Identifying and Assessing Students with Emotional Disturbance

Terry Tibbetts

• Publisher: Brookes Publishing
• Year: 2014
• Print ISBN: 9781598572711
• eBook ISBN: 9781598572728
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

To help improve social and academic outcomes for all students, school psychologists must be ready to accurately identify, assess, and support students with emotional disturbance. This essential resource gives them the clear information, practical guidance, and up-to-date research they need. Ideal for use as a supplemental textbook or a key reference for in-service school psychologists, this book will clarify what constitutes emotional disturbance in educational settings, how it differs from the clinical definition, and how to assess and intervene effectively so students learn and thrive.

PREPARE SCHOOL PSYCHOLOGISTS TO:

• Differentiate social maladjustment from emotional disturbance (includes clear coverage of the exclusionary clause)
• Understand the RTI model as it relates to identification of behavioral and emotional issues
• Meet the legal requirements for assessment procedures
• Determine eligibility for the "emotional disturbance" identification
• Help ensure meaningful individualized educational programs for students
• Help teachers develop classroom supports that address the needs of students with emotional disturbance

PRACTICAL FEATURES:

Brief vignettes and excerpts from federal- and state-level court findings help illuminate the educational definition of emotional disturbance, and practical tables and charts aid with the assessment process and determining eligibility.

1	Understanding Educational and Clinical Definitions of Emotional Disturbance
	A Comparative Overview

This book is designed to assist clinical and educational professionals in understanding what constitutes emotional disturbance (often abbreviated as ED in the educational field) from an educational point of view. It is necessary to understand that there is a significant amount of debate and discussion among professionals as to what constitutes ED and the reasons for these disagreements.

The purpose of any identification or classification effort is to produce groupings that either improve professional understanding of the origin or causes of a condition or provide a foundation for differential intervention (Kirk, Gallagher, & Anastasiow, 2000). Attempting to validly and reliably define ED is a difficult undertaking, however, and even to this date professionals in the field do not agree on a definition (Shepherd, 2010).

Part of the difficulty in defining ED lies in factors such as differences among conceptual models of ED, difficulties in measuring and defining emotional states, variation in emotions and behaviors among children with and without ED, relationships or comorbidity between ED and other contributing conditions (e.g., hyperactivity, intellectual disability), cultural and social expectations of behavior, and the functions and roles of the labeling agents (Kauffman & Landrum, 2009; Rich, 1982).

This lack of a clear and limited set of criteria is also complicated by the fact that emotional health and resiliency in children involves a similar number of different and interrelated factors, including cognitive capacities, social skills, adaptive and coping abilities, family dynamics, and community resources (Wicks-Nelson & Israel, 2003). Furthermore, children often demonstrate wide variations in any or all of these capacities during the course of social-emotional maturation (Kerig & Wenar, 2005). Lifter emphasized that identifying very young children with ED is extremely difficult due to several factors:

There is a tremendous range of “normal” behavior; children’s behaviors are influenced by parental expectations and cultural values; children’s behaviors are highly individualistic unless contextual constraints (e.g., day care) require conformity; social-emotional and personality characteristics are continuing to evolve . . . many behavior problems may be transient in the period; and manifestations of various impairments cut across different disorders. (1999, p. 45)

Identifying ED in a child is often a difficult and complex process because of these multiple dynamics. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the primary reference source for psychiatrists and clinical psychologists, clearly states, “No definition adequately specifies precise boundaries for the concept of ‘mental disorder.’ The concept of mental disorder . . . lacks a consistent operational definition that covers all situations” (American Psychiatric Association [APA], 2000, p. xxx). Furthermore, any definition derived from assumptions or beliefs of one conceptual model “does little but baffle or disappoint those who hold the assumptions of a different model” (Kauffman & Landrum, 2009, p. 12). As a result of the continuing lack of such an operational definition, a number of approaches have emerged among different professional groups to create a valid methodology for identifying ED in children.

Nowhere is this lack of agreement on a working definition of ED more notable than in the definitional interface between educational and clinical professionals. Clinical professionals utilize an inclusive approach in defining and diagnosing various emotional disorders that students may demonstrate. Their approach is most often based on using the most current edition, at the time of this writing, of the APA’s DSM (the text revision from 2000), with its classifications and descriptions of what constitutes the presence of specific mental disorders.

