Behavioral Disturbances
Including Bullying &
Cyberbullying, ASD, ADHD,
SLD, and IDD
October 24, 2012
JEROME M. SATTLER
Department of Psychology
San Diego State University
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Question: Where is the English Channel?
Answer: I don’t know. My TV doesn’t pick
it up.
Question: Please use the word
“information” in a sentence.
Answer: “During the air show, the Blue
Angels flew information.”
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Question: Use the word “handsome” in a
sentence.
Answer: “The robber was broke when he
went in the bank, so he pointed a pistol at
the clerk and said, ‘handsome money
over!”
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Question: Please use the word
“stagecoach” in a sentence.
Answer: “The stagecoach was so mean
that I decided to quit acting class.”
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Question: What is the chemical formula for
water?
Answer: H, I, J, K, L, M, N, O.
Follow-up question: Tell me about your
answer.
Answer: “That’s what I learned in school,
H to O
Commentary on Children [1]

“Experience early in life may be especially
crucial in organizing the way the basic
structures of the brain develop. For
example, traumatic experiences at the
beginning of life may have more profound
effects on the ‘deeper’ structures of the
brain, which are responsible for basic
regulatory capacities and enable the mind
to respond later to stress.”
—Daniel Siegel
Commentary on Children [2]

“Children are ever the future of a society.
Every child who does not function at a
level commensurate with his or her
possibilities, every child who is destined to
make fewer contributions to society than
society needs, and every child who does
not take his or her place as a productive
adult diminishes the power of that society's
future.”
—Degen Horowitz and Marion O’Brien
AAIDD Has Issues With
DSM-V Proposed Criteria [1]
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AAIDD = American Association on
Intellectual and Developmental Disabilities
Letter Dated May 16, 2012 from AAIDD to
President, American Psychiatric
Association
The information from the AAIDD letter is
quoted verbatim unless otherwise noted.
AAIDD Has Issues With
DSM-V Proposed Criteria [2]
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TERMINOLOGY
DSM-V uses the term “Intellectual
Developmental Disorder”
AAIDD uses the term “Intellectual
Disability”
AAIDD Has Issues With
DSM-V Proposed Criteria [3]

DEFINITION
DSM-V (Criterion A): Intellectual
Developmental Disorder (IDD) is a
disorder that includes both a current
intellectual deficit and a deficit in adaptive
functioning with onset during the
developmental period.
AAIDD Has Issues With
DSM-V Proposed Criteria [4]

DEFINITION
AAIDD: Intellectual disability is
characterized by significant limitations
both in intellectual functioning and in
adaptive behavior as expressed in
conceptual, social, and practical adaptive
skills. This disability originates before age
18.
AAIDD Has Issues With
DSM-V Proposed Criteria [5]

ARGUMENT AGAINST DSM-V
DEFINITION
Having the two most authoritative manuals
in the country defining “intellectual
disability” using different terminology and
different definitions would create havoc in
the education system, service delivery
system, state and federal eligibility
determinations, and courts (especially in
death penalty cases).
AAIDD Has Issues With
DSM-V Proposed Criteria [6]
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DIAGNOSTIC CRITERIA
DSM-V (Criterion B): Impairment in
adaptive functioning for the individual’s
age and sociocultural background.
Adaptive functioning refers to how well a
person meets the standards of personal
independence and social responsibility in
one or more aspects of daily life activities,
AAIDD Has Issues With
DSM-V Proposed Criteria [7]
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DIAGNOSTIC CRITERIA (Cont.)
DSM-V: such as communication, social
participation, functioning at school or at
work, or personal independence at home
or in community settings. The limitations
result in the need for ongoing support at
school, work, or independent life.
AAIDD Has Issues With
DSM-V Proposed Criteria [8]
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ARGUMENT AGAINST DSM-V
CRITERION A
AAIDD Recommendation 1:
We recommend that Criterion A be
modified so that to meet Criterion A, a
significant limitation in intellectual
functioning is considered to be
“approximately” 2 standard deviations
below the population mean.
AAIDD Has Issues With
DSM-V Proposed Criteria [9]
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ARGUMENT AGAINST DSM-V
CRITERION A (Cont.)
This level of impairment equates to an IQ
score of “about” 70 or less. . . . [We
suggest that] a cut-off score of 70 should
be considered to represent a range from
65 to 75.
AAIDD Has Issues With
DSM-V Proposed Criteria [10]
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ARGUMENT AGAINST DSM-V
CRITERION B
AAIDD Recommendation 2:
We recommend that Criterion B be
modified so that to meet Criterion B, a
significant limitation in adaptive behavior is
defined as deficits of approximately 2 or
more standard deviations below the
population mean in one or more aspects of
adaptive behavior, including: conceptual,
social, or practical skills.
AAIDD Has Issues With
DSM-V Proposed Criteria [11]

