Discussion on whether the correct provision is being offered for the specific student with Social, Emotional, Behavioral Difficulties and ADHD also whether the teachers involved are appropriately equipped with the skills, training, support and resources required.
Social, Emotional and Behavioural Difficulties
An emotional or behavioural disorder can be defined as circumstances where the child's behavioural or emotional responses are very dissimilar from those commonly accepted from children of his/her age. There is no clear classification or definition of SEBD even though it does not seem to be a new problem (Howarth, 2005, Cooper, 2002 et al). Children with SEBD often display depressive, aggressive, a tendency to self-harm behaviours they may also exhibit withdrawn, depressive, moody behaviours. This can be caused by a culmination of many or just one cause.
Segregating emotional or behavioural problems is not easy as classifying difficulties related to physical disabilities. SEBD appears in the form of disruptive behaviour, in school these behaviours often impede learning, often the actions displayed can be aggressive this can be directed towards other pupils and staff (Cooper, 2002). These actions can unfavourably affect functioning in areas such as self-care, academic progress, social relationships, classroom behaviour or adjustment to the work environment.
It is estimated that in England and Wales between 10% and 20% of school age children experience SEBD to a degree that significantly impairs their social and educational development. (DfES, 2005)Cited in Cooper, 2001)
When considering emotional and behavioural disorders the cultural background, social relationships, educational progress, classroom behaviour and much more must be taken into consideration. Social factors seem to be the most predominant in the development of SEBD characteristics in children and young people. The problems faced tend to reach a peak in adolescence around the ages fourteen to fifteen.
The frequent disruption caused by young people with SEBD often leads to exclusion from school, it has been acknowledged that students with SEBD often have problems integrating into the mainstream education environment and hence are placed in exclusionary locations that can provide more concentrated behavioural support than would be available in conventional education settings. The special education need code of practice (2001) confirms that pupils with emotional, behavioural and social difficulties are the most difficult group for schools to manage. Conflicts can arise between meeting individual needs and the efficient education of other children; hence they are then placed in alternative educational provision which is supposed to be a short term placement of around six weeks with the child then being re-integrated back into mainstream school. A frequent attitude by many towards these young people is often very negative which then adds to their feelings of low self-esteem.
Attention Deficit Hyperactivity Disorder (ADHD) is defined as a severe difficulty in focusing and sustaining attention, which often leads to learning and behaviour problems in all areas of life, is a developmental disorder of self-control. It has been defined as:
ADHD, or attention-deficit hyperactivity disorder, is a behavioural condition that makes focusing on everyday requests and routines challenging.
People with ADHD typically have trouble getting organized, staying focused, making realistic plans and thinking before acting. They may be fidgety, noisy and unable to adapt to changing situations.
Children with ADHD can be defiant, socially inept or aggressive. (APA 2010)
ADHD was first described in 1902 by George Still an English Physician, it was used to describe children who displayed inattention or distractibility, hyperactivity and impulsiveness to such an extent that it impeded their daily functioning and interaction with others. Children who have ADHD have difficulty completing tasks as they cannot pay attention for any period of time as each new stimulus presents itself they turn their attention to this. The distracting stimuli can be auditory or visual, simple things that most children would ignore often children with ADHD have a heightened sense of hearing to the extent that certain noises cause them physical pain. Another symptom of inattention involves difficulties in organisation skills, losing things and being forgetful.
Impulsiveness makes conformity to rules and regulation difficult, behaviourally the child with ADHD wants to have things immediately, they do whatever comes to mind choosing for short term pleasure despite any consequences, they do not consider the effects of their own actions. Academically they tend to blurt out and rush through tasks this leads to mistakes. Emotionally the child becomes frustrated and responds in a variety of ways - being agitated, verbally or physically aggressive, being a victim and/or moody. The aggression can be directed towards others or at self. ADHD sufferers do not seem to know that they are behaving inappropriately while they are 'actually doing the act', but they do show the genuine remorse when understanding and realisation of their actions become apparent to themselves. Sufferers do not necessarily show any basic deficiencies or disabilities (intellectual or interpersonal) they seem 'normal' in the very perception of the word.
Hyperactivity shows itself in continuous bodily movements e.g. wriggling in seats, fidgeting, also having a feeling of confinement when having to be restricted to a desk or classroom for any period of time. Thirdly they can display over activity in the form of constant talking, being on the go all the time and constantly badgering peers/teachers. They are often bemused when their behaviours bring out anger or rejection from others and apologise intensely for what they have just done.
