Emotional and behavioral disorders

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Emotional and behavioral disorder with onset usually occurring in childhood and adolescence
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Emotional and behavioral disorders (EBD; also known as behavioral and emotional disorders) [1] [2] refer to a disability classification used in educational settings that allows educational institutions to provide special education and related services to students who have displayed poor social and/or academic progress. [3]

Contents

The classification is often given to students after conducting a Functional Behavior Analysis. These students need individualized behavior supports such as a Behavior Intervention Plan, to receive a free and appropriate public education. [4] Students with EBD may be eligible for an Individualized Education Plan (IEP) and/or accommodations in the classroom through a 504 Plan. [4]

History

Early history

Before any studies were done on the subject, mental illnesses were often thought to be a form of demonic possession or witchcraft. Since much was unknown, there was little to no distinction between the different types of mental illness and developmental disorders that we refer to today. Most often, they were dealt with by performing an exorcism on the person exhibiting signs of any mental illness. [5] In the early to mid-1800s, asylums were introduced to America and Europe. There, patients were treated cruelly and often referred to as lunatics by doctors in the professional fields. [6] The main focus of asylums were to shun people with mental illnesses from the public. In 1963, the Community Mental Health Centers Construction Act (Public Law 88–164), was passed by Congress and signed by John F. Kennedy, which provided federal funding to community mental health centers. This legislation changed the way that mental health services were handled and also led to the closure of many large asylums. [5] Many laws soon followed assisting more and more people with EBDs. 1978 came with the passing of Public Law 94- 142 which required free and public education to all disabled children including those with EBDs. An extension of PL 94–142, PL 99-457, was put into act which would provide services to all disabled children from the ages of 3-5 by the 1990–91 school year. [7] PL 94-142 has since been renamed to the Individuals with Disabilities Education Act (IDEA).

Use and development of the term

Various terms have been used to describe irregular emotional and behavioral disorders. Many of the terms such as mental illness and psychopathology were used to describe adults with such conditions. [8] Mental illness was a label for most people with any type of disorder and it was common for people with emotional and behavioral disorders to be labeled with a mental illness. [9] However, those terms were avoided when describing children as it seemed too stigmatizing. In the late 1900s the term "behaviorally disordered" appeared. Some professionals in the field of special education accepted the term while others felt it ignored emotional issues. [8] In order to make a more uniformed terminology, the National Mental Health and Special Education Coalition, which consists of over thirty professional and advocacy groups, coined the term "emotional and behavioral disorders" in 1988.

Criteria

According to the Individuals with Disabilities Education Act an EBD classification is required if one or more of the following characteristics is excessively observed in a student over a significant amount of time: [10]

The term "EBD" includes students diagnosed with schizophrenia. However, it does not have any significant bearing on students who are socially maladjusted unless they also meet the above criteria.

Criticisms

Providing or failing to provide an EBD classification to a student may be controversial, as the IDEA does not clarify which children would be considered "socially maladjusted". Students with a psychiatric diagnosis of conduct disorder are not guaranteed to receive additional educational services under an EBD classification. [11] Students with an EBD classification who meet the diagnostic criteria for various disruptive behavior disorders, including attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD) do not have an automatic eligibility to receive an IEP or 504 Plan. [11] Students considered "socially maladjusted", but ineligible for an EBD classification (i.e., students diagnosed with conduct disorder), often receive better educational services in special education classrooms or alternative schools with high structure, clear rules, and consistent consequences. [12]

Student characteristics

Students with EBD are a diverse population with a wide range of intellectual and academic abilities. Males, African-Americans, and economically disadvantaged students are over-represented in the EBD population, and students with EBD are more likely to live in single-parent homes, foster homes, or other non-traditional living situations. [13] These students also tend to have low rates of positive social interactions with peers in educational contexts. [14] Students with EBD are often categorized as "internalizers" (e.g., have poor self-esteem, or are diagnosed with an anxiety disorder or mood disorder) or "externalizers" (e.g., disrupt classroom instruction, or are diagnosed with disruptive behavior disorders such as oppositional defiant disorder and conduct disorder). Male students may be over-represented in the EBD population because they appear to be more likely to exhibit disruptive externalizing behavior that interferes with classroom instruction. Females may be more likely to exhibit internalizing behavior that does not interfere with classroom instruction, though to what extent this perception is due to social expectations of differences in male and female behavior is unclear. In any case, it is important to note that both internalizing and externalizing behaviour can and do occur in either sex; [13] Students with EBD are also at an increased risk for learning disabilities, school dropout, substance abuse, and juvenile delinquency. [13]