ARGUMENT AGAINST DSM-V
CRITERION B (Cont.)
The proposed definition of adaptive
behavior as “communication, social
participation, functioning at school or at
work, or personal independence at home
or in community settings” is neither
consistent with either the AAIDD position
nor with current psychometric literature,
and substitutes adaptive functioning for
adaptive behaviors.
AAIDD Has Issues With
DSM-V Proposed Criteria [12]
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SEVERITY GRID
DSM-V suggests a three level severity grid
covering three domains: Mild, moderate,
and severe for conceptual, social, and
practical domains.
AAIDD: Eliminate the severity grid.
AAIDD Has Issues With
DSM-V Proposed Criteria [13]
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SEVERITY GRID
AAIDD Rationale
We feel strongly that the proposed DSM-5
severity grid does not reflect or represent
best practices in the field of intellectual
disability.
AAIDD Has Issues With
DSM-V Proposed Criteria [14]
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SEVERITY GRID
AAIDD Rationale (Cont.)
The grid is problematic for the following
reasons: (a) it does not address severity of
the disability, but merely provides
examples of possible adaptive behavior
limitations in conceptual, social, and
practical adaptive behavior areas;
AAIDD Has Issues With
DSM-V Proposed Criteria [15]
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SEVERITY GRID
AAIDD Rationale (Cont.)
(b) repeats the error found in the proposed
definition of substituting adaptive
functioning for adaptive behavior; (c) is
internally inconsistent with the proposed
APA definition; and (d) represents an old
paradigm from the 1980s
AAIDD Has Issues With
DSM-V Proposed Criteria [16]
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Sources
http://www.aaidd.org/media/Publications/A
AIDD%20DSM5%20Comment%20Letter.p
df
http://www.dsm5.org/proposedrevision/Pa
ges/NeurodevelopmentalDisorders.aspx
Bullying Generally Involves:
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Repeated physical, verbal, psychological,
sexual, and/or electronic media acts
That may threaten, insult, dehumanize,
and/or intimidate another individual who
cannot properly defend himself or herself
Children May Feel Victimized
Because of:
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Size and strength of bully
Outnumbered by several bullies
Less psychologically resilient than bullies
Bullies Attempt to:
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Control and dominate
Use power to subjugate their victims by
undermining their worth and status
Bullying and Morality
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Bullying has been described as an
immoral action because it humiliates and
oppresses innocent victims (Gini, Pozzoli,
& Hauser, 2011)
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Source
Gini, G., Pozzoli, T., Borghi, F., &
Franzoni, L. (2008). The role of bystanders
in students’ perception of bullying and
sense of safety. Journal of School
Psychology, 46, 617–638.
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Bullies have adequate moral competence–
that is, they have knowledge of right and
wrong and an understanding of moral
norms
But paradoxically they do not have moral
compassion–that is, emotional awareness
and sensitivity about their moral infractions
In fact, bullies may disregard the harmful
effects of their actions and blame the
victim for causing the bullying behavior
Case Example
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“I was a victim of bullying for two years in
gyms. Boys from the football team called
me names like ‘lard ass, fat boy, and fag.’
They threw things at me in class and
shoved me in the hall. One day they put
my head in the toilet and gave me a
‘swirly.’ When I told the gym teacher he
told me to ‘toughen up.’ I just stopped
going to gym after that.” (Raskauskas &
Stotlz, 2007, p. 565)
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Source
Raskauskas, J., & Stoltz, A. D. (2007).
Involvement in traditional and electronic
bullying among adolescents.
Developmental Psychology, 43(3), 564–
575. doi: 10.1037/0012-1649.43.3.564
Case Points Out the Following:
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Verbal and nonverbal acts of bullying can
co-occur
School personnel may fail to respond to
acts of bullying
Examples of Bullying
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Physical acts such as tripping, shoving,
punching, theft, defacing property, and
hazing
Verbal acts such as name calling,
teasing, extortion, and writing insulting
graffiti
Psychological acts such as rumor
spreading, humiliation, and threats of
retaliation
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Sexual acts such as exhibitionism,
voyeurism, sexual propositioning, and
unwanted physical contact
Electronic media acts such as
cyberbullying and cyberstalking
Cyberbullying
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Refers to the use of any digital technology
device intended to hurt, defame, or
embarrass another person
Devices include Internet or mobile phones
to send or post text or images via text
messaging, email, instant messaging, chat
rooms, blogs, and social networking
websites, such as Facebook and Twitter
Cyberstalking
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Use of any electronic communication to
stalk or harass another person in a way
that causes substantial emotional distress
Cyberstalking includes messages that
have threats of harm or that are highly
intimidating and make a person afraid
about personal safety
National Profile of Victims of
Bullying, 2008
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Children Ages 2 to 17
Physical bullying: 13.2%
 Males: 16.7%
 Females: 12.8%
Emotional bullying: 19.7%
 Males: 20.6%
 Females: 23.5%
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Internet harassment: 5.6%
 Ages 14 to 17 years
Source: Finkelhor, D., Turner, H., Ormrod,
R., Hamby, S., & Kracke, K. (2009).
Children’s exposure to violence: A
comprehensive national survey. Retrieved
from
http://www.ncjrs.gov/pdffiles1/ojjdp/227744
.pdf
National Profile of LGBT Victims
of Bullying, 2009
Lesbian, Gay, Bisexual, and Transgender
 84% reported being verbally harassed
 40% reported being physically harassed
 19% reported being physically assaulted
 72% often heard homophobic remarks
(such as "faggot" or "dyke")
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LGBT (Cont.)
61% reported feeling unsafe in school
because of their sexual orientation
29% missed at least one day of school in
the past month because of safety
concerns compared to about 8% of a
national sample
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LGBT (Cont.)
GPA was almost half a grade lower of
students who were frequently harassed
than other students (2.7 vs. 3.1)
Increased levels of victimization were
related to increased levels of depression
and anxiety and decreased levels of selfesteem
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Source: Presgraves, D. (2010). 2009
National School Climate Survey: Nearly 9
out of 10 LGBT students experience
harassment in school. Retrieved from
http://www.glsen.org/cgibin/iowa/all/news/record/2624.html
Which Children Become
Victims of Bullying?
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Children who are LGB T
Children with medical, intellectual,
learning, and/or psychological disabilities
Characteristics of children that may draw
attention include:
 Overweight or underweight
 Physical disabilities (Cerebral Palsy)
 Reading problems (Learning Disability)
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Characteristics of children that may draw
attention include: (Cont.)
 Speech and communication problems
(Stuttering)
 Hyperactivity (ADHD)
 Ritualistic behaviors (Autism Spectrum
Disorders)
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Characteristics of children that may draw
attention include: (Cont.)
 Use of special devices (visually, hearing,
or physically impaired)
 Dress differently (cultural or religious
practices)
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Characteristics of children that may draw
attention include: (Cont.)
 Different skin color
 Low self-esteem
 Appear weak
Signs of Bullying in Victims
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Physical Signs—Child…
Has unexplained bruises, scratches, cuts,
and/or torn clothes
Brings to school damaged possessions or
reports them ‘lost’
Complains of tiredness and fatigue
Complains of illness (nonspecific pains or
headaches)
Has loss of appetite, sleep difficulties,
and/or wets bed
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Behavioral Signs—Child…
Takes an “illogical” walking route to and
from school
Shows little interest in school work
Has deteriorating school performance
Stays late at school in order to avoid
encounters with other students
Displays “victim” body language (hangs
head, hunches shoulders, and/or avoids
eye contact)
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Emotional Signs—Child …
Feels picked on or persecuted
Feels isolated, lonely, and rejected
Withdraws socially and/or feels ashamed
Has poor concentration, cries easily, has
angry outbursts, and/or displays mood
swings
Talks about hopelessness
Talks about committing suicide
Signs of Cyberbullying Distress—Child…
 Is upset after being online
 Is upset after seeing text messages
 Stops using the computer, cell phone,
and/or smartphone unexpectedly
 Shows any of the physical, behavioral,
and/or emotional signs presented for
bullying in general
Characteristics of Student Bullies
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Aggressive and dominant
Impulsive, prone to losing temper, and
outbursts of anger
Devious and manipulative
Spiteful, selfish, mean, and/or unpleasant
Insincere, insecure, and/or immature
Poor social skills
Average popularity
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Desire to increase their social status
Want to climb school social ladder
Have limited empathy for their victims
As adults may:
 Continue their aggressive behavior
 Engage in child abuse or domestic
violence
 Tend to remain bullies unless they
receive counseling
Why are Victims Reluctant to
Report Bullying?
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Fear retaliation
Feel shame at being a victim
Fear would not be believed
Fear parents would worry
Don’t think anything would change
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Think advice of parents or teachers would
make problem worse
Fear teacher would tell the bully who told
on him or her
Don’t want to be thought of as a snitch
Why are Bystanders Reluctant to
Report Bullying?
They know that bullying is wrong but . . .
 Don’t want to raise the bully’s wrath and
become the next target
 Don’t want to be thought of as a snitch and
be rejected by their peers
 May wrongly believe that they are not
responsible for stopping the bullying
 May think that bullying is acceptable
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May assume that school personnel don’t
care enough to stop the bullying
May feel unsafe in the classroom and on
the playground
May worry about becoming the next victim
May feel powerless to report bullying
May feel guilty for not reporting it
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May have heightened anxiety, depression,
and/or substance abuse
May become bullies themselves because
they think that this is a way to become part
of a group
May think that bullying is not so bad
because sometimes adults don’t seem to
care about who is bullied
Why do Some Bystanders
Intervene?
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Are victim’s friends
Believe that their parents expect them to
support victims
Believe that it is the moral and proper thing
to do
Believe that their peer group supports their
actions
Differences Between Bullying
and Cyberbulling
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Bullying
Victim can hide from bully when at home
Event is discrete
Audience is limited
Bully is present and not anonymous
Bully can see suffering of victim
Bully has opportunities for empathy and
remorse
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Bullying (Cont.)
Bystanders can intervene
Bully may gain status by showing abusive
power
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Cyberbullying
Victim cannot hide from bully when at
home
Event can be continuous
Audience is potentially very large
Bully is invisible and may be anonymous
Bully cannot see suffering of victim
Bully has few opportunities for empathy
and remorse
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Cyberbullying (Cont.)
Bystanders have little opportunity to
intervene
Bully lacks opportunity to show his or her
abusive power immediately
Shaniya Boyd
A Child with Special Needs
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Shaniya is 8 years old and has cerebral
palsy.
She tried to jump out of a window at
school and told her mother that she just
wanted to get away.
Shaniya had been teased, kicked in the
forehead, and knocked off her crutches.
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The bullying had been going on for some
time and the school did little to stop it.
Shaniya was put in a special class, but the
bullying still happened in the hallway,
cafeteria, or outside during play time.
Mrs Boyd said, “They still managed to get
their hands on my child.”
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Source: Abilitypath.org. (n.d.). Walk a mile
in their shoes: Bullying and the child with
special needs. Retrieved from
http://www.abilitypath.org/areas-ofdevelopment/learning-schools/bullying/articles/walk-a-mile-intheir-shoes.pdf
Children with Special Needs
Children with special needs may have:
 Limited social network and few friends
 Difficulty describing their victimization
 Difficulty distinguishing good-natured
kidding from bullying
 Difficulty understanding nuances and
jokes, which they may interpret as bullying
Children with special needs may also act as
bullies if they:
 Want to protect themselves from further
victimization
 Learn bullying behavior in other social
settings
 Feel extremely anxious
 Cannot size up a situation realistically
 Have limited frustration tolerance
Children with special needs may also act as
bullies if they: (Cont.)
 Feel they are being pushed too far
 Feel their resources are exhausted
 Fail to realize that their “playful” behavior
can hurt others
Bullying may have harmful effects on
children with special needs:
 Limit motivation to achieve
 Increase anxiety about academic
performance
 Interfere with their use of assistive
technology
 Lower their grades
Bullying may have harmful effects on
children with special needs: (Cont.)
 Interfere with their compliance with
treatment regimens
 Increase frequency and strength of their
symptoms
Helping Victims of Bullying
Help them develop:
 Problem solving skills
 Conflict resolution skills
 Emotional regulation skills, including how
to handle anxiety, depression and anger
Help them develop: (Cont.)
 Assertiveness skills
 Self-adequacy skills
 Ability to say “no” or “stop that”
 Ability to know when to go to a safe room
when under severe stress
Helping Bullies
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Change habitual patterns of thought and
action that support bullying:
 Develop new skills
 Challenge old beliefs
 Replace impulsive with reflective
decision-making
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Helping children who are bullies:
 Develop anger management skills
 Develop empathy skills
 Recognize that they can engage in
responsible and moral behavior
 Appreciate the harm they cause their
victims
 Give up self-justifying mechanisms,
egocentric reasoning, and distortions in
morality
Effective Strategies To Counter
Bullying In Schools
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Designing comprehensive intervention
strategies involving students, teachers,
administrators, families, and communities
Building bullying prevention programs
based on principles of science and
supported by scientifically valid evidence
of effectiveness
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Applying school discipline rules, policies,
and sanctions fairly and consistently
Implementing policies at all levels,
including primary, junior, intermediate, and
high school
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Motivating students, teachers,
administrators, and parents to understand
that:
 Bullying is a serious and preventable
problem
 Antibullying programs must be given a
chance to work
 They themselves can make a difference
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Presenting strategies that are clear,
relevant, and comprehensible to both
teachers and students
Encouraging bystanders to report bullying
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Partnering with law enforcement and
mental health agencies to identify and
address serious cases of bullying
Assessing the frequency of bullying, the
effectiveness of the intervention program,
and making adjustments as needed (see
Delaware Attorney General, n.d.;
Hamburger et al., 2011; Safe School
Survey, 2003)

Sources
Delaware Attorney General. (n.d.). Bully
Worksheet Questionnaire. Retrieved from
http://attorneygeneral.delaware.gov/school
s/bullquesti.shtml

Sources
Hamburger, M. E., Basile, K. C., Vivolo, A. M.
(2011). Measuring bullying victimization,
perpetration, and bystander experiences: A
compendium of assessment tools. Atlanta,
GA: Centers for Disease Control and
Prevention, National Center for Injury
Prevention and Control. Retrieved from
http://www.cdc.gov/violenceprevention/pdf/Bu
llyCompendiumBk-a.pdf