These problems are reflected in impairment in a child's will or capacity to control her own behaviour relative to the passage of time - to keep future goals and consequences in mind. (Barkley 2000)
ADHD is therefore often unnoticed and they are seen as just another trouble-maker, naughty child. ADHD children have problems with self-control and parents often expect age-appropriate behaviour without giving much merit to positive behaviour. This can leave the child with a poor self-image.
Children with ADHD show a significant discrepancy between their mental abilities and their achievement such difficulties are evident in literacy, numeracy and other subjects that require sustained mental effort predominantly when tasks do not hold any intrinsic interest for the child. Research studies into children with SEBD have found the prevalence of communication difficulties within this group to be between 55% and 100% defined by Cohen and Lipsett et al, 1991 ( Cited in Heneker 2005). Often these difficulties seem to be overlooked as language problems are not always paramount when dealing with behavioural problems. The speech and language problems often exacerbate the emotional and behavioural problems purely out of frustration felt by the individual. Cohen and Lipsett 1991 (Cited in Heneker 2005) advocate the need to screen for language impairments in children with EBD, Jones and Cheeson (Cited in Heneker 2005) identify the need for preventative work to be carried out at an early stage, following a precautionary approach to language impairments with these young people could therefore prove to be counteractive in the further development of SEBD.
ADHD used to be thought of as a brain injury, maybe at childbirth and there were also suggestions that those who are brought up in a dysfunctional family are prone to the condition. However, much research has criticised these insinuations in light of Positron Emission Tomography (PET) scans, research regarding damage to the foetus (foetal alcohol syndrome, FAS), drugs (cocaine), toxins (lead in soil and dust, but this is found only in a small number of cases) and genetic innovations (at least 1/3rd of fathers who endure ADHD have a son also diagnosed with ADHD), Morrison & Stewart (1971) (Cited in Canter 1975:261) found that hyperactive children had at least one hyperactive parent. A recent study led by Professor Anita Thapar found that children with ADHD were suffering from a neurodevelopment disorder, which has revealed that a direct genetic link has been found. Findings show that children with ADHD are more likely to have small segments of their DNA missing or duplicated than other children. (Williams, 2010)
There is no known "cure" for ADHD, but there are a range of ways in which the symptoms of ADHD can be treated. Behavioural management allows professionals to develop programmes to replace negative behaviours with more positive behaviours. Counselling is also an option and may be carried out with the child discretely or with parents and allows everyone an opportunity to work through their emotions and help with understanding their behaviours. Medication may also be an option. When a child is diagnosed with ADHD, the specialist involved will inform the parents and child of their options and what the best course of action for their situation would be.
Medical psychostimulants are considered very effective in controlling the behaviours associated with ADHD and work by stimulating the brain to better able to identify and control behaviours relating to attention, activity and impulsivity. Ritalin is the most commonly heard of medication prescribed for ADHD sufferers.
Daniel is fifteen years old and has been diagnosed with ADHD he takes Ritalin regularly to maintain this. He has recently joined the special provision at the college where I work as a teacher and co-ordinator of our special programmes for disengaged young people aged 14 - 16. The college provision for these young people offers an alternative curriculum combining academic, social and vocational studies. The provision started with a group of ten learners five years ago and has developed and grown to accommodate around 30 fulltime learners and 50 part time day release learners at present. Alternative provision is described in the Back on Track Strategy as:
Alternative provision is education for children and young people who are unable to be provided for in mainstream or in a special school.(Back on Track 2008)
The report states that all Local Authorities are required by law to provide some educational provision for school age children. At any one time just under 1 per cent of pupils (70,000) are in some form of alternative provision (Back on Track, 2008)
The learners who take part in this alternative curriculum are all described as being impaired with social, emotional and behavioural difficulties (SEBD), currently all attending are boys. They are referred to the college provision via an external agency that liaises directly with the local schools regarding their excluded children.
Daniel previously attended a local Inclusion Centre it was deemed by his current school that this was the appropriate placement for Daniel; However, he failed to make any progress either socially or academically as he rarely attended; Talking to Daniel about his experiences he has explained that he didn't go because they restrained him and he doesn't like people touching him. Prior to his placement at the inclusion centre he was in mainstream school in his local area, Daniels presence was also an issue, he didn't attend very often as he found the main school environment difficult to cope with, he has been described as very limited academically and gets easily frustrated by work he thinks he should be able to do. Despite the provision of 1:1 support and individual support to help Daniel acquire basic literacy skills, he has refused to engage and remains a virtual non-reader. When he was in attendance at school he displayed extremely disruptive behaviour or would retract himself completely and close down No further academic history is available.