Internalizing and externalizing behavior

A person with EBD with "internalizing" behavior may have poor self-esteem, have depression, experience loss of interest in social, academic, and other life activities, and may exhibit non-suicidal self-injury or substance abuse. Students with internalizing behavior may also have a diagnosis of separation anxiety or another anxiety disorder, post-traumatic stress disorder (PTSD), specific or social phobia, obsessive–compulsive disorder (OCD), panic disorder, and/or an eating disorder. Teachers are more likely to write referrals for students that are overly disruptive. Screening tools used to detect students with high levels of "internalizing" behavior are not sensitive and are rarely used in practice. [15] Students with EBD with "externalizing" behavior may be aggressive, non-compliant, extroverted, or disruptive.

Students with EBD that show externalizing behavior are often diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder,autism spectrum disorder and/or bipolar disorder; however, this population can also include typically developing children that have learned to exhibit externalizing behavior for various reasons (e.g., escape from academic demands or access to attention). These students often have difficulty inhibiting emotional responses resulting from anger, frustration, and disappointment. Students who "externalize" exhibit behaviors such as insulting, provoking, threatening, bullying, cursing, and fighting, along with other forms of aggression. Male students with EBD exhibit externalizing behavior more often than their female counterparts. [15]

Children and adolescents with ADD or ADHD may display different types of externalizing behavior and should be either medicated or going through behavioral treatment for their diagnosis. [13] Adolescents with severe ADHD would likely benefit most from both medication and behavioral treatment. Younger children should go through behavioral treatment before being treated with medication. Another recommended form of treatment for children and adolescents diagnosed with ADHD would be counseling from a mental health professional. Treatment options will improve performance of children and adolescents on emotion recognition tasks, specifically response time as there is no difficulty recognizing human emotions. [15] The degree of required treatments vary depending on the degree of ADD or ADHD the individual has.

Treatment for these types of behaviors should include the parents as it is evident that their parenting skills impact on how their child deals with their symptoms, especially when at a younger age. Parents going through a parenting skills training program were reported a decrease in internalizing and externalizing behavior in their children post-training program. [16] The program included learning how to give positive attention, increase good behavior with small frequent rewards and specific praise as well as learning how to decrease attention when the child behaved poorly.

Effect in cognition

In recent years, many researchers have been interested in exploring the relationship between emotional disorders and cognition. Evidence has revealed that there is a relationship between the two. Strauman (1989) investigated how emotional disorders shape a person's cognitive structure, that is, the mental processes people utilize to make sense of the world around them. [17] He recruited three groups of individuals: those with social phobias, those with depression, and controls with no emotional disorder diagnosis. He wanted to determine whether these groups had a cognitive structure showing an actual/ideal (AI) discrepancy (referring to an individual not believing that they have achieved their personal desires) or actual/own/other (AOO) discrepancy (referring to an individual's actions not living up to what their significant other believes that they need to be). He found that depressed individuals had the highest AI discrepancy and social phobics had the greatest AOO discrepancy, while the controls were lower or in between the two for both discrepancies. [18]

Specific cognitive processes (e.g., attention) may be different in those with emotional disorders. MacLeod, Mathews, and Tata (1986) tested the reaction times of 32 participants, some of whom were diagnosed with Generalized Anxiety disorder, when presented with threatening words. They found that when threatening words were presented, people with greater anxiety tended to have increased selective attention, meaning that they reacted quicker to a stimulus in an area where a threatening word was just presented (32-59ms faster). When in the control group, subjects reacted slower when there was a threatening word proceeding the stimulus (16-32ms slower). [19]

Emotional disorders can also alter the way people regulate their emotions. Joormann and Gotlib (2010) conducted a study with depressed, or previously depressed, individuals to test this. They found that, when compared to individuals who have never had a depressive episode, previously and currently depressed individuals tended to use maladaptive emotion regulation strategies (such as rumination or brooding) more. They also found that when depressed individuals displayed cognitive inhibition (slowing of response to a variable that had been previously ignored) when asked to describe a negative word (ignored variable was a positive word), they were less likely to ruminate or brood. When they displayed cognitive inhibition when asked to describe a positive word (ignored variable was a negative word), they were more likely to reflect. [20]

Services in the United States

There are many types of services available to EBD students, referenced below. One service is one-on-one support (or an aide) who assists in everyday activities and academics. Another service is foundations offer behavior services as well as counseling support. Some services include classrooms that are dedicated to educational foundations and work on building the student up possessively. States also offer dedicated schools with multiple resources that help students with EBD excel and transition (back) into local schools.