Sources
Safe School Survey. (2003). Safe School
Survey sample menu. Retrieved from
https://sdfs.esc18.net/Sample_Surveys/SS
M.asp
10 Tips for Parents
1.
2.
3.
Talk often with your child, listen carefully,
and note any changes in your child’s
behavior, especially signs of anxiety
Talk about what bullying and
cyberbullying means. See such websites
as www.stopbullying.gov and
www.stopbullyingnow.com
Encourage your child to tell you when he
or she is being bullied and discourage
your child from bullying others
4.
5.
6.
Encourage your child to tell a member of
the school staff if the bullying took place
at school
Tell your child to refuse to join in if he or
she sees another child being bullied and
offer support to the child who is being
bullied
Tell your child to learn about the school’s
rules and sanctions regarding bullying
and cyberbullying
7.
8.
Remind your child that real people with
real feelings are behind screen names
and profiles
Discuss with your child why it is a good
idea to post only information that he or
she is comfortable with others seeing and
to never share passwords with anyone
except you and another close family
member
Tell your child to take Internet
harassment seriously because it is
harmful and unacceptable
10. Tell your child that you may review his or
her online communications if you think
there is reason for concern about his or
her safety
9.
10 Tips for Teachers
1.
2.
3.
Explain to students the difference
between playfulness and bullying or
cruelty
Let students know that bullying is
unacceptable and against school rules
Tell students, whether they are victims or
bystanders, to report bullying or
cyberbullying immediately to a member of
the school staff
4.
5.
6.
Emphasize the difference between
tattling and telling on someone who is
bullying another student
Identify and intervene upon undesirable
attitudes and behaviors that could be
“gateway behaviors” to bullying and
cyberbullying
Watch for signs of bullying and
cyberbullying and stop either one
immediately
Listen receptively to parents who report
bullying and/or cyberbullying
8. Report all incidents of bullying and
cyberbullying to the school administration
9. Always respond to requests of help from
victims and make sure that they know
that being bullied is not their fault and that
it is OK to feel scared or upset
10. Closely monitor students’ use of
computers at school and become familiar
with cyberbullying, its dangers
7.
State Laws Against Bullying
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45 states have passed anti-bullying laws
designed to protect students from being
harassed, threatened, or humiliated
Other states may be considering similar
legislation
Seth’s Law (AB9)
An Anti-Bullying Law
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Governor Jerry Brown signed “Seth’s Law”
on October 9, 2011
Named for 13-year-old Seth Walsh, who
killed himself in 2010 after years of antigay bullying.
Seth was routinely verbally harassed for
his nonconforming appearance
Was touched inappropriately by other
students
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Had food and water containers thrown at
him
Was made the subject of rumors and
verbal assaults regarding his sexuality
Bullying became so bad that he ceased
changing in the locker room as he feared
for his own safety
Requirements of Seth’s Law
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Schools must:
Implement anti-harassment and antidiscrimination policies and programs
directed toward sexual orientation and
gender identity and expression, race,
ethnicity, nationality, disability, and religion
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Schools must: (Cont.)
Give parents clearer knowledge of:
 What to expect from school
administrators when they are handling
instances of bullying
 Ways parents can report their concerns
if they think school administrators are
not acting appropriately
Put bullying complaint forms on schools’
websites
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Schools must: (Cont.)
Post schools’ anti-bullying policies in
visible places on school grounds
Investigate and resolve bullying
complaints within a set period of time
Source: Williams (2011)

Source
Williams, S. (2011). Anti-bullying ‘Seth’s
law’ passes California senate. Retrieved
from http://www.care2.com/causes/antibullying-seths-law-passes-californiasenate.html
State Laws Generally Require
Schools To
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Have anti-bullying policies that also
address cyberbullying
Investigate reports of bullying
Provide counseling to bullies and their
victims
Report incidents of bullying to parents and
law enforcement
Take action even if the bullying occurs off
campus, through the Internet, or other
telecommunications methods
Comment on State Laws:
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Who will train teachers and administrators?
How will the new curriculum be added to
the existing curriculum?
Developing a cyberbullying policy for
schools is not easy
Laws must balance individuals’ protection
against their free-speech rights
This issue came up in the famous case of
United States v. Drew, 2008

United States v. Drew, 2008
Meier, a 13-year-old girl from Missouri,
hanged herself after being harassed online
by Lori Drew, a 49-year-old middle-aged
woman


United States v. Drew, 2008 (Cont.)
After courting Meier by posing as a
16-year-old boy on a social networking site
and gaining her trust, Drew sent insulting,
hurtful messages to Meier, who had a
history of depression and low self-esteem,
at one point telling her that the world
would be better without her in it
Drew was prosecuted under the Computer
Fraud and Abuse Act

United States v. Drew, 2008 (Cont.)
The judge acquitted Drew because he
found that the language in the Act was
written so broadly that, were she to be
found guilty for creating this fictitious
profile, many other relatively innocent
Internet users who were in violation of
similar terms of agreement could be
prosecuted for relatively minor offenses
D.C. et al. v. R.R. et al., 2010
However, in another case, the court ruled
that free speech is not unlimited
 2nd District Court of Appeal of California
ruled that the 1st Amendment does not
protect Internet banter among teenagers if
a message contains genuine threats of
harm


D.C. et al. v. R.R. et al., 2010 (Cont.)
The threats in this case included the
posting of death threats and anti-gay
diatribes against D.C. on his website
The threatening and insulting messages
included saying that:
 The classmates wanted to “pound your
head in with an ice pick”
 D.C. was “wanted dead or alive”

D.C. et al. v. R.R. et al., 2010 (Cont.)
Appeals court concluded that:
 “The students who posted the threats
sought to destroy D.C.'s life, threatened
to murder him, and wanted to drive him
out of Harvard-Westlake and the
community in which he lived” (p. 3)
Concluding Comment

John Palfrey (2010), a professor of law at
Harvard Law School, pointed out that “No
one federal law will prevent tragedies from
happening. Most of the time, we have the
laws on the books that we need. It’s a
commitment to teaching and mentoring, to
being supportive and to being tough where
we have to be, that can help.”

Source
Palfrey, J. (2010). Solutions beyond the
law. Retrieved from
http://www.nytimes.com/roomfordebate/20
10/09/30/cyberbullying-and-a-studentssuicide/palfrey
Features of a Positive
School Climate [1]




Fosters feelings of belonging
Promotes the self-worth and dignity of
each student
Inspires efforts for self-improvement
Maximizes opportunities for the full
realization of each student’s potential
Features of a Positive
School Climate [2]



Promotes self-determination, social
responsibility, and empowerment among
all students
Develops, promotes, and reinforces
nonstigmatizing language
Disavows and sanctions antidemocratic
policies and practices, especially
repression and discrimination
Features of a Positive
School Climate [3]



Encourages diversity and emphasizes its
strengths, assets, and opportunities
Rejects and prevents the isolation and
marginalization of individuals and groups
Provides regular occasions for positive
interactions for all students
Features of a Positive
School Climate [4]



Communicates routinely high expectations
for everyone in the school community
Promotes cooperative learning, mutual
responsibility, social competency, and
democratic participation in decision
making
Shows awareness of the mental health
needs of students and staff and provides
adequate mental health services
Features of a Positive
School Climate [5]


Promotes norms of caring and concern for
the dignity and worth of every student in a
safe, secure school environment
Provides conflict resolution leaders and
mechanisms
Features of a Positive
School Climate [6]

Source: Lawson, H. A., Quinn, K. P.,
Hardiman, E., & Miller, R. L., Jr. (2006).
Mental health needs and problems as
opportunities for expanding the boundaries
of school improvement. In R. J. Waller
(Ed.), Fostering child & adolescent mental
health in the classroom (pp. 293–309).
Thousand Oaks, CA: Sage.
Autism Spectrum Disorder
(ASD)[1]


DSM-V, Revised January 26, 2011
Definition: Autism spectrum disorder is a
neurodevelopmental disorder and must be
present from infancy or early childhood,
but may not be detected until later
because of minimal social demands and
support from parents or caregivers in early
years.
Autism Spectrum Disorder
(ASD)[2]