Daniel lives with his father and older step brother, through discussions with the agency staff and Daniel I have ascertained that he has very little contact with his mother, sister or any extended family; since his mother and father divorced he mentioned lots of violence in the family home but gave no indication who the aggression was directed towards. Interaction between Daniel, his father and brother is minimal and Daniel spends the majority of his time alone in the house. He often comes to college dirty and hungry, when asked what he has had for breakfast it is usually crisps and coke. Contact with Daniels father to promote involvement in Daniels learning has come to no fruition as the phone just rings and upon visiting the house no one answers the door. Improving pupils' behaviour often requires schools and local authorities to work closely with other partners and agencies, particularly when the behaviour stems from pupils' home circumstances (Estyn report 2006).
Daniel has presented extremely challenging behaviour since joining the college programme, as well as an unwillingness to engage in learning. He has poor communication skills and a history of difficulties with learning this makes accessing the curriculum difficult thus has resulted in very low self-esteem. Robin states that the cumulatively increasing life failure experiences, which often occur as children with ADHD move into adolescence, take their toll on self-esteem (Robin, Barkley 1998). The frustration that he feels leads to the resultant behavioural issues which have developed as a learned response. There has been a considerable amount of research into behaviour, examining types of behaviour and ways in which these can be managed. The majority of behaviour is learned; however there are also behaviours that seem to be innate. The nature verses nurture debate is one that has been on-going and continues to be controversial. This debate concerns the importance of nature or heredity opposed to environmental influences such as a person's education, quality of parenting and other social and cultural influences, and the impact that these have on one's behaviour and abilities. There are various theorists who have different views of the ways in which behaviour develops and why certain behaviours are exhibited by different people and at different stages of life. However, there seems to be a general consensus that nature and nurture are both contributors to behaviour.
Daniel uses distracting techniques such as teasing peers, refusing to remain on task if he perceives the work as difficult; he will remove himself from lessons without permission and can become aggressive if he doesn't get his own way. Daniel also likes to make an entrance drawing attention to him when entering a classroom late, this then often leads to open defiance from Daniel refusing to cease from disrupting the class in any way that he can.
In order to promote social skills and a sense of belonging a breakfast club has been started which enables the learners to group together promoting social cohesion and fulfilling the basic need of food, they also have the opportunity to mix on a social level with myself and the support workers allowing them to engage in a more relaxed, pastoral and nurturing atmosphere promoting the feeling of safety and a sense of belonging. Greenhalgh (1994) states to experience the feeling of safety and acceptance, we have to allow ourselves to feel in some ways dependent upon significant other people in our lives. By providing a safe base room environment we are trying to provide a place where the learners are able to build trusting relationships by being dependable only then will the learners feel safe and accepted therefore allowing them to grow emotionally.
We have introduced a 'merit chart' for Daniel, this includes targets and objectives that are personalised to him and will hopefully help to increase his social skills, by setting Daniel targets we are encouraging goal directed , purposeful behaviour which will result in him learning to control his own actions. In the programmes base room we have a group merit board; this has pictures of the tutorial group promoting an awareness of belonging. Weekly during tutorial the individual merit charts are discussed as a group promoting the good work and behaviours displayed by the learners throughout the week these marks are then transferred to the group merit board this promotes self-esteem and self-worth amongst the learners and seems to be having a positive effect on Daniels opinion of his abilities to achieve and enhancing his self-perceptions. The increase in his attainments is leading to better behaviour in class. There are dangers in an educational setting in an over emphasis on "managing the behaviour" without attempts to understand the child's feelings, giving Daniel the opportunity to discuss his good work and behaviours on a regular basis allows staff and peers to be aware of how he is feeling and justification and understanding for responses that may occur. Co-operative activities such as group discussions and group problem solving also take place throughout the course offered at the college this gives the pupils an opportunity to communicate, share ideas and develop their interpersonal skills, when working together as a team. Although this strategy may result in less control over the class it will present possibilities for the learners to learn from each other and build their confidence, team work and research skills. Any learning style implemented must focus and challenge the pupils from the start, the use of visual and auditory are the preferred learning styles as this enables fewer opportunities for pupils to digress from tasks set and helps with classroom control.