Texas

The state of Texas has the Texas Behavior Support Initiative (TBSI) authorized by Senate Bill 1196 and Texas Administrative Code §89.1053. With its design to provide knowledge for the use of constructive behavior interventions and to aid students, including students with disabilities. TBSI meets the legislative requirements for the use of restraint and time-out, along with providing the baseline work for behavior strategies and prevention throughout each environment. [21]

New York

The state of New York has the Foundations Behavioral Health that has been approved out of state educations and residential provider with the New York State Education Dept. Foundations offer Academic and Behavioral Health Services to students between the ages of 14 and 21. This program allows students educational experience to have strategic interventions to aid their social and behavioral functioning. Some of the program's highlights include Functional Behavioral Assessment (FBA), Behavioral Intervention Plan (BIP) & Community Based Instruction (CBI). [22]

California

The state of California has Spectrum Center classrooms in Los Angeles and the San Francisco area which are providing Emotional Disabilities and Behavioral Services. They provide academic classrooms for students who are actively working to improve grade-level standards and working toward getting their high school diploma. The main practice is the use of Positive Behavior Interventions and Supports (PBIS). PBIS instructional practices help students determine their skill level and progress, restore their skills through direct instruction, knowing the standards on their grade level and small group counseling. [23]

Michigan

The state of Michigan has a Behavioral Education Center (BEC) in Bangor. Its purpose is to aid local schools directs with students between the ages of 5 and 26 years old with EBD's. [24] Along with having students use appropriate behaviors and skills to successfully return to their local school setting. Classroom programs, consultation, coaching, and professional development services are available within the school districts. [25]

Florida

The state of Florida has Students with Emotional/Behavioral Disabilities Network (SEDNET). SEDNET projects across the state aid the local school districts to work with those at-risk of EBD's. “Dealing with adverse behavior in the educational environment,” it serves students who poorly function at home, school, or community due to drugs and substance abuse or mental health issues. SEDNET 2A Services: Family Services Planning Team (FSPT)- agencies, school officials and SEDNET meet with parents to assist and aid the child's poor performance at school and home. Positive Behavior Support providing technical assistance to promote positive behavior. Classroom Observation/Teacher Consultation- working with EBD children using successful strategies and tips in a classroom environment. [26]

Related Research Articles

<span class="mw-page-title-main">Conduct disorder</span> Developmental disorder

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules, in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors", and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioral modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

<span class="mw-page-title-main">Anger management</span> Therapy for anger prevention and control

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Adult Attention Deficit Hyperactivity Disorder is the persistence of attention deficit hyperactivity disorder (ADHD) in adults. It is a neurodevelopmental disorder, meaning symptoms must have been present in childhood except for when ADHD occurs after a traumatic brain injury. Specifically, multiple symptoms must be present before the age of 12, according to DSM-5 diagnostic criteria. The cutoff age of 12 is a change from the previous requirement of symptom onset, which was before the age of 7 in the DSM-IV. This was done to add flexibility in the diagnosis of adults. ADHD was previously thought to be a childhood disorder that improved with age, but recent research has disproved this. Approximately two-thirds of childhood cases of ADHD continue into adulthood, with varying degrees of symptom severity that change over time, and continue to affect individuals with symptoms ranging from minor inconveniences to impairments in daily functioning.

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.

School refusal is a child-motivated refusal to attend school or difficulty remaining in class for the full day. Child-motivated absenteeism occurs autonomously, by the volition of the child. This behavior is differentiated from non-child-motivated absences in which parents withdraw children from school or keep them home for circumstances such as homelessness. School refusal is characterized by avoidance and/or emotional distress at the time of attending school.

Cognitive disengagement syndrome (CDS) is an attention syndrome characterised by prominent dreaminess, mental fogginess, hypoactivity, sluggishness, slow reaction time, staring frequently, inconsistent alertness, and a slow working speed. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures, including law enforcement officials. Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit. One-half of children with ODD also fulfill the diagnostic criteria for ADHD.

Emotional dysregulation is characterized by an inability in flexibly responding to and managing emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.