Neural development comprises the
processes that generate, shape, and
reshape the nervous system, from the
earliest stages of embryogenesis to the
final years of life.
Defects in neural development can lead to
cognitive, motor, and intellectual disability,
as well as neurological disorders such
as autism and intellectual disability.
Autism Spectrum Disorder
(ASD)[3]
Diagnostic Criteria
Must meet criteria A, B, C, and D:
Autism Spectrum Disorder
(ASD)[4]
Diagnostic Criteria A
Persistent deficits in social communication
and social interaction across contexts, not
accounted for by general developmental
delays, and manifest by all 3 of the
following:
Autism Spectrum Disorder
(ASD)[5]
Diagnostic Criteria A
1. Deficits in social-emotional reciprocity
ranging from abnormal social approach and
failure of normal back and forth conversation
through reduced sharing of interests,
emotions, and affect and response to total
lack of initiation of social interaction,
Autism Spectrum Disorder
(ASD)[6]
Diagnostic Criteria A
2. Deficits in nonverbal communicative
behaviors used for social interaction;
ranging from poorly integrated- verbal and
nonverbal communication, through
abnormalities in eye contact and bodylanguage, or deficits in understanding and
use of nonverbal communication, to total
lack of facial expression or gestures.
Autism Spectrum Disorder
(ASD)[7]
Diagnostic Criteria A
3. Deficits in developing and maintaining
relationships, appropriate to developmental
level (beyond those with caregivers);
ranging from difficulties adjusting behavior to
suit different social contexts through
difficulties in sharing imaginative play and in
making friends to an apparent absence of
interest in people
Autism Spectrum Disorder
(ASD)[8]
Diagnostic Criteria B
Restricted, repetitive patterns of behavior,
interests, or activities as manifested by at
least two of the following:
Autism Spectrum Disorder
(ASD)[9]
Diagnostic Criteria B
1. Stereotyped or repetitive speech, motor
movements, or use of objects; (such as
simple motor stereotypies, echolalia,
repetitive use of objects, or idiosyncratic
phrases).
Autism Spectrum Disorder
(ASD)[10]
Diagnostic Criteria B
2. Excessive adherence to routines,
ritualized patterns of verbal or nonverbal
behavior, or excessive resistance to change;
(such as motoric rituals, insistence on same
route or food, repetitive questioning or
extreme distress at small changes).
Autism Spectrum Disorder
(ASD)[11]
Diagnostic Criteria B
3. Highly restricted, fixated interests that are
abnormal in intensity or focus; (such as
strong attachment to or preoccupation with
unusual objects, excessively circumscribed
or perseverative interests).
Autism Spectrum Disorder
(ASD)[12]
Diagnostic Criteria B
4. Hyper-or hypo-reactivity to sensory input
or unusual interest in sensory aspects of
environment; (such as apparent indifference
to pain/heat/cold, adverse response to
specific sounds or textures, excessive
smelling or touching of objects, fascination
with lights or spinning objects).
Autism Spectrum Disorder
(ASD)[13]
Diagnostic Criteria C
Symptoms must be present in early
childhood (but may not become fully
manifest until social demands exceed limited
capacities)
Autism Spectrum Disorder
(ASD)[14]
Diagnostic Criteria D
Symptoms together limit and impair
everyday functioning
Autism Spectrum Disorder
(ASD)[15]
Severity Level for ASD
Level 3 Level 2 Level 1
Requiring very
substantial
support
Requiring
substantial
support
Requiring
support
Social
Communication
Social
Communication
Social
Communication
RRB
RRB
RRB
Autism Spectrum Disorder
(ASD)[16]


Severity Level for ASD
Level 3: Requiring very substantial
support
Social Communication
Severe deficits in verbal and nonverbal
social communication skills cause severe
impairments in functioning; very limited
initiation of social interactions and minimal
response to social overtures from others.
Autism Spectrum Disorder
(ASD)[17]

Severity Level for ASD (Level 3)
Restricted Interests & Repetitive
Behaviors (RRB)
Preoccupations, fixated rituals and/or
repetitive behaviors markedly interfere
with functioning in all spheres. Marked
distress when rituals or routines are
interrupted; very difficult to redirect from
fixated interest or returns to it quickly
Autism Spectrum Disorder
(ASD)[18]


Severity Level for ASD
Level 2: Requiring substantial support
Social Communication
Marked deficits in verbal and nonverbal
social communication skills; social
impairments apparent even with supports
in place; limited initiation of social
interactions and reduced or abnormal
response to social overtures from others
Autism Spectrum Disorder
(ASD)[19]

Severity Level for ASD (Level 2)
Restricted Interests & Repetitive
Behaviors (RRB)
RRBs and/or preoccupations or fixated
interests appear frequently enough to be
obvious to the casual observer and
interfere with functioning in a variety of
contexts. Distress or frustration is
apparent when RRB’s are interrupted;
difficult to redirect from fixated interest
Autism Spectrum Disorder
(ASD)[20]

Severity Level for ASD
Level 1: Requiring support
Autism Spectrum Disorder
(ASD)[21]

Severity Level for ASD (Level 1)
Social Communication
Without supports in place, deficits in social
communication cause noticeable
impairments. Has difficulty initiating social
interactions and demonstrates clear
examples of atypical or unsuccessful
responses to social overtures of
others. May appear to have decreased
interest in social interactions
Autism Spectrum Disorder
(ASD)[22]

Severity Level for ASD (Level 1)
Restricted Interests & Repetitive
Behaviors (RRB)
Rituals and repetitive behaviors (RRB’s)
cause significant interference with
functioning in one or more
contexts. Resists attempts by others to
interrupt RRB’s or to be redirected from
fixated interest
Autism Spectrum Disorder
(ASD)[23]



Deleted from DSM-V
Asperger’s Disorder
Childhood disintergrative disorder
Pervasive developmental disorder not
otherwise specified
Associated Features of ASD [1]
1. Regression in development
Gradual or rapid backward movement in
their development.
 Regression occurs in approximately 15%
to 50% of children with autism spectrum
disorder,
 Most commonly at approximately 18
months of age
Associated Features of ASD [2]
2. Difficulties in eating or sleeping:
 “Picky eaters”—Feeding problems occur in
approximately 46% to 89% of children with
autism spectrum disorder
 Approximatley 40% to 80% of children with
autism spectrum disorder also
demonstrate sleep problems
Associated Features of ASD [3]
3. Aggressive behavior
 Display aggressive behavior toward
themselves (self-injurious behavior) or
toward other people
Associated Features of ASD [4]
3. Aggressive behavior (Cont.)
 Examples of self-injurious behaviors
include
 Head banging
 Hair pulling
 Self-scratching
 Self-biting
Associated Features of ASD [5]
3. Aggressive behavior (Cont.)
 Explanation for self-injurious behavior:
 In response to frustration (e.g., when a
child is unable to communicate)
 Or as a form of self-stimulation
Associated Features of ASD [6]
3. Aggressive behavior (Cont.)
 Ranges from relatively mild (e.g.,
scratching the skin) to life threatening
(e.g., repeated head-banging)
 Incidence of self-injurious behavior ranges
from 20% to 71%
Associated Features of ASD [7]
3. Aggressive behavior (Cont.)
 Higher levels of self-injury associated with
children who
 Are also intellectually disabled
 With those who have severely impaired
communication, socialization, and daily
living skills
Associated Features of ASD [8]
4. “Savant Skills”
 May have special skills or what has been
termed “savant skill.”
 Examples include:
 Ability to draw incredibly accurate and
detailed perspective drawings
 Having perfect pitch
Associated Features of ASD [9]
4. “Savant Skills” (Cont.)
 Examples include:
 Being able to state the day of the week
for a date far in the future
 Being able to play a piano concerto after
hearing it once
 Being able to calculate extremely
difficult mathematical equations without
a calculator
Associated Features of ASD [10]
4. “Savant Skills”
 These abilities may not be used
functionally. Example:
An adolescent who is able to calculate
difficult mathematical equations without a
calculator may not be able to calculate the
correct change when purchasing items
Assessment Techniques for ASD
[1]






Case history review, including medical
evaluation
Educational history review
Interview
Observation
Autism Diagnostic Interview–Revised
(ADI–R)
WISC–IV
Assessment Techniques for ASD
[2]






SB5
DAS–II
Mullen Scales of Early Learning
Bayley Scales of Infant Development–
Third Edition (Bayley-III)
Merrill-Palmer-Revised (M-P-R)
Leiter International Performance Scale–
Revised (Leiter–R)
Assessment Techniques for ASD
[3]




Universal Nonverbal Intelligence Test
(UNIT)
Receptive Peabody Picture Vocabulary
Test–Fourth Edition (PPVT–IV)
Listening Comprehension Scale of the
Oral and Written Language Scales
(OWLS)
Comprehensive Assessment of Spoken
Language (CASL)
Assessment Techniques for ASD
[4]




Bracken Basic Concept Scale–Revised
(BBCS–R)
Peabody Individual Achievement Test–
Revised Normative Update (PIAT–R/NU)
Group achievement tests
Hearing tests, visual, medical
examinations, and genetic testing may
also be recommended
Observation Before Testing [1]
Observe the child in his or her classroom,
playground, or home.
Consider the following:
 Does the child make eye contact?
 Does the child point or gesture to indicate
a response?
 Does the child use signs, words, phrases,
or sentences?
Observation Before Testing [2]


Does the child use an augmentative or
alternative communication system (AAC),
such as a speech-generating device or a
picture system to communicate (e.g.,
pointing to pictures instead of using
words).
Does the child understand gestures or
signing?
Observation Before Testing [3]


Does the child follow simple verbal
directions?
Does the child have sufficient attention to
do the class assignment?
Co-Occurring Disorders with
ASD[1]
Estimated prevalence rates of cooccurrence of autism spectrum disorder with
other disorders are difficult to establish, but
here is what we know:
 Intellectual disability (40% to 69%)
 Depression (4% to 58%)
 Anxiety disorders (7% to 84%)
 Tic disorders (30%)
Co-Occurring Disorders with
ASD[2]





Seizure disorders (11% to 39%)
Fragile-X syndrome (2% to 6%)
Gastrointestinal problems (9% to 70%)
One or more other psychiatric conditions
(up to 70%)
Two or more other psychiatric disorders
(up to 41%)
WISC–IV and High Functioning
Children with Autism [1]









Mayes & Calhoun (2007)
N = 54
Ages 6 to 14 yrs., M = 8.2 yrs.
FSIQ = 101
GAI = 113
VC =107
PR = 115
WM = 89
PS = 85
WISC–IV and High Functioning
Children with Autism [2]




