RUNNING HEAD: INTERVENTION FOR CHILDHOOD ONSET SCHIZOPHRENIA

Classroom Behavioral Intervention For Students with Childhood Onset Schizophrenia Terri L. Meadows Armstrong Azusa Pacific University

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Abstract This paper is a review of one classroom intervention for students with Childhood Onset Schizophrenia when they return to the classroom after being release from psychiatric facilities. While they will have a time at home to recover and readjust to any change in medication, the return to the classroom is one of the most stressful situations for the student. Through one-onone time helping the student develop their own graphic-organizer behavior plan and a classroom game that rewards individual good behavior and team effort at making good behavior choices, the student can acclimate back into the classroom with both their classroom teacher and their classmates providing support and hoping to eliminate the rate of anxiety-driven acting out.

INTERVENTION FOR CHILDHOOD ONSET SCHIZOPHRENIA Classroom Behavioral Intervention For Students with Childhood Onset Schizophrenia

Disability According to the National Dissemination Center for Children with Disabilities, mental illnesses are medical conditions that disrupts a persons thinking, feeling, mood, ability to relate to others and daily functioning. In the Fall of 2008, approximately 4.1 of all students ages 6-21 were diagnoses with a mental disorder. (Turnbull, A., Turnbull R., Wehmeyer, M. & Shogren, K. 2013) (Gearing 2007) By 2010, that number had grown to approximately 8.3 million children between ages 4-17 suffer from some form of mental illness. (National Dissemination Center for Children with Disabilities [NDCCD] 2010) Schizophrenia is classified as a psychotic disorder which can be manifested by delusions, hallucinations, disorganized speech and behavior, among other negative symptoms. Males tend to have an earlier onset, usually between 15-25 years of age; females later between ages 25-35 years of age. However, research has found that 39% of males and 23% of females will experience the first episode before the age of 19. (Gearing 2007) Unfortunately for our children, the earlier the diagnosis, the poorer prognosis. Their cycle of hospitalizations, release and readmissions are higher, which leads to a more impaired social functioning. (Gearing 2007) When these children leave the hospital, they will eventually return to school. The transition from hospitalization to the home and school environment must be addressed in terms of returning to the expected classroom behavior. The erratic behavior of the child of mental illness typically indicates they are not coping with their environment or peers.

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(NDCCD 2010) It is vital that the classroom teacher and additional support providers have behavioral plans in place. (Li, Pearrow and Jimerson 2010) Specific Problem In a Moderate/Severe classroom, it is likely that during an educators career, they will have students diagnosed with a serious emotional disturbance. Although rare, Childhood-Onset Schizophrenia does exist and an educator should be prepared for this possibility. As educators, we are accountable for the classroom behaviors. Children who are in and out of the classroom will have a harder time acclimating back into expected classroom behaviors, especially when absent for any significant period of time. How can a Special Education teacher make the transition back to classroom smooth and with the least amount of trauma and the best behavior choices? Possible Solution Before a student returns to the classroom, there must already be a support system in place in regards to supports in place to help the child. This should already be in the IEP. If it is not, then it is suggested that prior to the students return, a plan be written into the IEP that satisfies the childs emotional and mental health needs. However, as the classroom teacher of record, there are interventions for a students behavior that wont single out the student, include the entire class, and give the student clear expectations and appropriate behavior to model. Strained social situations and missed school says can result in the student not wanting to participate in school. However, educators can make the environment as welcoming as possible, but it requires a multimodal approach. (Li et al. 2010) Upon a students return to the classroom,

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schedule some time at the beginning of their day to sit one-on-one with them and develop a Gameplan to help organize their thoughts. The plan can be created as best fits them and their learning style into an easily-followed graphic organizer (either written or pictorial) that gives the student a clear guide for making strong behavior choices and ways in which the teacher can support them in making these choices. Upon completion, both teacher and student should sign it so it becomes something both are bound to follow. (Turnbull, A., Turnbull, R., Erwin, E.J., Soodak, L.C. 2010) Assist the student in successfully implementing their gameplan throughout the day in various ways, either naturally occurring events or contrived situations meant to provide the student strong classroom models to follow and an environment in which they are safe. One method is the Good Behavior Game, which was first developed and tested in 1969 and is still a recommended method. (Wright 2013) (Barrish, Saunders, Wolf 1969) In 1969, Barrish, Saunders and Wolf devised a plan to test their theoretical method of classroom containment of disruptive behaviors. In a classroom of 24 fourth graders, a quarter of whom had been referred by their classroom teacher for behavior issues, the class was divided into teams. The unwanted behaviors were discussed and then the children were explained The Good Behavior Game (which is detailed below.) The results were clear, as the undesired behaviors changed only when the game was applied. Of the 17 class periods that were observed, both teams won 82% of the time. (Barrish et al. 1969) The website Intervention Central gives very clear directions in how to successfully run the game. For this game to work, however, in the situation of having a student with severe emotional disturbances, there do need to be some alterations to the game as originally implemented. Adding a layer of depth to the game, and giving the student with Schizophrenia