By contrast, educational professionals utilize an exclusive approach that primarily focuses on legal definitions under educational laws. These laws are limited to delineating specific handicapping conditions that may determine eligibility for special education services. These eligibility criteria are solely used to support a limited population of students with ED who are unable to benefit from their educational programs primarily because of their emotional condition. Students who might easily be identified by clinical professionals as having an ED are often found ineligible for special education services because of the lack of significant impact their emotional state has on their educational performance.

The resulting difference in approach is perhaps best summarized by a California administrative law judge who noted that both the student’s and the district’s expert witnesses

Each agreed that ED is not a medical diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR, American Psychiatric Association). Instead, ED is a legal category created by Congress to distinguish a narrow range of pupils with emotional problems who are eligible for special education services. Thus, the criteria regarding emotional disorders in the medical and mental health fields are significantly different than the educational criteria for ED. (Student v. Placentia-Yorba Linda Unified School District, 2009, p. 3)

The remainder of this chapter focuses on exploring in more detail the differences between clinical and educational approaches to identifying ED in students.

CLINICAL APPROACHES

The field of mental health has created at least three major clinical approaches to classifying ED in children and youth—psychiatric, behavioral, and empirical (multivariate).

Psychiatric/Medical

Initial efforts to define and classify emotional disorders in children historically emerged from psychiatry in response to patterns of behavior described by professionals in fields such as clinical psychology and psychiatric social work (Kirk et al., 2000). This in turn has led to developing more specialized classification systems by multiple organizations such as the Group for the Advancement of Psychiatry (GAP; 1966), ZERO TO THREE (2005), the APA (2000), and the Alliance of Psychoanalytic Organizations (2006).

Group for the Advancement of Psychiatry

The first major clinical attempt to specifically focus on children’s psychiatric disorders was developed in 1966, when the DSM was in its second edition. GAP (1966) identified key categories of clinical disorders, including reactive disorders, developmental deviations, psychoneurotic disorders, personality (ego-syntonic) disorders, psychotic disorders, brain syndromes, and what was then called mental retardation (now called intellectual disability). The GAP system placed a heavy focus on developmental issues, emphasizing the fluidity of children’s behaviors. It also included one of the first organized attempts to create a category for healthy responses.

This category is presented as the first on the list in order to emphasize the need for the assessment of positive strengths in the child wherever possible and to avoid so far as possible the diagnosis of healthy states by the exclusion of pathology. (1966, pp. 219–220)

The GAP classification system has been criticized, however, for its heavily psychodynamic view of ED and lack of specificity in diagnostic criteria descriptions. The GAP system is primarily of historical interest because of its emphasis on psychodynamic explanations of ED and the publication of subsequent editions of the DSM.

ZERO TO THREE

ZERO TO THREE: National Center for Infants, Toddlers, and Families, an organization representing interdisciplinary professional leadership in infant development and mental health, developed a classification system to address the need for a systematic, developmentally based approach to classify mental health and developmental difficulties in the first 4 years of life (ZERO TO THREE, 2005). The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R) utilizes a multiaxial diagnostic framework. The first axis represents the primary disorder, whereas the second axis is designed to assist in understanding the quality of the parent–child relationship. The third axis addresses physical, neurological, developmental, or other mental health disorders or conditions, and the fourth axis identifies psychosocial stress dynamics. The fifth axis uses seven categories to identify age-appropriate functional developmental levels.

American Psychiatric Association

The DSM system is the most widely used classification model in the clinical profession. It is a categorical approach to classification that assumes that the difference between normal and pathological is one of kind rather than degree (Wicks-Nelson & Israel, 2003). That is, a child either meets the criteria for a particular specified disorder or does not. Disorders are identified in the DSM system based on quantitative and clinical research reviews and clinical trials as developed by the APA. Children are assigned a DSM diagnosis based on the number and type of symptoms they exhibit, which is reflective of an operationalized and atheoretical definition of a particular disorder.

Such an approach must be based on ordered and group distinctions so that the classifications in the system reflect intrinsic distinctions among individuals assigned to different classifications (Achenbach & Edelman 1989). For example, the characteristics associated with a generalized anxiety disorder should significantly differ from those associated with a conduct disorder. This reflects the recognition that a major purpose of any diagnostic classification systems is to organize a wide range of research and clinical findings into a manageable and coherent set of constructs (Power & Eiraldi, 2000).

