Handling Physical Problems among Students with Behavioral Disorders.

Some students exhibit behavioral disorders because of physical problems and not because of instructional problems. When this occurs, instructional efficiency can be reduced until the student receives the treatment he needs. Because physical problems among school-age children often go undetected, teachers working in programs for the behaviorally disordered must be prepared to identify and handle any physical problems which interfere with the instruction of their students. The research on behavioral disorders abounds with evidence which shows that developing and implementing instructional activities geared to the functioning level of learners have a profound affect upon their disposition to participate in instruction (e.g., Hammill & Bartel, 1978; O'Leary & O'Leary, 1977; Swanson & Reinert, 1979). As a consequence, teacher training programs in the area of behavioral disorders include many types of experiences designed to increase the competence of trainees in the area of instruction and behavior management. It is apparent, however, that many of the learning and behavior problems exhibited by students in programs for the behaviorally disordered can be attributed to physical problems and not instructional problems (Adler, 1978; Hawkins & Pauling, 1973; Knapczyk, 1979a). For example, Mayron (1978), in a study of childhood behavioral disorders, concluded that allergies may be one of the major contributing factors to disruptive behavior in the classroom. Other conditions, such as chronic headaches, sensory impairments, metabolic disorders, hypoglycemia, and vitamin and mineral deficiencies, have also been shown to cause be havioral disorders in children (Cheraskin & Ringsdorf, 1973; Fredericks, 1976; Haslam & Valletutti, 1975; Rimland, 1974). Where this occurs, well-planned and executed instruction may be wasted because the learner is physically unable to participate in instruction (Valletutti, 1975). It has also been shown that when the physical condition which causes the behavioral disorder is properly diagnosed and treated, the level of the behavioral disorder greatly decreases or completely dissipates (Fredericks, 1976; Hawkins & Pauling, 1973; Krischner, 1978). However, physical problems of a child with behavioral disorders often go undetected because the learner is unable to communicate the physical symptoms of the condition or because his/her behavioral disorder masks the symptoms (Haslam & Valletutti, 1975; Knapczyk, 1979b). The relationship between behavior disorders and physical problems presents the pos sibility that teachers may encounter students who exhibit behavior problems which may best be treated through a physical intervention and not an instructional intervention. When classroom teachers or other instructional personnel suspect that a student may have an undetected physical problem, they must act as advocates for this student to ensure that he/she receives treatment for the physical problem. To do this, there are four responsibilities which school personnel should assume: 1. Screen students for physical problems; 2. Refer students with suspected physical problems for appropriate diagnosis and treatment; 157 This content downloaded from 207.46.13.71 on Fri, 21 Oct 2016 04:55:43 UTC All use subject to http://about.jstor.org/terms 158 3. Program for the special needs of students with physical problems within the school setting; and 4. Monitor interventions which are prescribed to alleviate the effects of the physical condition. The role of the classroom teacher in assuming each of these responsibilities has not been clearly defined within most school systems. This is because most students either do not have physical problems which affect classroom performance, or those who do have physical problems have them under control. However, in the case of children with behavioral disorders, the frequency of undetected physical problems demands that teachers under stand the relationship between physical problems and behavioral disorders. In addition, teachers in programs for the behaviorally disordered will need to work in collaboration with parents, school ancillary personnel, school medical staff, and the other instructional per sonnel. Although the teacher is often in the best position to make long-term and continuous observations of the students, working in collaboration with other personnel will assist in developing a consistent treatment program for physical problems if needed. This article was written to delineate these four responsibilities so that teachers in programs for the behav iorally disordered can assist in handling their students' physical problems. SCREEN FOR PHYSICAL PROBLEMS There are many physical conditions which can cause or contribute to behavioral disorders in school-age children. Those commonly reported are: sensory impairments, allergies, or thopedic problems, metabolic disorders, nutritional deficiencies, hypoglycemia, neurologic disorders, chronic headaches, drug abuse, and medication side-effects. Descriptions of the physical manifestations which may indicate the presence of the above conditions are also contained in these reports. For example, Dever and Knapczyk (1980) have developed a detailed screening device for physical problems for use in a classroom situation. This device provides an organized format for obtaining information to be used in making referrals for appropriate diagnosis and treatment. Many of the other references at the end of this article provide additional information useful for screening students. Although school personnel are not qualified to diagnose and treat many of these conditions, the observations they make can be a valuable source of information for medical personnel. One difficulty teachers may have in screening their students is that the behaviors which often characterize the children placed in programs for the behaviorally disordered can be symptoms of a physical problem. For example, behavioral indicators such as irritability, withdrawal, hyperactivity, impulsiveness, or aggressiveness may actually be manifestations of a physical problem. Thus, teachers often have to look for symptoms which may indicate the presence of a chronic physical problem, such as: frequent colds; chronic headaches; stomach cramps; hayfever; nasal congestion; swollen eyes; lethargy or sluggishness; irrit ability; crying spells for no apparent reason; walking or moving as if in a daze; rubbing, pulling, or banging a spot on the body including the head; appearing pale, ashen, or flushed; and swollen or aching joints. Information needed for screening students can come from three sources: (a) school and medical records, (b) parent reports, and (c) direct observation. School and Medical Reports Previous records can be useful in screening students for physical problems when the condition is hereditary. For example, Mayron (1978) and Ftapp (1978) indicated that allergies may be one of the major physical causes of behavioral disorders in children. Allergies are also considered to be a hereditary condition (Aas, 1971 ; Frazier, 1975). If previous records indicate that a student or his/her family has a history of allergic reactions, further study by an allergist may be warranted. School and medical records may also indicate longstanding problems which have not been properly evaluated. For example, a previous teacher may have reported that the student seemed to have momentary lapses in attention or sometimes appeared awkward or clumsy, but may not have followed up on this information. If the student currently exhibits This content downloaded from 207.46.13.71 on Fri, 21 Oct 2016 04:55:43 UTC All use subject to http://about.jstor.org/terms these characteristics, his/her present teacher should consider initiating a referral to a neu rologist or other appropriate medical professional to determine if the student may have seizures or other neurological problems.