INTERVENTION FOR CHILDHOOD ONSET SCHIZOPHRENIA instant and continual feedback, during the game, students (especially the student with

Schizophrenia) who are making strong behavior choices and modeling good behavior for the class can earn additional rewards, such as stickers. It is easy for the teacher to hand out stickers and providing specific praise to students. This is modeling good behavior and should be the focus in positive reinforcement behavior. In the classroom, the Good Behavior Game (GBG) is introduced. For short durations of time, the class is given specific behavior instructions. It seems wise to align these expectations with the returning students written Gameplan. For the GBG to work, the teacher must set up the students with a set of simple instructions, discussing disruptive behaviors and why they are disruptive, the rules of the game and how the students will know the game is being played. Once this portion is complete, the teacher must decide when the first round will be played. On a visible place in the classroom, clearly identify the reward for winning and the number of points the team must be under to win. Divide the class into two or more teams. During game time, remind the students of what behaviors are expected. During the time the Good Behavior Game is in play, the students are split into a minimum of two teams and everyone helps one another follow the expectations. If someone from the team, after given a fair opportunity to apply their understanding, still insists on being disruptive, their team receives a point. At the end of the game, the team with the fewest points wins a pre-determined prize. It is possible for both teams to win the prize. (Wright 2013) There are some obvious problems with the GBG. In the original study of 1969, several students expressed frustration that they didnt like the rules they were expected to follow and

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how unfair it is that they were subject to the behaviors of students who continued to act out during class. These feelings, however, were outweighed by students who liked the game because it encouraged others to join in making better behavior choices and found the game itself fun and the rewards for winning worth their efforts. (Barrish et al. 1969) Not liking to be subject to the behavior choices of others is a fair assessment, which is why when applying this game to a Special Education classroom or a General Education classroom with students with severe emotional disturbances one must apply the earlier suggested multiple modalities. There must be multiple ways to succeed, with receiving instant praise and rewards and by the teacher enforcing positive group interaction and not allowing the GBG to turn into a bullying session. Conclusion The student with Childhood Onset Schizophrenia will go through cycles of inpatient care in mental facilities and then return to the classroom. The stress of academics and social situations can lead to acting out. Through a one-on-one written Gameplan and the chance to practice that plan during the Good Behavior Game, along with instant rewards and specific praise can make the transition one in which the student feels supported and is successful.

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References Barrish, Harriet H., Saunders, Muriel and Wolf Montrose M. (1969) Good behavior game: effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis. Summer 1969; 2(2)119

Gearing, PhD, Robin Edward (February 2008) Evidence-Based Family Psychoeducational Interventions for Children and Adolescents with Psychotic Disorders Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2008 February; 17(1)2

Li, Huijun, Pearrow, Melissa, and Jimerson, Shane R. (September 2010) Identifying, Assessing, and Treating Early Onset Schizophrenia at School (Developmental Psychopathology at School), (1st ed.). Springer Publications

The National Dissemination Center for Children with Disabilities (June 2010) Emotional Disturbance. The Iris Center. Retrieved from http://iris.peabody.vanderbilt.edu/resource_infoBrief/info_brief_files/nichcy_org_wp_co ntent_uploads_docs_fs5_pdf.html

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References

Turnbull, A., Turnbull, R., Erwin, E.J., Soodak, L.C. (2010). Families, Professionals, and Exceptionality: Positive outcomes through partnership and trust, (6th ed.). Prentice Hall Video Presentation Supplemental Supports: Behavior Management Plans: Using the Decision Making Model Pt. II

Turnbull, A., Turnbull R., Wehmeyer, M. & Shogren, K. (2013). Exceptional lives: Special education in todays schools (7th ed.), Upper Saddle River, NJ: Merrill/Prentice Hall.

Wright, Jim (2013) The Good Behavior Game. Intervention Central. Retrieved from http://www.interventioncentral.org/behavioral-interventions/schoolwideclassroommgmt/good-behavior-game