A small reading and handwriting group was recently started, which Daniel is a member of. This is a small group of children who need a little, or a lot of help with their reading and handwriting. This is in-line with Ofsted (2005) recommendation to do more to improve the literacy and other communication skills of pupils with difficult behaviour. We meet for twenty minutes every morning, the group also works on a reward basis with the learners gaining vouchers daily for attendance, this reward is instant and builds up over time. It has been found that children with ADHD perform better under conditions of immediate, rather than delayed reward. (Metcalfe 2001) The learners then participate in a field trip to the city where they can redeem their vouchers for books, games etc. Specific examples of successful research tested strategies incorporating behavioural principles include direct instruction to improve the academic performance of struggling young readers this has been highlighted by Rupley, Blair and Nichols, 2009. Also the engagement of peer tutoring to improve the spelling skills of secondary students with emotional and behavioural disorders emphasised by Bowman - Perrott, greenwood and Tapia, 2007. (Cited in Obiakor, Bakken, Rotatori, 2010)
Daniel, alongside his peers follows a curriculum that entails classroom based academic lessons such as literacy, numeracy, ICT in conjunction with PHSE and preparation for work at entry level. These sessions are predominantly morning activities as the learners are more focused. The afternoon periods are set aside for practical vocational subjects and offer an alternative daily. This offers a provision of an appropriate curriculum that engages the more difficult pupils (Ofsted 2005). The vocational subjects are awarded entry level certificates. Daniel has shown a preference for following the motor vehicle course and has been accommodated to follow this for two afternoons per week.
We are also ensuring that Daniel sits at the front of the class; the seating is arranged in the base room so that all learners are of an equal distance from the teacher and that no one is alienated. As Daniels group is small they are able to sit in a semicircle formation allowing input to class tasks easier and he will be less distracted this also ensures that he can focus his attention on the teacher. Instructions are also broken down for him into more manageable pieces. The use of a base room for the learners gives them a feeling of ownership, safety and a relaxed trusting atmosphere; they are more likely to express themselves freely about any anxieties or problems they may be experiencing. This environment seems to be proving beneficial to Daniel as when he is feeling low, frustrated or aggressive he seeks solace and comfort in the base room, he is effectively learning coping skills. I am Daniels keyworker and located in the base room. The familiarity enables Daniel to feel relaxed, one to one sessions to review progress and set new targets are carried out weekly the time offers Daniel pastoral care to discuss any issues or problems he may be facing.
It is hard to determine whether or not Daniel has a behavioural problem or whether this could be due to his background and his home environment. Rutter (1992) believes that a person's learning is about 60% nature and 40% nurture. Daniel may be suffering effects from his early childhood environment. J. Bowlby thought that the theory of attachment was very important to a child's development. He believed that the relationship between the baby and his/her mother figure was the most important. He believed that a baby needs one central person to be the mother figure. It is possible that Daniel was not able to form an attachment to his mother during the early stages of his life because of the circumstances that were present. Daniels behaviour of acting out, externalising to draw attention to him could also be attributed to this theory.
The environment that Daniel has been subjected to could have influenced his behaviour and his attitude as to what is acceptable behaviour. His early home environment when living with his mother and father may not have been ideal. Various theorists such as Maslow, Pavlov and Skinner all believe that a child's environment and experiences have an impact on how a child behaves and conducts themselves. It is these environments and experiences, whether positive or otherwise, that moulds and shape people.
Assertive discipline offering a clear non hostile response is a useful approach to effective classroom and behaviour management where pupils with emotional and behavioural issues are concerned this strategy is employed with Daniel in the hope that it will build upon deficits that he has endured prior to joining the special programme at the college.
The tutors who work within the special programmes at the college tend to be more lenient with misbehaviour than if the student was in school. The 'minor' infractions are often overlooked in order to focus on the more important issues of their behaviour. The suggestion is, work on the larger issues, reintegrate them into the classroom environment once the greater issues have been conquered the teacher can cope with the smaller concerns. The principle is to reduce the burdens on both the teacher and learner so they can focus on the important tasks such as being part of a group and self-control.