In clinical diagnostic and functional development, special needs refers to individuals who require assistance for disabilities that may be medical, mental, or psychological. Guidelines for clinical diagnosis are given in both the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases 9th edition. Special needs can range from people with autism, cerebral palsy, Down syndrome, dyslexia, dyscalculia, dyspraxia, dysgraphia, blindness, deafness, ADHD, and cystic fibrosis. They can also include cleft lips and missing limbs. The types of special needs vary in severity, and a student with a special need is classified as being a severe case when the student's IQ is between 20 and 35. These students typically need assistance in school, and have different services provided for them to succeed in a different setting.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

<span class="mw-page-title-main">Learning disability</span> Range of neurodevelopmental conditions

Learning disability, learning disorder, or learning difficulty is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficulty learning in a typical manner", this does not exclude the ability to learn in a different manner. Therefore, some people can be more accurately described as having a "learning difference", thus avoiding any misconception of being disabled with a possible lack of an ability to learn and possible negative stereotyping. In the United Kingdom, the term "learning disability" generally refers to an intellectual disability, while conditions such as dyslexia and dyspraxia are usually referred to as "learning difficulties".

<span class="mw-page-title-main">Residential treatment center</span> Live-in healthcare facility

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.

Mental disorders diagnosed in childhood can be neurodevelopmental, emotional, or behavioral disorders. These disorders negatively impact the mental and social wellbeing of a child, and children with these disorders require support from their families and schools. Childhood mental disorders often persist into adulthood. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM-5 and in the ICD-11.

An emotional or behavioral disability is a disability that impacts a person's ability to effectively recognize, interpret, control, and express fundamental emotions. The Individuals with Disabilities Education Act of 2004 characterizes the group of disabilities as Emotional Disturbance (ED). This term is controversial as it is seen by some as excluding or even discriminating against students with behavior issues and just focuses on the emotional aspects.

Children with Special Healthcare Needs (CSHCN) are defined by the Maternal and Child Health Bureau as:

Expressive suppression is defined as the intentional reduction of the facial expression of an emotion. It is a component of emotion regulation.

Externalizing disorders are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize their maladaptive emotions and cognitions, such feelings and thoughts are externalized in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality.

<span class="mw-page-title-main">Mental health in education</span>

Mental health in education is the impact that mental health has on educational performance. Mental health often viewed as an adult issue, but in fact, almost half of adolescents in the United States are affected by mental disorders, and about 20% of these are categorized as “severe.” Mental health issues can pose a huge problem for students in terms of academic and social success in school. Education systems around the world treat this topic differently, both directly through official policies and indirectly through cultural views on mental health and well-being. These curriculums are in place to effectively identify mental health disorders and treat it using therapy, medication, or other tools of alleviation.

Social emotional development represents a specific domain of child development. It is a gradual, integrative process through which children acquire the capacity to understand, experience, express, and manage emotions and to develop meaningful relationships with others. As such, social emotional development encompasses a large range of skills and constructs, including, but not limited to: self-awareness, joint attention, play, theory of mind, self-esteem, emotion regulation, friendships, and identity development.