Correlations between the
WIAT–II and WISC–IV
(Mayes & Calhoun, 2007)
FSIQ
Word Reading =
.64
Reading Comprehension = .68
Numerical Operations =
.80
Written Expression =
.75
GAI
.60
.64
.78
.68
WISC–IV and High Functioning
Children with Autism [3]
SOURCE
Mayes, S. D., & Calhoun, S. L. (2007).
Wechsler Intelligence Scale for Children–
Third and –Fourth Edition predictors of
academic achievement in children with
attention-deficit/hyperactivity disorder.
School Psychology Quarterly, Vol 22(2),
234–249. doi: 10.1037/10453830.22.2.234
Interventions for ASD [1]

Characteristics of Early Intervention
Programs
Intensive intervention (at least 25 hours
per week) in a highly motivating
environment with measurable educational
objectives as soon as an autism spectrum
disorder is suspected
Interventions for ASD [2]

Characteristics of Early Intervention
Programs (Cont.)
A curriculum focused on attention and
compliance, joint attention, motor and
behavioral imitation, communication,
reciprocal interaction (e.g., responding to
the behavior of others), appropriate use of
toys, and self-management of behavior
Interventions for ASD [3]


Characteristics of Early Intervention
Programs (Cont.)
Highly structured teaching environments
with visual schedules and clear physical
boundaries and with low student-to-staff
ratios
Systematic strategies for generalizing
newly acquired skills to a wide range of
situations
Interventions for ASD [4]



Characteristics of Early Intervention
Programs (Cont.)
Maintenance of predictability and routine
in daily schedules
Promotion of social interaction
A functional approach to problem
behaviors (e.g., replacing the functions
served by negative behaviors with positive
behaviors)
Interventions for ASD [5]


Characteristics of Early Intervention
Programs (Cont.)
A focus on skills needed for successful
transition from an early intervention
program to the skills needed for regular
preschool and kindergarten classrooms
A high level of family involvement,
including parental training, where
appropriate
Interventions for ASD [6]

Characteristics of Early Intervention
Programs (Cont.)
Progress regularly evaluated and
objectives regularly adjusted based on
ongoing assessment of skills
Attention Deficit/Hyperactivity
Disorder (AD/HD)[1]


DSM-V, Revised May 1, 2012
Definition: AD/HD consists of a pattern of
behavior that is present in multiple settings
where it gives rise to social, educational or
work performance difficulties.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[2]
Diagnostic Criteria
Must meet criteria A1 or A2, B, C, and D:
Attention Deficit/Hyperactivity
Disorder (AD/HD)[3]
Diagnostic Criteria A
Either (A1) and/or (A2).
A1. Inattention: Six (or more) of the
following symptoms have persisted for at
least 6 months to a degree that is
inconsistent with developmental level and
that impact directly on social and
academic/occupational activities.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[4]
Diagnostic Criteria A1
a. Often fails to give close attention to
details or makes careless mistakes in
schoolwork, at work, or during other
activities (e.g., overlooks or misses details,
work is inaccurate).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[5]
Diagnostic Criteria A1
b. Often has difficulty sustaining attention in
tasks or play activities (e.g., has difficulty
remaining focused during lectures,
conversations, or reading lengthy writings).
c. Often does not seem to listen when
spoken to directly (e.g., mind seems
elsewhere, even in the absence of any
obvious distraction).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[6]
Diagnostic Criteria A1
d. Often does not follow through on
instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g.,
starts tasks but quickly loses focus and is
easily sidetracked; fails to finish
schoolwork, household chores, or tasks in
the workplace).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[7]
Diagnostic Criteria A1
e. Often has difficulty organizing tasks and
activities (e.g., difficulty managing sequential
tasks; difficulty keeping materials and
belongings in order; messy, disorganized,
work; poor time management; tends to fail to
meet deadlines).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[8]
Diagnostic Criteria A1
f. Often avoids, dislikes, or is reluctant to
engage in tasks that require sustained
mental effort (e.g., schoolwork or homework;
for older adolescents and adults, preparing
reports, completing forms, or reviewing
lengthy papers).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[9]
Diagnostic Criteria A1
g. Often loses things necessary for tasks or
activities (e.g., school materials, pencils,
books, tools, wallets, keys, paperwork,
eyeglasses, or mobile telephones).
h. Is often easily distracted by extraneous
stimuli (for older adolescents and adults,
may include unrelated thoughts).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[10]
Diagnostic Criteria A1
i. Is often forgetful in daily activities (e.g.,
chores, running errands; for older
adolescents and adults, returning calls,
paying bills, keeping appointments).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[11]
Diagnostic Criteria A2
A2. Hyperactivity and Impulsivity: Six (or
more) of the following symptoms have
persisted for at least 6 months to a degree
that is inconsistent with developmental level
and that impact directly on social and
academic/occupational activities.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[12]
Diagnostic Criteria A2
a. Often fidgets with or taps hands or feet or
squirms in seat.
b. Often leaves seat in situations when
remaining seated is expected (e.g., leaves
his or her place in the classroom, office or
other workplace, or in other situations that
require remaining seated).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[13]
Diagnostic Criteria A2
c. Often runs about or climbs in situations
where it is inappropriate. (In adolescents or
adults, may be limited to feeling restless).
d. Often unable to play or engage in leisure
activities quietly.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[14]
Diagnostic Criteria A2
e. Is often “on the go,” acting as if “driven by
a motor” (e.g., is unable or uncomfortable
being still for an extended time, as in
restaurants, meetings, etc; may be
experienced by others as being restless and
difficult to keep up with).
f. Often talks excessively.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[15]
Diagnostic Criteria A2
g. Often blurts out an answer before a
question has been completed (e.g.,
completes people’s sentences and “jumps
the gun” in conversations, cannot wait for
next turn in conversation).
h. Often has difficulty waiting his or her turn
(e.g., while waiting in line).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[16]
Diagnostic Criteria A2
i. Often interrupts or intrudes on others (e.g.,
butts into conversations, games, or
activities; may start using other people’s
things without asking or receiving
permission, adolescents or adults may
intrude into or take over what others are
doing).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[17]
Diagnostic Criteria B
Several inattentive or hyperactive-impulsive
symptoms were present prior to age 12.
Diagnostic Criteria C
Criteria for the disorder are met in two or
more settings (e.g., at home, school or work,
with friends or relatives, or in other
activities).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[18]
Diagnostic Criteria D
There must be clear evidence that the
symptoms interfere with or reduce the
quality of social, academic, or occupational
functioning.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[19]
Diagnostic Criteria E
The symptoms do not occur exclusively
during the course of schizophrenia or
another psychotic disorder and are not
better accounted for by another mental
disorder (e.g., mood disorder, anxiety
disorder, dissociative disorder, or a
personality disorder).
Attention Deficit/Hyperactivity
Disorder (AD/HD)[20]


Combined Presentation: If both Criterion
A1 (Inattention) and Criterion A2
(Hyperactivity-Impulsivity) are met for the
past 6 months.
Predominantly Inattentive Presentation:
If Criterion A1 (Inattention) is met but
Criterion A2 (Hyperactivity-Impulsivity) is
not met and 3 or more symptoms from
Criterion A2 have been present for the
past 6 months.
Attention Deficit/Hyperactivity
Disorder (AD/HD)[21]


Inattentive Presentation (Restrictive): If
Criterion A1 (Inattention) is met but no
more than 2 symptoms from Criterion A2
(Hyperactivity-Impulsivity) have been
present for the past 6 months.
Predominantly Hyperactive/Impulsive
Presentation: If Criterion A2
(Hyperactivity-Impulsivity) is met and
Criterion A1 (Inattention) is not met for the
past 6 months.
Other Problems in Children with
ADHD [1]
COGNITIVE DEFICITS





Deficits in executive functions
Mild deficits in intelligence test scores
Learning disabilities
Memory difficulties
Impaired behavioral and verbal creativity
Other Problems in Children with
ADHD [2]
SOCIAL AND ADAPTIVE FUNCTIONING DEFICITS



Difficulties with social and adaptive
functioning
Difficulties adhering to rules and
instructions
Difficulties in regulating the pace of their
actions, including being able to slow down
or speed up as needed
Other Problems in Children with
ADHD [3]
MOTIVATIONAL AND EMOTIONAL DEFICITS



Motivation difficulties
Limited persistence
Emotional reactivity
Other Problems in Children with
ADHD [4]
MOTOR, PHYSICAL, AND HEALTH DEFICITS





Poor fine-motor and gross-motor
coordination
Minor physical anomalies
Difficulties regulating sleep and alertness
General health problems and possible
delay in growth during childhood
Proneness to accidental injuries
ADHD and Organophosphate
Pesticides [1]



Sample:1,139 children representative of
US population; 119 met ADHD criteria
Results: These children were 1.55 times
more likely than others to have high
concentrations of urinary dimethyl
alkylphosphate, an organophosphate
Conclusion: organophosphate exposure,
at levels common among US children,
may contribute to ADHD prevalence.
ADHD and Organophosphate
Pesticides [2]
SOURCE
Bouchard, M. F., Bellinger, D. C., Wright, R.
O. & Weisskopf, M. G. (2010). Attentiondeficit/hyperactivity disorder and urinary
metabolites of organophosphate
pesticides. Pediatrics,125(6), e1270–
e1277. doi: 10.1542/peds.2009-3058
ADHD and Organophosphate
Pesticides [3]