It is common for poor behaviour and emotional issues to affect the attendance of the pupils. Assertive discipline therefore can be used effectively to help solve this and improve the behaviour of the student. As assertive discipline considers pre-empting poor behaviour, the support staff and tutors who work with the pupils individually gain an invaluable insight into how the children conduct themselves in both a good and poor manner. The proactive principle of assertive discipline allows the environment to be adjusted to cater for the individual needs of the pupil.
For instance, if a pupil is more disruptive when working in a group, then the staff will prepare a lesson that focuses on individual work. This eliminates the stimulus in advance. Other strategies may include the number of lessons the student has to undergo in a day. Some pupils struggle to concentrate for more than two or three sessions, so the tutors may only plan two sessions, or alternatively give a free period between lessons complementing their attention span.
Discussed earlier, creating a welcoming and comfortable environment is a key principle of assertive discipline. As we utilise assertive discipline, in conjunction with behaviourism, tailoring strategies to individual's needs according to Anderson, Marchant, Somarriba, 2010 ( Cited in Obiakor, Bakken, Rotatori, 2010) this provides consistency through the programme thus aiding development both socially, academically and behaviourally. However, an issue that will arise will be the corrective actions to misbehaviour. Negative discipline does not work as well as positive discipline as it is more confrontational and more personal to that student. Therefore, positive discipline is favoured with these students. A delicate balance must be provided between supportive feedback and corrective actions (Canter and Canter, 2001). To reduce the quantity of corrective actions, applying assertive discipline prior to class does this.
The other value of assertive discipline is the teamwork that exists between the support staff and tutors. If the support and tutors' corrective managements contrast, this can create confusion and perhaps frustrate the pupil leading to disruptiveness. Therefore, assertive discipline rules and routines create a familiarity to the student in both environments. Furthermore, if two adults correct behaviour in the same pre-planned way, it suggests to the student this is the accepted form of behaviour. The Steer report (2005) recommended that effective behaviour management in a school requires that agreed policies are followed consistently by all staff. The behaviour policy of the college is not appropriate to the learners on the AP Programme; therefore learners develop rules during the induction process at the beginning of the academic year. The merit system then works as an incentive, there is no confusion for students or staff involved as far as boundaries, limitations and expectation that are in force to manage behaviour and learning. This is in accordance with Ofsted that boys respond best when there is a consistent and fair minded approach to discipline. (Ofsted, 2005)
The staff training for SEN and behavioural difficulties within my setting is usually voluntary and needs to be sought out by individuals; many staff have had little or no formal training in the area of SEN or BESD. This leads to differing attitudes and practice. The Steer report recommended providing training for all staff on current evidence-based thinking on the management of pupils' behaviour with a particular regard to classroom teachers and staff with pastoral care responsibilities; (2006) From research this seems to be common practice the Estyn Report for Wales states that only two authorities as having provided training for more than 30% of teachers, with 10 authorities training less than 15% of teachersâ€¦.. Staff who work directly with pupils with difficult behaviour receive the least training. (2006)
This assignment has proved to be very interesting and enlightening, and enabled me to analyse my own teaching with reference to social emotional and behavioural difficulties. I wanted to explore the provision for a disengaged young man named Daniel who has a statement for ADHD and also displays SEBD, to identify the good practice and any deficits in the provision he was being offered. I also wanted to investigate whether the teaching and support staff were properly equipped with training, support and resources for the roles they are undertaking.
The SEN code of practice states that strategies to enable the child to progress should be recorded within an Individual Education Plan (IEP). Daniel has an IEP that in line with the SEN Code of Practice has short term targets and teaching strategies clearly outlined; his IEP is reviewed on a weekly basis during one to one time in the AP programme base room. All staff that are involved with Daniel have access to his IEP and are brought up to date during team meetings with his progress. A copy of Daniels updated IEP is regularly sent home to his father, as communication with him to attend or even speak to staff is non-existent. Despite research increasingly showing that when parents are involved with their child's education, children do better (Working with Parents, Teachernet) some parents are just unable to show any commitment. A behaviour plan has been carried out with Daniel to identify triggers that set off his aggression and he has clear targets set for alternative behaviours to use, when he feels that he may be in danger of displaying aggression, clear consequences are displayed on the assessment for Daniel to identify with regularly, reviews are carried out weekly during pastoral time. The Steer Review 2009 recommends pastoral systems for pupils to ensure all pupils have someone that knows them well and who is able to support them with their learning and development and, through effective monitoring, ensure that any needs are quickly identified and addressed.
