Emotional / Behavioral Disorders and Physical / Health Impairments

Introduction A special education teacher will undoubtedly have a class filled with children that come to school with varied disabling conditions, temperaments, skills and abilities. Some students will arrive with emotional/behavioral disorders that may

A special education teacher will undoubtedly have a class filled with children that come to school with varied disabling conditions, temperaments, skills and abilities. Some students will arrive with emotional/behavioral disorders that may or may not have been yet diagnosed. Others may have physical or heath impairments that require specialized equipment. As broad as they are, the teacher needs to be aware of the definitions and characteristics of disabling conditions. Additionally, the teacher must have in his or her tool box strategies for creating and maintaining a classroom where expectations are high, motivation to learn is fostered and every child is embraced and accepted for who he or she is. The teacher should be ready to meet the child where he or she is and guide that student to a new more skilled and independent place.

Physical/Health Impaired

Heward (2009) asserts a student served by special education in a public school system due to the Individuals with Disability in Education Act (IDEA) categorized as health impaired, or as having a severe orthopedic impairment is one that:

Adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly (e.g. clubfoot, absence of some member, etc.) impairments caused by disease (e.g.., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures (p.407).

Orthopedic impairments include neuromotor impairments that involve the central nervous system (CNS). Impairment in the CNS may manifest itself by causing one to move, use, feel or control certain parts of the body in a diminished way or non functional way. IDEA also recognizes other health impairments as having:

limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—

i). is due to chronic or acute health problems such as asthma. Attentions deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and tourette syndrome: and

(ii) Adversely affects academic performance (p. 408).

Conditions that adversely affect the educational performance of the child are the defining qualifying characteristics for special education services. The student must require specially designed instruction in order to develop the skills and abilities required to learn.


Characteristics of physical disabilities and health impairments are impossible to describe as a grouping, as they are immensely varied in description. Heward (2009) depicts in general terms the categories of mild, moderate or severe with some intellectual function being impaired and with others not. Many children may have more than one disabling condition requiring physical, occupational or speech therapy, or a combination of these and/or others for help in access or communication during school.

Emotional Behavioral Disorder

Anderman & Anderman (2009) claims that attempting to define emotional behavioral disorder (EBD) is difficult at best and the “federal definition is seriously flawed” (p.361). Attempting to distinguish between whether the condition is an emotional disturbance or a behavioral disorder is impossible. Agreement does appear to be consistent that all definitions include the following commonalities: (1) extreme behavior (not just slightly different from the usual), (2) a chronic problem (constant and on-going, which does not resolve quickly) and (3) violation of social or cultural expectations. Furthermore, much controversy surrounds the definition as IDEA does not allow for students who are socially maladjusted, but not considered emotionally disturbed. The problem seems to lie in the concept that a judgment is being placed on the student or the family as to why the student is maladjusted and not just that he or she is incapable of being socially appropriate at school.

Characteristics of Emotional Behavioral Disorders

Children with emotional /behavioral disorders may have externalizing or internalizing problems around behavior. A child with externalizing difficulties will act out more often frequently exhibiting anti social behaviors. Those with internalizing behaviors may be more withdrawn, lack adequate social skills and not be able to appropriately interact with peers and others. As students, the child with EBD will generally will have a below average IQ and perform below grade level. Also, these students will have a greater risk of having a learning disability and have a difficult time getting and keeping friends. About one third of students with EBD will become delinquent and be arrested during their school years (Heward, 2009).

Teaching Toolbox Strategies for Success

The following matrix is for use by the beginning special educator to assist in developing a classroom that is conducive to optimum learning, or either students who exhibit physical or health impairments or emotional behavioral disorders.

Effective Teaching Strategies

Emotional/Behavioral Disordered Students

Strategy for Skill Deficits Definition of Strategy

Identify Learning Strengths Learning strengths are the set of skills or attributes that each individual has and can be used in the development of instructional programming (Wheeler & Richey, 2010).

Identify response formats previously tried Response formats are instructional methods that have been tried. It is important to know which ones have been successful in the past to help the student be successful (Wheeler & Richey, 2010).

What is the cognitive level of the learner? The cognitive level of the learner is the intellectual ability the learner has and is imperative when determining the students’ academic program. Cognition also many times affects language and communication (Wheeler & Richey, 2010).