Purpose: Is maternal urinary dialkyl
phosphate metabolites, an
organophosphate, associated with ADHD?
Sample: Mexican-American children living
in Salinas Valley, CA
Followed to ages 3½ (N = 331) and 5 (N =
323) years
Findings and conclusion: Maternal urinary
dialkyl phosphate metabolites are
associated with ADHD, especially at age 5
years
ADHD and Organophosphate
Pesticides [4]
SOURCE
Marks, A. R., Harley, K., Bradman, A., Kogut,
K., Barr, D. B., Johnson, C., Calderon, N., &
Eskenazi, B. (2010). Organophosphate
pesticide exposure and attention in young
Mexican-American children. Environmental
Health Perspectives. Advance online
publication. doi: 10.1289/ehp.1002056
ADHD
WISC–IV and ADHD [1]
McConaughy, Ivanova, Antshel, & Eiraldi (2009)
ADHD
Control
 N = 74
26
 Ages 6 to 11 yrs
 FSIQ = 96
113
 VCI = 97
112
 PRI = 99
113
 WMI = 96
109
 PSI = 93
103
WISC-IV and ADHD [2]
SOURCE
McConaughy, S. H., Ivanova, M. Y., Antshel,
K., & Eiraldi, R. B. (2009). Standardized
observational assessment of attention
deficit hyperactivity disorder combined and
predominantly inattentive subtypes. I. Test
session observations. School Psychology
Review, Vol 38(1), 45–66.
Long-Term Effects of ADHD—
Research Study



Introduction
About 5.4 million children are diagnosed
with ADHD in the U.S.
3% to 7% of school-aged children are
currently struggling with ADHD
How does ADHD affects their adult lives?
Long-Term Effects of ADHD—
Research Study


Introduction (Cont.)
33-year follow-up study of 135 middleaged men with childhood ADHD without
conduct disorders
Men were in their forties at follow-up
Long-Term Effects of ADHD—
Research Study



Results in Comparison with
Control Group
About 2.5 years fewer years of education
3.7% had higher degrees compared to
nearly 30% of the control group
Majority (84%) were holding jobs, but at
significantly lower positions than peers
without ADHD
Long-Term Effects of ADHD—
Research Study




Results in Comparison with
Control Group (Cont.)
ADHD group earned $40,000 less in
salary than their unaffected counterparts
Higher divorce rates (22% vs 5%)
More antisocial personality disorders (16%
vs 0%)
More substance abuse (14% vs 5%)
Long-Term Effects of ADHD—
Research Study



Results in Comparison with
Control Group (Cont.)
Higher rate of psychiatric hospitalizations
(24% vs 7%)
Higher rate of incarcerations (36% vs
12%)
Did not have higher rates of mood and
anxiety disorders, like depression
Long-Term Effects of ADHD—
Research Study



Suggested Interventions
Children with ADHD need academic
support in school
Need help in overcoming their frustrations
and challenges in paying attention and
retaining what they learn
Need emotional support from the family
Long-Term Effects of ADHD—
Research Study

Suggested Interventions (Cont.)
Need help in developing coping skills
needed to meet their adult challenges in
the workplace, in relationships, and in
social interactions.
Long-Term Effects of ADHD—
Research Study
Source
Klein, R. G., Mannuzza, S., Olazagasti, M.
A., Roizen, E., Hutchison, J. E., Lashua, E.
C., & Castellanos, F. X. (2012). Clinical and
functional outcome of childhood attentiondeficit/hyperactivity disorder 33 years later.
Archives of General Psychiatry. Advanced
online publication.
doi:10.1001/archgenpsychiatry.2012.271
Specific Learning Disorder
(SLD)[1]


DSM-V, Revised May 1, 2012
Definition: A diagnosis of Specific
Learning Disorder is made by a clinical
synthesis of the individual’s history
(development, medical, family, education),
psycho-educational reports of test scores
and observations, and response to
intervention, using the following diagnostic
criteria.
Specific Learning Disorder
(SLD)[2]
Diagnostic Criteria
Must meet criteria A, B, C, and D:
Specific Learning Disorder
(SLD)[3]
Diagnostic Criteria A
History or current presentation of persistent
difficulties in the acquisition of reading,
writing, arithmetic, or mathematical
reasoning skills during the formal years of
schooling (i.e., during the developmental
period). The individual must have at least
one of the following:
Specific Learning Disorder
(SLD)[4]
Diagnostic Criteria A
1. Inaccurate or slow and effortful word
reading
2. Difficulty understanding the meaning of
what is read (e.g., may read text accurately
but not understand the sequence,
relationships, inferences, or deeper
meanings of what is read
Specific Learning Disorder
(SLD)[5]
Diagnostic Criteria A
3. Poor spelling (e.g., may add, omit, or
substitute vowels or consonants)
4. Poor written expression (e.g., makes
multiple grammatical or punctuation errors
within sentences, written expression of ideas
lack clarity, poor paragraph organization, or
excessively poor handwriting)
Specific Learning Disorder
(SLD)[6]
Diagnostic Criteria A
5. Difficulties remembering number facts
6. Inaccurate or slow arithmetic calculation
7. Ineffective or inaccurate mathematical
reasoning.
8. Avoidance of activities requiring reading,
spelling, writing, or arithmetic
Specific Learning Disorder
(SLD)[7]
Diagnostic Criteria B
Current skills in one or more of these
academic skills are well-below the average
range for the individual’s age or intelligence,
cultural group or language group, gender, or
level of education, as indicated by scores on
individually-administered, standardized,
culturally and linguistically appropriate tests
of academic achievement in reading, writing,
or mathematics.
Specific Learning Disorder
(SLD)[8]
Diagnostic Criteria C
The learning difficulties are not better
explained by Intellectual Developmental
Disorder, Global Developmental Delay,
neurological, sensory (vision, hearing), or
motor disorders.
Specific Learning Disorder
(SLD)[9]
Diagnostic Criteria D
Learning difficulties identified in Criterion A
(in the absence of the tools, supports, or
services that have been provided to enable
the individual compensate for these
difficulties) significantly interfere with
academic achievement, occupational
performance, or activities of daily living that
require these academic skills, alone or in
any combination.
Specific Learning Disorder
(SLD)[10]

Descriptive Feature Specifiers
Specify which of the following domains of
academic difficulties and their subskills are
impaired, at the time of assessment:
Specific Learning Disorder
(SLD)[11]
Descriptive Feature Specifiers
1. Reading
a) Word reading accuracy
b) Reading rate or fluency
c) Reading comprehension
Specific Learning Disorder
(SLD)[12]
Descriptive Feature Specifiers
2. Written expression
a) Spelling accuracy
b) Grammar and punctuation accuracy
c) Legible or fluent handwriting
d) Clarity and organization of written
expression
Specific Learning Disorder
(SLD)[13]
Descriptive Feature Specifiers
3. Mathematics
a) Memorizing arithmetic facts
b) Accurate or fluent calculations
c) Effective math reasoning
Etiology of Learning Disabilities [1]



Genetic Basis
Eight times greater when parents have a
reading disorder
Higher incidence in identical twins
Related to multiple genes transmission
Etiology of Learning Disabilities [2]



Biological Basis
Different patterns of brain activation than
non-LD
Disruption in the neural systems while
reading
More irregularities in cerebral blood flow
and glucose metabolism than non-LD
Etiology of Learning Disabilities [3]





Environmental Basis
Ineffective learning strategies
Pedagogically induced
Parental attitudes toward learning
Parents’ child-management techniques
Family verbal interaction patterns
Etiology of Learning Disabilities [4]




Environmental Basis (Cont.)
Early reading experiences
Children’s temperament
Children’s level of motivation
Family’s socioeconomic status
Precursors of LD at Preschool Age [1]






Motor
Delays in gross-motor development
Delays in fine-motor development
Behavioral
Hyperactivity
Impulsivity
Inattention
Distractibility
Precursors of LD at Preschool Age [2]





Cognitive/Executive
Difficulty in planning ahead
Sequence confusion of routine activities
Losing clothes, toys, and school materials
Memory
Memory difficulties
Difficulty in acquiring facts, accumulating
general knowledge, and learning word
sounds
Precursors of LD at Preschool Age [3]



Communication
Speech and language delays
Difficulties in learning listening and
speaking skills
Problems with syntax, articulation, and
pragmatics
Precursors of LD at Preschool Age [4]




Perceptual
Visual or auditory processing difficulties
Auditory processing difficulties
Social-Emotional
Difficulties in regulating emotions
Difficulties in developing friendships
School-Age Children with LD [1]




Problems
Cognitive/Academic Problems
Information-Processing/Executive
Problems
Perceptual Problems
Social-Behavioral Problems
School-Age Children with LD [2]



Possible Reasons
Behavioral problems may stem from
learning problems
Learning problems may stem from
behavioral problems.
Both learning and behavioral problems
may stem from a common etiology
Advantages of Discrepancy Model
1.
2.
3.
4.
5.
Reliability and validity are known to be
adequate.
A rationale is provided for dispensing
services.
The focus is on the core area.
The identification procedure is
characterized by objectivity.
Special education services are provided
to those most likely to benefit from them.
Disadvantages of Discrepancy Model
[1]
1.
2.
Clinicians using the same discrepancy
formula, but different tests, may arrive at
different classifications.
Using discrepancy formulas without
regard for the absolute level of the child’s
performance may result in serious
misinterpretations and misclassifications.
Disadvantages of Discrepancy Model
[2]
3.
Discrepancy formulas are based on the
assumption that the tests used to
evaluate a child’s intelligence and
achievement measure independent
constructs, when in fact achievement
and intelligence tests measure similar
constructs (e.g., vocabulary,
mathematics, factual information).
Disadvantages of Discrepancy Model
[3]
4.
5.
6.
Discrepancy formulas fail to identify
children with learning disabilities who
show no discrepancy between
achievement and intelligence test scores.
Discrepancy formulas have never been
empirically validated.
The discrepancy formula approach
prevents children from receiving services
during their early school years.
Curriculum Based Measurement
(CBM)[1]