The DSM utilizes a multiaxial approach to categorization in which students are classified according to five different dimensions (Axis I through Axis V). The first two axes refer to types of mental health problems, whereas the remaining three axes refer to general medical conditions, psychosocial and environmental problems or stressors, and the level of the student’s adaptive functioning.

The DSM system continues to be criticized by a number of clinicians and researchers, despite its wide use. These criticisms include its dependence on a medical model of pathology, its lack of test–retest reliability, its validity concerns, and its excessive differentiation of “different” mental disorders. Knoff (2002) noted that although DSM-I (APA, 1952) had approximately 100 diagnoses, DSM-IV (APA, 1994) identifies more than 350. As in any classification system, the search for a label can often obscure the importance of focusing on the most appropriate interventions for treatment.

Alliance of Psychoanalytic Organizations

The Alliance of Psychoanalytic Organizations’ (2006) classification system was developed through a collaborative effort of major organizations representing psychoanalytically oriented mental health professionals. As such, it is primarily limited to clinicians of that particular theoretical persuasion. It describes healthy and disordered personality functioning, individual profiles of mental functioning, and symptom patterns (including differences in each individual’s personal or subjective experience of symptoms). Its connectedness to the educational setting is limited.

Behavioral

As the field of applied behavior analysis has grown, there has also been an increasing interest in developing a more behaviorally based approach to defining ED. Rising concerns about inaccuracies in clinical diagnostic procedures and the disproportionate rates of diagnosis among children from minority ethnic and cultural groups have led to a search for an alternative that is more objective and will directly lead to effective interventions (Gresham & Gansle, 1992). Such an approach is sometimes described as idiographic because it focuses on the behaviors of individual students without comparisons to other students or groups.

Applied behavior analysis utilizes a functional approach, which means that all behavior is viewed as serving an environmental purpose. Although the behavioral approach may include modified diagnostic formulations (Cipani & Schock, 2007), its primary emphasis is on identifying the function and purpose of specific child behaviors. A function-based diagnostic classification system focuses on the contextual nature of the problem behavior and recognizes that there are relationship and ecological variables that contribute to the child’s pattern of behavior and must be altered for improvement to occur. Any diagnostic formulations are solely made for the purpose of planning and implementing effective differential intervention programs.

Thus, although a clinical definition of depression might utilize and discuss psychodynamic constructs such as anaclitic and introjective emotional variables (APA, 2006), a behavioral definition would more narrowly focus on factors such as the student’s loss or reduction of reinforcement provided by the environment for acquisition of skills and/or a lack of understanding of consequences provided through environmental events (Lewinsohn, 1974, as cited in Pfeffer, 2006).

A function-based diagnostic classification system examines the contextual nature of the problem behavior and does not presume that the exhibition of behavior is driven by characteristics inherent in the client or child. As Rhodes suggested, the locus of the ED is assumed to be in the “encounter point between the child and the microcommunity or microcommunities which surround him” (as cited in Wood, 1982, p. 4). This sharply contrasts with the other clinical approaches to diagnosing client behavior. Behavior analysts feel the role of a clinical diagnosis is irrelevant at best (Cipani & Schock, 2007) and can often be counterproductive to the degree that it influences professionals to label children rather than critically examining behavioral function and contextual factors as the key intervention points (Harry & Klingner, 2006).

An ecological perspective views student behavior as a function of the interaction between the student’s behavior and the response that the behavior receives from others in the environment, which differs from clinical models that place the responsibility for the student’s disability within the individual (APA, 2000). Rhodes (1970) argued that the student does not have an inherent ED but may be labeled as “disturbed” because of others’ reactions to the behaviors exhibited. Accordingly, rather than describing the individual as being disturbed, these behaviors can be defined as disturbing to others.

If a student is assumed to be disturbed because of the behaviors that he ...

Table of contents

•  Cover
• Title
• Copyright
• Contents 
• About the Author
• Preface
• Acknowledgments
• Dedication
• 1. Understanding Educational and Clinical Definitions of Emotional Disturbance: A Comparative Overview
• 2. Toward an Understanding of Educationally Based Emotional Disturbance
• 3. The Educational Definition of the Student with Emotional Disturbance
• 4. The Exclusionary Clause: Social Maladjustment and Behavior Disorders
• 5. Psychoeducational Components of Assessment
• 6. Clinical Considerations for Assessment
• 7. Response to Intervention: An Alternative Model of Assessment
• 8. Placement Characteristics
• References
• Index