Differentiation is used throughout by all teachers in sessions that Daniel attends. This ensures that Daniels individual learning style is met by the teachers involved. Vissor stated 'Differentiation is the process whereby teachers meet the need for progress through the curriculum by selecting appropriate teaching methods to match the individual student's learning strategies, within a group situation'. (Visser 1993)
Daniels reading deficit is being targeted throughout the curriculum alongside one to one sessions daily that are rewarded with vouchers, this is proving to be very successful as he is no longer reluctant to join in and seems to be enjoying the time spent. Daniel seems to have an improved perception of himself as a "learner" and his relationship with most of his teachers making his learning experience on the whole a positive one. He has started to contribute to class discussions and even reads the odd thing aloud during class when he forgets himself. The self-motivation that Daniel has shown with his reading is very rewarding for both staff and student alike. One of his goals is to learn to read to enable him to return to the college environment to follow a full time study course in motor mechanics, the books that have been acquired for Daniel are about motorbikes and cars, his interest is driving his determination in his reading and writing sessions. This is in line with what Barkley expresses that the curriculum should be made more motivating and interesting to students.
Students need clear rules and well defined limits, students are more committed to rules when they have contributed to the formulation of them. As the rules are set at induction jointly devised with the class they have more meaning and understanding to/for the students, they are always set out positively are succinct and displayed in classrooms so are observable at all times. The consequences are also planned as a group so they agree to incur the penalties. Rules are referred to daily so Daniel has clear boundaries as to acceptable behaviour all rules set tell students how to behave rather than how not to behave.
The small class size seems to suit Daniel, the nurturing atmosphere and feeling of safety created by small group size, breakfast club, pastoral care and a personal keyworker to identify with have had a positive impact, his social interaction skills are developing and he has a sense of belonging to something, this helps with deficits he may experience elsewhere in his life. His self-esteem and confidence are growing noticeably and he attempts tasks that he would avoid at any cost. Humphrey highlights that an important source of self-esteem is the experience of acceptance or being valued, it is also one of the fundamental features of inclusive schooling (Humprey, 2004, Booth and Ainscow, 2002; Clark et al., 1995; CSIE, 1996). Daniel is taking part in a golf session weekly at the local driving range with his tutorial group and has helped with his self-control and social skills. This activity acts as a reward for good behaviour.
The teachers who are involved with delivering the curriculum to Daniel were trained in FE education and the majority completed their training at least eight to ten years ago with a view to teaching adults. Due to the latest trends in educational provision for 14-19 year olds and the links that schools are making with colleges for alternative provision I feel that the tutors are often not equipped with the relevant knowledge to deal with the many issues that young people have let alone learners' who have a statement of educational needs and/or SEBD. Literature suggests that regular teachers are not trained to teach social skills and manage behaviour of their students as stated by Kaufmann and Wong 1991. (Cited in Hunter-Cursh, 2006) This statement is evident in my educational setting as some of the vocational staff are 'old school' and the strategies they employ seem to act as an antecedent for many of the SEBD learners.
Overall I feel that we are meeting Daniels individual educational needs he has made good progress in his reading and writing abilities, he is becoming more aware of his behaviour and how to manage himself, being able to evaluate with help what he has done and work out strategies to reduce the incidents occurring. His behaviour and attitude have improved since he joined and he is responding well to positive reinforcement of good behaviour. Immediate and specific feedback to Daniel about his work is consistent; this helps with keeping him focused not digressing from task as he wants to sense the feeling of achievement. During Daniels weekly reviews he has recognised the progress he is making and has gained a sense of pride in himself, as his pastoral tutor this is very rewarding to note.
Due to the lack of training and staff development offered and undertaken I feel that holistically as a department we are falling short, teacher workloads, hours, available funding and family commitments reduce the time that could be allocated to furthering knowledge of teaching and learning for the staff working with our SEBD students also the attitudes to these learners that are often displayed, staff attitudes often express that they feel as though the college programme and other of a similar nature are a dumping ground for the schools, often they are placed to teach these young people without choice. Research into teachers views of inclusion also show negative attitudes, children with emotional and behavioural problems were frequently seen as needing to be educated in a special setting. (Ellis, Tod and Graham-Matheson, 2008) In conclusion a multi-modal approach encompassing medication, cognitive behaviour therapy and providing a secure nurturing environment is the strategy that appears to be effective at the present time for Daniels development.