Designed to monitor students’ growth in
basic academic domains
 Reading
 Spelling
 Written expression
 Mathematics
Tied to the curriculum of instruction
Curriculum Based Measurement
(CBM)[2]

Provides teachers with data useful for
 Comparing how students have done
recently on other, similar tasks
 Evaluating how students are
progressing toward a long term goal
 Making adjustments in instructional level
and type of instruction
 Comparing students to a local group,
such as classroom or grade
Curriculum Based Measurement
(CBM)[3]



CBM TESTS
Multiple forms of tests are possible
Inexpensive to create and produce
Sensitive to students’ achievement and
change over time
Curriculum Based Measurement
(CBM)[4]


CBM TESTS (Cont.)
Standardized assessment
 Specific directions
 Timed
 Scoring rules
Can be given repeatedly to the same
student
Curriculum Based Measurement
(CBM)[5]




CBM TESTS (Cont.)
Tests designed to measure what students
were taught and expected to learn
Quick, efficient, and easy to give
Short duration permits frequent
administration
Focus on direct and repeated measures of
student performance
Curriculum Based Measurement
(CBM)[6]

CBM TESTS (Cont.)
Can be used for
 Eligibility determination
 Screening
 Decision-making (both individual,
criterion referenced, and norm
referenced)
 Progress monitoring
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [1]



EXAMPLE OF A CBM MEASURE
Five measures designed to determine if
students need additional instructional
support
Typically, students are tested once in the
fall and once in the spring
Aim is to determine what instructional
modifications should be made
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [2]
EXAMPLE OF A CBM MEASURE (Cont.)
 Initial Sounds Fluency (ISF)
 12 pictures are shown
 Students asked to identify the beginning
sound
 Primarily for kindergarteners
 Measures basic literacy skills
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [3]
EXAMPLE OF A CBM MEASURE (Cont.)
 Letter Naming Fluency (LNF)
 Students given a page containing upperand lower-case letters
 Asked to name as many letters as they
can
 Phoneme Segmentation Fluency (PSF)
 Students hear distinct words
 Asked to verbally produce the individual
phonemes
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [4]
EXAMPLE OF A CBM MEASURE (Cont.)
 Nonsense Word Fluency (NWF)
 Students see written CVC (consonant
vowel consonant) and VC (vowel
consonant) nonsense words
 Asked to verbally produce the individual
sound of each letter or read the whole
word
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [5]
EXAMPLE OF A CBM MEASURE (Cont.)
 Oral Reading Fluency (ORF)
 Students are given a standardized set of
reading passages
 Asked to read the passage out loud in
one minute
DIBELS (Dynamic Indicators of
Basic Early Literacy Skills) [6]
SOURCE
Kaminski, R. A., & Good, R. H., III. (2005).
Dynamic Indicators of Basic Early Literacy
Skills—6th Edition (DIBELS-6). Eugene,
OR: University of Oregon
Academic Competence Evaluation
Scales (ACES) [1]



ANOTHER EXAMPLE OF A CMB TEST
Part of Academic Intervention
Monitoring System (AIMS)
Academic Skills Subscales
Reading/Language Arts
Mathematics
Critical Thinking
Academic Competence Evaluation
Scales (ACES) [2]

ANOTHER EXAMPLE OF A CMB TEST
Part of Academic Intervention
Monitoring System (AIMS)
Academic Enablers Subscales
Motivation
 Reflects a student’s approach,
persistence, and level of interest
regarding academic subjects
Academic Competence Evaluation
Scales (ACES) [3]

ANOTHER EXAMPLE OF A CMB TEST
Part of Academic Intervention
Monitoring System (AIMS)
Academic Enablers Subscales (Cont.)
Engagement
 Reflects a student’s attention and active
participation in classroom activities
Academic Competence Evaluation
Scales (ACES) [4]

ANOTHER EXAMPLE OF A CMB TEST
Part of Academic Intervention
Monitoring System (AIMS)
Academic Enablers Subscales (Cont.)
Study skills
 Reflects a student’s behaviors that
facilitate the processing of new material
and taking tests
Academic Competence Evaluation
Scales (ACES) [5]

ANOTHER EXAMPLE OF A CMB TEST
Part of Academic Intervention
Monitoring System (AIMS)
Academic Enablers Subscales (Cont.)
Interpersonal skills
 Reflects a student’s cooperative
learning behaviors necessary to interact
with others
Academic Competence Evaluation
Scales (ACES) [6]
SOURCE
DiPerna, J. C., & Elliott , S. N. (2000).
Academic Competence Evaluation Scales
(ACES). San Antonio, TX: Pearson
Curriculum Based Assessment



A test written by a teacher
Focus on evaluating what a student
learned from the instruction given in a
specific course
Example: A weekly spelling test based on
a spelling list
Intellectual Developmental
Disorder (IDD)[1]


DSM-V, Revised April 2012
Definition: Intellectual Developmental
Disorder (IDD) is a disorder that includes
both a current intellectual deficit and a
deficit in adaptive functioning with onset
during the developmental period.
Intellectual Developmental
Disorder (IDD)[2]
Diagnostic Criteria
Must meet criteria A, B, and C
Intellectual Developmental
Disorder (IDD)[3]
Diagnostic Criteria A
Intellectual Developmental Disorder is
characterized by deficits in general mental
abilities such as reasoning, problem-solving,
planning, abstract thinking, judgment,
academic learning and learning from
experience.
Intellectual Developmental
Disorder (IDD)[4]
Diagnostic Criteria B
Impairment in adaptive functioning for the
individual’s age and sociocultural
background.
Intellectual Developmental
Disorder (IDD)[5]
Diagnostic Criteria B (Cont.)
Adaptive functioning refers to how well a
person meets the standards of personal
independence and social responsibility in
one or more aspects of daily life activities,
such as communication, social participation,
functioning at school or at work, or personal
independence at home or in community
settings.
Intellectual Developmental
Disorder (IDD)[6]
Diagnostic Criteria B (Cont.)
The limitations result in the need for ongoing
support at school, work, or independent life.
Intellectual Developmental
Disorder (IDD)[7]
Diagnostic Criteria C
All symptoms must have an onset during the
developmental period.
Intellectual Developmental
Disorder (IDD)[8]

DSM-V Discussion of IQ
IQ tests in DSM-V. Intellectual functioning
is typically measured using standardized
tests of intellectual function.
Intellectual Developmental
Disorder (IDD)[9]

DSM-V Discussion of IQ (Cont.)
On such tests, the category of IDD is
considered to be approximately 2 standard
deviations below the population mean.
This level of impairment equates to an
Intelligence Quotient (IQ) score of 70 or
below, with a measurement error of
approximately 5 points on each side of the
cut point.
Intellectual Developmental
Disorder (IDD)[10]

DSM-V Discussion of IQ (Cont.)
Assessment procedures and diagnosis
must take into account factors other than
IDD that may limit performance (e.g.,
sociocultural background, native language,
associated communication/language
disorder, motor or sensory handicap).
Intellectual Developmental
Disorder (IDD)[11]

DSM-V Discussion of IQ (Cont.)
Cognitive profiles are generally more
useful for describing intellectual abilities
than a single full-scale IQ score, and
clinical training and judgment are required
for interpretation of test results.
Intellectual Developmental
Disorder (IDD)[12]
Severity Level for IDD
Mild
Moderate
Severe
Conceptual
Domain
Conceptual
Domain
Conceptual
Domain
Social
Domain
Social
Domain
Social
Domain
Practical
Domain
Practical
Domain
Practical
Domain
Intellectual Developmental
Disorder (IDD)[13]

Mild Severity Level for IDD
Conceptual Domain
For preschool children, there may be no
obvious conceptual differences.
Intellectual Developmental
Disorder (IDD)[14]

Mild Severity Level for IDD
Conceptual Domain (Cont.)
For school-aged children and adults,
person has difficulties and limitations in
acquisition of academic skills involving
reading, writing, arithmetic, time, money,
and needs support in at least some of
these areas in order to meet age-related
expectations.
Intellectual Developmental
Disorder (IDD)[15]

Mild Severity Level for IDD
Conceptual Domain (Cont.)
In adults, abstract thinking, executive
function (planning, strategizing, setting
priorities, and cognitive flexibility) and
short term memory are impaired. Older
children and adults may have a concrete
approach to problems and solutions
compared to agemates. There are usually
lifelong limitations in these areas.
Intellectual Developmental
Disorder (IDD)[16]

Mild Severity Level for IDD
Social Domain
Compared to typically developing
agemates, the person is immature in
social interactions. For example, there
may be difficulty in accurately perceiving
peers’ social cues. Communication and
language are more concrete than
expected for age.
Intellectual Developmental
Disorder (IDD)[17]

Mild Severity Level for IDD
Social Domain (Cont.)
There may be difficulties regulating
emotion and behavior in age-appropriate
fashion. These difficulties are noticed and
are generally accommodated for by peers
in social situations. Social judgment is
immature for age and the person is at risk
of being manipulated by others
(gullibility).
Intellectual Developmental
Disorder (IDD)[17]

Mild Severity Level for IDD
Practical Domain
Person may function age-appropriately in
personal care, though in childhood these
skills may not be age-appropriate. Persons
need some support with complex tasks in
comparison to peers.
Intellectual Developmental
Disorder (IDD)[17]

