1992).

Obsessive Compulsive Disorder

For many years, obsessive compulsive disorder was considered a rare disease. Recent research by the National Institute of Mental Health (1996), however, suggests that perhaps as many as 2% of the population may have obsessive compulsive disorder. Individuals with this disorder have obsessions, or unwanted, intrusive, and unpleasant ideas that occur repeatedly, which they manage through compulsions, or repetitive behaviors usually involved with counting. listing, or rearranging objects. The most common obsessions are thoughts about contamination; doubts, such as those concerning turning off the stove or locking a door; or a need to have things in a particular order, such as lining objects up on desks or tables. Common compulsions include handwashing. ordering, checking, or repeating words silently (American Psychiatric Association, 1994).

Individuals with obsessive compulsive disorder respond well to specific medications, supporting a neurobiological basis of the disorder. The use of positron emission tomography (PET) scanners to study the brains of individuals with obsessive compulsive disorder have demonstrated unusual neuro-chemical activity in regions known to play a role in other neurological disorders, such as Tourette syndrome (National Institute of Mental Health [NIMH] 1996).

Children Prenatally Exposed to Drugs and Alcohol

Infants who have been prenatally exposed to drugs and alcohol are at risk for physical and behavioral/emotional problems. According to Williams and Howard (1993), these children demonstrate a marked failure to adapt to the environment; difficulties in appropriate interaction with caregivers; and problems in language, learning, and motor skills. Initial follow-up on infants prenatally exposed to drugs and alcohol suggest that some will suffer long-term behavioral and education disabilities. However. little empirically documented data concerning the characteristics of exposed children who are in school is available. Although the potential causal mechanisms for neural damage to children who have been prenatally exposed to cocaine are strong. the empirical literature does not support an inevitable developmental consequence. Infants who have been exposed to cocaine in utero are similar to other children with neurological challenges. but may have an added disadvantage of a chaotic caregiving environment in which the parent focuses more on obtaining and using drugs than on caring for the child. This combination of biological problems and chaotic environment increases the probability that the child will demonstrate disabilities.