Curriculum Design Strategies

Task Design Tasks must be relevant to the student

Tasks must be modified to coincide with the learners ability (cognitive, motoric and developmental level)

Tasks must include an element of choosing to involve/empower the learner

Tasks must be designed to be completed in an appropriate length of time for the student

Tasks over the course of the day need to be varied and have some flexibility

Tasks should be posted on a classroom schedule or the students personal daily calendar(Heward, 2009)

Task Presentation Teacher must give clear and consistent clues especially when teaching a new task. They should be brief, clear and direct.

Teacher should use verbal, gesture, picture or physical cues when appropriate for each student.

Cues should also be embedded within the task.

Systematic instruction teaches in a stepwise or building block manner.

Prompt hierarchies (independent, verbal, gestural, physical prompting)

Use of naturally occurring reinforcers, (i.e. Free time with choice of activity) as reward for work completion

(Wheeler & Richey, 2010).

Teacher Praise

Give many opportunities to respond during instruction

Use direct instruction for introducing new material (Heward, 2009)

Shaping Reinforcing the skill by continually and successively reducing assistance

Contingency contracting The teacher makes clear what will happen ’if.’ If you do this, this will happen. Expectations must be clear and followed through with at all times.

Extinction The teacher stops reinforcing something he or she has been reinforcing.

Differential Reinforcement Giving praise or reinforcement when the student is on task at an unexpected time

Differential reinforcement of incompatible behavior Giving the student something to occupy his/herself during a time when misconduct usually occurs.

Response cost Requires the loss of something the student desires as in a penalty or fine. The student looses recess for refusing to do work.

Token economy or level system Student works for a reinforcer that can be exchanged for a preferred object or activity

Behavioral; expectations are stated A simple list of classroom rules

Behavioral expectations are defined and taught Taught to ALL students in the building. The general rule is presented and the rationale for the rule is given using positive examples. These are modeled and practiced routinely.

Appropriate behaviors are acknowledged This is done either formally (tickets, rewards) or informally social events. 4 positives to 1 negative interaction between adults and students are acceptable.

Behavioral errors are corrected proactively Clear procedures previously taught and agreed upon are enforced.

Program evaluations and adaptations are data driven and made by a team Data keeping should be simple but effective. Included for school wide assessment should be incident reports, attendance rates, and tardiness, detention, and suspension rates.

Individual student support systems are integrated with school-wide discipline systems (Heward, 2009) Used for secondary and tertiary prevention for at risk or students who require a more restrictive environment

Self Monitoring

Specify the target behavior Choose target behavior with the student. Begin with one that is most easily attainable

Gather materials Keep it simple. Paper and pencil recording using a + or – system works in most cases

Supplement materials Sometimes a visual reminder will give the student prompts and help him/her be more successful.

Give direct instruction The teacher must take the time to teach the system to the students and model the components of the system.

Reinforce accurate self-monitoring The teacher must pay attention to ensure the student is correctly self-monitoring

Reward improvements Highly preferred rewards can be given to motivate the student to continue to self motivate.

Encourage self-evaluation Give encouragement and keep the reinforcers positive

Evaluate the program It the program is not working, look at the data and determine and alternative approach.

Strategies for motivational deficits

Identify the preferred activities/objects of the learner The preferred object or activities are those things that give the students joy enough that he or she will be willing to produces or comply in order to engage in or with (Wheeler & Richey, 2010).

Interspersed requesting Within the task are simplified problems the student has mastered so the student will feel successful as he or she completes new material.

Environmental Modifications

Assistive Technology Work with the OT or assistive technology expert in the district to have in place and AT devices the student may require. Make sure there is ample room for the device(s) and that they are operational before class starts.

Furniture and classroom equipment placement Place desks, computer tables, health equipment must be placed for greatest student access and so the student feels a part of the class not segregated from classmates.

Ensure the student has access to classroom modalities like the other students, i.e. sink and water access, art supplies.

Allow modifications for class participation and work completion.


Understanding the complexities of special children who arrive at school with physically or emotionally disabling conditions is crucial for the special educator. Whether the nature of the disability is mild, moderate or severe, the teacher is bound to have some modifications or adjustments to make in order for the student to reap optimum benefit from what is being taught on any given day. Strategies for classroom management and organization, as well as individual curriculum modifications are essential for all special education teachers.


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