References

  1. ↑ World Health Organization (2016). "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10): Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90–F98)" . Retrieved 2 November 2018.
  2. ↑ World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. Geneva. p. 40.
  3. ↑ "EMOTIONAL AND BEHAVIORAL DISORDER (EBD)" (PDF). Cherokee County School District. Archived from the original (PDF) on 2019-05-02. Retrieved 2019-05-09.
  4. 1 2 "Are Students with EBD Given an IEP Plan? | Synonym". classroom.synonym.com. Retrieved 2019-05-06.
  5. 1 2 "Mental Health Treatment: Then and Now | Introduction to Psychology". courses.lumenlearning.com. Retrieved 2019-05-07.
  6. ↑ "The History of Asylums in the 1800s - Video & Lesson Transcript". Study.com. Retrieved 2019-05-07.
  7. ↑ Fong, Yvonne. "The History of Emotional and Behavioral Disorders". Academia.
  8. 1 2 "Overview of Emotional and Behavioral Disorders" (PDF). Pro Ed Inc.
  9. ↑ "History of Emotional Behavioral Disorders". Emotional Behavioral Disorders. Retrieved 2019-05-07.
  10. ↑ "Emotional Disturbance |". Center for Parent Information and Resources. 2010-06-16. Archived from the original on 2017-07-28. Retrieved 2019-05-06.
  11. 1 2 "Students with Emotional Disturbance: Eligibility and Characteristics". The Center for Effective Collaboration and Practice. American Institutes for Research. 2001. Archived from the original on 18 October 2015. Retrieved 22 October 2015.
  12. ↑ "Social Maladjustment". Reinforcement Unlimited. Georgia. Archived from the original on 2 May 2001. Retrieved 22 October 2015.
  13. 1 2 3 4 Danielson, Melissa L.; Bitsko, Rebecca H.; Ghandour, Reem M.; Holbrook, Joseph R.; Kogan, Michael D.; Blumberg, Stephen J. (2018-03-04). "Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016". Journal of Clinical Child & Adolescent Psychology. 47 (2): 199–212. doi:10.1080/15374416.2017.1417860. ISSN   1537-4416. PMC   5834391 . PMID   29363986.
  14. ↑ Wehby, Joseph; Symons, F.; Shores, R. E. (1995). "A descriptive analysis of aggressive behavior in classrooms for children with emotional and behavioral disorders". Behavioral Disorders. 20 (2): 87–105. doi:10.1177/019874299502000207. S2CID   151985694.
  15. 1 2 3 Wells, Erica L.; Day, Taylor N.; Harmon, Sherelle L.; Groves, Nicole B.; Kofler, Michael J. (2018-11-26). "Are emotion recognition abilities intact in pediatric ADHD?". Emotion. 19 (7): 1192–1205. doi:10.1037/emo0000520. ISSN   1931-1516. PMC   6535378 . PMID   30475028.
  16. ↑ Cartwright-Hatton, Sam; McNally, Deborah; White, Caroline; Verduyn, Chrissie (2005). "Parenting Skills Training: An Effective Intervention for Internalizing Symptoms in Younger Children?". Journal of Child and Adolescent Psychiatric Nursing. 18 (2). Wiley: 45–52. doi:10.1111/j.1744-6171.2005.00014.x. ISSN   1744-6171. PMID   15966947.
  17. ↑ Garner, B. K. (2007). Getting to “got it!”. Alexandria, VA: Association for Supervision and Curriculum Development.
  18. ↑ Strauman T. J. (1989). "Self-discrepancies in clinical depression and social phobia: Cognitive structures that underlie emotional disorders?". Journal of Abnormal Psychology. 98 (1). APA: 14–22. doi:10.1037/0021-843x.98.1.14. eISSN   1939-1846. ISSN   0021-843X. OCLC   818916111. PMID   2708634.
  19. ↑ MacLeod, Colin; Mathews, Andrew; Tata, Philip (1986). "Attentional bias in emotional disorders". Journal of Abnormal Psychology. 95 (1). APA: 15–20. doi:10.1037/0021-843x.95.1.15. eISSN   1939-1846. ISSN   0021-843X. OCLC   818916111. PMID   3700842.
  20. ↑ Joormann, Jutta; Gotlib, Ian H. (2010). "Emotion regulation in depression: Relation to cognitive inhibition". Cognition & Emotion. 24 (2). Routledge: 281–298. doi:10.1080/02699930903407948. eISSN   1464-0600. ISSN   0269-9931. LCCN   00238845. OCLC   1039330776. PMC   2839199 . PMID   20300538.
  21. ↑ "Texas Support Initiative". Texas Behavior Support. Archived from the original on 2011-08-23. Retrieved 2019-05-08.
  22. ↑ "Out of State Education and Residential Provider |". Foundations Behavioral Health. Archived from the original on 2016-07-13. Retrieved 2019-05-08. All the locations listed are in PA
  23. ↑ "Emotional Disabilities and Behavioral Services |". Spectrum Center Schools and Programs. San Pablo, CA. Archived from the original on 2019-05-06. Retrieved 2019-05-08.
  24. ↑ "Behavioral Education Center". Special Education Programs and Services. Van Buren Intermediate School District. Lawrence, MI. Archived from the original on 2020-08-05. Retrieved 2019-05-08.
  25. ↑ "Classrooms for Students With Severe Emotional Impairment". Special Education Programs and Services. Van Buren Intermediate School District. Lawrence, MI. Archived from the original on 2020-09-20. Retrieved 2019-05-08.
  26. ↑ "Students with Emotional/Behavioral Disabilities Network". Panhandle Area Educational Consortium. Chipley, FL. 2019. Archived from the original on 2019-05-06. Retrieved 2019-05-08.
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