Mild Severity Level for IDD
Practical Domain (Cont.)
In adulthood supports typically involve
grocery shopping, transportation,
organizing home and childcare, nutritious
food preparation, banking and money
management. Recreational skills resemble
those of age-mates, though judgment
related to wellbeing and organization
around recreation requires support.
Intellectual Developmental
Disorder (IDD)[17]

Mild Severity Level for IDD
Practical Domain (Cont.)
As adults, persons can work in competitive
employment in jobs that do not emphasize
conceptual skills. Persons generally need
support to make health care decisions,
legal decisions, and to learn to perform a
vocation competently. Support is typically
needed to raise a family.
Intellectual Developmental
Disorder (IDD)[18]

Moderate Severity Level for IDD
Conceptual Domain
All through development, the person’s
conceptual skills lag markedly behind
peers. For preschoolers, language and
pre-academic skills develop slowly.
Progress in reading, writing, math, time,
and money occurs gradually across the
school years.
Intellectual Developmental
Disorder (IDD)[19]

Moderate Severity Level for IDD
Conceptual Domain (Cont.)
For adults, academic skill development is
typically at an elementary rather than
secondary level. Ongoing assistance on a
daily basis is needed to complete
conceptual tasks of day to day life.
Intellectual Developmental
Disorder (IDD)[20]

Moderate Severity Level for IDD
Social Domain
Person shows marked differences from
peers in social and communicative
behavior across development. Spoken
language is typically a primary tool for
social communication but is less complex
than peers.
Intellectual Developmental
Disorder (IDD)[21]

Moderate Severity Level for IDD
Social Domain (Cont.)
People have social motivation for
relationships with family and peers, and
may have successful friendships across
life and sometimes romantic relations in
adulthood. However, people may not
perceive or interpret social cues
accurately.
Intellectual Developmental
Disorder (IDD)[22]

Moderate Severity Level for IDD
Social Domain (Cont.)
Social judgment and decision-making
abilities are limited, and caretakers must
assist the person with life decisions.
Friendships with typically developing peers
are often affected by communication or
social limitations. Social and
communicative support is needed in work
settings for success.
Intellectual Developmental
Disorder (IDD)[17]

Moderate Severity Level for IDD
Practical Domain
Person can care for personal needs
involving eating, dressing, elimination,
hygiene as an adult, though an extended
period of teaching and time is needed to
become independent in these areas.
Intellectual Developmental
Disorder (IDD)[17]

Moderate Severity Level for IDD
Practical Domain (Cont.)
Similarly, participation in all household
tasks can be achieved by adulthood,
though an extended period of teaching
and support is needed.
Intellectual Developmental
Disorder (IDD)[17]

Moderate Severity Level for IDD
Practical Domain (Cont.)
Independent employment may be
achieved, but considerable support from
co-workers, supervisors, and coaches is
needed to manage social expectations,
complexities of the job, and ancillary
responsibilities such as scheduling,
transportation, health benefits, and money
management.
Intellectual Developmental
Disorder (IDD)[17]

Moderate Severity Level for IDD
Practical Domain (Cont.)
A variety of recreational skills can be
developed and typically requires additional
supports and learning opportunities over
an extended period of time. Maladaptive
behavior is present in a significant minority
and causes social problems.
Intellectual Developmental
Disorder (IDD)[23]

Severe Severity Level for IDD
Conceptual Domain
Attainment of conceptual skills is
extremely limited. Person may understand
use of objects as tools, may be able to
complete simple cause and effect actions
with objects.
Intellectual Developmental
Disorder (IDD)[24]

Severe Severity Level for IDD
Conceptual Domain (Cont.)
Person lacks understanding of written
language. Person lacks concepts involving
number, quantity, time, money. Caretakers
provide all supports for this
area throughout life.
Intellectual Developmental
Disorder (IDD)[25]

Severe Severity Level for IDD
Social Domain
Persons generally use nonverbal
communication to initiate and respond to
social attention and interactions.
Language, if used or understood, involves
names of objects and people and simple
phrases tied to everyday events.
Intellectual Developmental
Disorder (IDD)[26]

Severe Severity Level for IDD
Social Domain (Cont.)
Persons may respond to direct emotional
communications and understand simple
social cues but in general lack
understanding of social context.
Relationships involve family, caretakers
and other long term ties and are more
typical of attachment relations than of
reciprocal friendships.
Intellectual Developmental
Disorder (IDD)[17]

Severe Severity Level for IDD
Practical Domain
Person requires support for all activities of
daily living, including meals, dressing,
bathing, elimination. Person requires
supervision at all times.
Intellectual Developmental
Disorder (IDD)[17]

Severe Severity Level for IDD
Practical Domain (Cont.)
Person may make choices for preferred
objects, activities, and people. Person
cannot make responsible decisions
regarding wellbeing of self or others. As an
adult, participation in practical and
vocational activities requires ongoing
support and assistance.
Intellectual Developmental
Disorder (IDD)[17]

Severe Severity Level for IDD
Practical Domain (Cont.)
Recreational activities require long-term
teaching and ongoing support.
Maladaptive behavior, including self injury,
is present in a significant minority.
Strategies Useful for
Coping with Stress [1]
Exercise, Nutrition, and Sleep Strategies
 Recognize and monitor any symptoms of
stress by listening to your body and mind
 Breathe deeply, with regular slow
breathing
 Exercise (take walks, participate in sports
that you enjoy, work in your garden)
Strategies Useful for
Coping with Stress [2]
Exercise, Nutrition, and Sleep Strategies
(Cont.)
 Eat a balanced diet, with plenty of fruits
and vegetables
 Get sufficient sleep
Strategies Useful for
Coping with Stress [3]



Social and Personal Strategies
Maintain a sense of humor
Devote time to hobbies or other activities
that you love
Make friends; do not be a social isolate
Strategies Useful for
Coping with Stress [4]



Social and Personal Strategies (Cont.)
Know your limits, stick to them, and learn
how to say “no”
Make your home environment as pleasant
as possible (and your work environment
as well)
Express your feelings to a good friend or
therapist (if needed)
Strategies Useful for
Coping with Stress [5]



Social and Personal Strategies (Cont.)
Adjust your standards if you are a
perfectionist
Don’t try to control events (or other
people) in your life that are uncontrollable
Take a moment to reflect on the positive
things in your life
Strategies Useful for
Coping with Stress [6]



Social and Personal Strategies (Cont.)
Manage your time effectively
Change your pace, making a conscious
effort to slow down and not do too much at
once or during a day
Set aside some time to relax (and learn
relaxation techniques as needed)
Strategies Useful for
Coping with Stress [7]




Social and Personal Strategies (Cont.)
Take breaks as needed
Spend time in nature
Play with a pet
Watch a comedy
Strategies Useful for
Coping with Stress [8]



Work-Related Strategies
Give yourself plenty of time to complete
tasks and assignments
Reduce overtime
Make efforts to create a manageable
workload, resisting the temptation to
volunteer for additional work or
responsibility
Strategies Useful for
Coping with Stress [9]



Work-Related Strategies (Cont.)
Consult with colleagues whenever you
have questions about how to handle a
difficult case
Keep your work goals realistic
Clarify ambiguous work assignments
Strategies Useful for
Coping with Stress [10]


Work-Related Strategies (Cont.)
Keep lines of communication with other
staff members open
Vary your work activities and the types of
clients you work with, if possible
Strategies Useful for
Coping with Stress [11]


Work-Related Strategies (Cont.)
Attend lectures, seminars, or conferences,
where you can renew your energy for the
job and meet others in your field who
confront similar problems
Take a vacation, during which you ignore
your emails, and give yourself time to
disengage and unwind
Strategies Useful for
Coping with Stress [12]


Sources
Corey, G., Corey, M. S., & Callanan, P.
(1993). Issues and ethics in the helping
professions (4th ed.). Pacific Grove, CA:
Brooks/Cole.
Helpguide.org. (2008). Stress
management: How to reduce, prevent, and
cope with stress. Retrieved from
http://grad.auburn.edu/cs/stress.pdf
Strategies Useful for
Coping with Stress [13]

Sources
Holland, J. C. (1989). Stresses on mental
health professionals. In J. C. Holland & J.
H. Rowland (Eds.), Handbook of
psychooncology: Psychological care of the
patient with cancer (pp. 678–682). New
York, NY: Oxford University Press.
Strategies Useful for
Coping with Stress [14]

Sources
Mateer, C. A., & Sira, C. S. (2008).
Practical rehabilitation strategies in the
context of clinical neuropsychology
feedback. In J. E. Morgan & J. H. Ricker
(Eds.), Textbook of clinical
neuropsychology (pp. 996–1007). New
York, NY: Psychology Press.
Children Learn What They Live
by Dorothy Law Nolte [1]
If children live with criticism,
They learn to condemn.
If children live with hostility,
They learn to fight.
If children live with ridicule,
They learn to be shy.
If children live with shame,
They learn to feel guilty.
If children live with encouragement,
They learn confidence.
Children Learn What They Live
by Dorothy Law Nolte [2]
If children live with tolerance,
They learn to be patient.
If children live with praise,
They learn to appreciate.
If children live with acceptance,
They learn to love.
If children live with approval,
They learn to like themselves.
Children Learn What They Live
by Dorothy Law Nolte [3]
If children live with honesty,
They learn truthfulness.
If children live with security,
They learn to have faith in
themselves and others.
If children live with friendliness,
They learn the world is a nice
place in which to live.