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Children and youth with emotional disturbance frequently require and receive services from a variety of agencies that apply different eligibility criteria. These young people are also quite diverse in terms of their needs and strengths. The students present with a complex range of disabilities, from conduct disorder to schizophrenia. Within this statistically and diagnostically diverse population, females appear to be underrepresented, and African Americans appear to be overrepresented. The following paragraphs elaborate on service eligibility for and the characteristics of these students.

Eligibility for Services

Emotional disturbance is 1 of 12 disability categories specified under IDEA. It is defined as follows:

"(i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems.

(ii) The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance" (CFR 300.7 (a) 9).

Children who meet these criteria, as determined by a multidisciplinary team, may receive services under IDEA. Children under the age of 9 who exhibit delays in social or emotional development may receive services under the developmental delay category.

Other Federal agencies use different eligibility criteria for youth with emotional disturbance. Their definitions cover a broad array of mental health conditions, some of which may also lead to eligibility under IDEA:

  • The Center for Mental Health Services’ (CMHS) definition covers children under 18. This definition requires the presence of a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), and which results in a functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities (Substance Abuse and Mental Health Services Administration, 1993).
  • The Social Security Administration’s (SSA) definition of eligibility for the children’s Supplemental Security Income program is the presence of a mental condition that can be medically proven and that results in marked and severe functional limitations of substantial duration.

Children identified under these two definitions may be eligible for services under IDEA or under Section 504 of the Rehabilitation Act of 1973. However, eligibility is not automatic. A child must meet the requirements of the Department of Education’s regulatory definition of emotional disturbance to receive services under IDEA (or must meet the requirements of other IDEA eligibility categories). Therefore, identification of a child as emotionally disturbed under the CMHS or SSA definitions does not necessarily lead to identification under IDEA.

States also define emotional disturbance and specify the criteria to be used by local school districts in the identification of children with this disability. Although they must specify criteria that are not inconsistent with the Federal definition, States interpret that definition based on their own standards, programs, and requirements (McInerney, Kane, & Pelavin, 1992). In fact, many States have adopted their own specific terminology and criteria (Tallmadge, Gund, Munson, & Hanley, 1985; Swartz, Mosley, & Koenig-Jerz, 1987; Gonzalez, 1991). Local variation may affect the ability of Federal authorities to monitor the impact of the IDEA Amendments of 1997. According to a 1992 report, "The resulting differences in definition and eligibility criteria make it difficult to evaluate the identification rates of children with serious emotional disturbance" (McInerney et al., 1992, p. 46).

For example, students identified as having conduct disorder are eligible for services in some States, but not in others. Conduct disorder is a persistent pattern of anti-social, rulebreaking, or aggressive behavior, including defiance, fighting, bullying, disruptiveness, exploitiveness, and disturbed relations with both peers and adults (Cohen, 1994; Forness, 1992; Forness, Kavale, & Lopez, 1993). Research suggests that conduct disorder frequently co-occurs with attention deficit hyperactivity disorder (ADHD), reading disabilities, anxiety disorders, and depression (Clarizio, 1992; Hinshaw, Lahey, & Hart, 1993; McConaughy & Skiba, 1993; Zoccolillo, 1992). The literature also suggests that there are no valid theoretical or empirical grounds for differentiating between conduct disorders and other behavioral and emotional disorders and that there are no reliable or socially validated instruments for making such a distinction (Cohen, 1994; Nelson, 1992; Nelson & Rutherford, 1988; Skiba & Grizzle, 1992; Stein & Merrell, 1992).

Children with emotional disturbance may also be socially maladjusted, but to receive services under IDEA, they must satisfy additional requirements. Since IDEA excludes social maladjustment without emotional disturbance from the definition of emotional disturbance, some State definitions and eligibility requirements serve to exclude students with conduct disorder (Gonzalez, 1991). Alternatively, some research has found that students with conduct disorder constituted the largest percentage of students with emotional disturbance who were served in day schools and residential schools (Forness, 1992; Forness, Kavale, King, & Kasari, 1994; Sinclair & Alexson, 1992). Children with conduct disorder were the largest diagnostic group in the National Adolescent and Child Treatment Study (Silver et al., 1992). That study was co-sponsored by the National Institute for Disability and Rehabilitative Research (OSERS/NIDRR) and the National Institute of Mental Health. Its purpose was to "describe. . . children with [emotional disturbance] and their families" (Greenbaum et al., 1998, p. 21). Students with conduct disorder were also the largest group served at the 31 sites of the CMHS’ Comprehensive Mental Health Services for Children and Their Families program (Doucette, 1997).

In general, the literature documents varying orientations to children with different patterns of behavior. While some of these students are "provided access to therapeutic services, and considered victims of their disorders . . . students who are considered antisocial or socially maladjusted are usually blamed for their aversive and maladaptive behavior patterns and exposed to control, containment, or punishment strategies" (Walker, Stieber, & O’Neill, 1990, p. 62).

Student Characteristics

Students with emotional disturbance who are eligible for services under IDEA typically exhibit mood disorders, anxiety disorders, ADHD, conduct disorders, or other psychiatric disorders (Forness et al., 1994; Mattison & Felix, 1997). Comorbidity of emotional and behavioral disorders is common (Caron & Rutter, 1991; Friedman, Kutash, & Duchnowski, 1996). In addition, the co-occurrence of emotional disturbance and other disabilities may intensify students’ behavioral problems and further compromise academic performance. Many students with emotional disturbance are at great risk for substance abuse disorders (Capaldi & Dishion, 1993; Leone, 1991; Leone, Greenberg, Trickett, & Spero, 1989) and negative encounters with the juvenile justice system (Gilliam & Scott, 1987; Leone, 1991). These problems may exacerbate the impact of emotional disturbance and of any co-occurring disabilities.

In comparison with other students, both with and without disabilities, children with emotional disturbance are more likely to be male, African American, and economically disadvantaged. They are also more likely to live with one parent, in foster care, or in another alternative living arrangement (Cullinan, Epstein, & Sabornie, 1992; Marder, 1992; Wagner, 1995). Students with emotional disturbance are particularly vulnerable to environmental changes such as transitions and to a lack of positive behavioral support during transitions. These students’ presenting behavior, as well as its intensity, is episodic, subject to change over time (Strayhorn, Strain, & Walker, 1993), and may serve to direct attention away from underlying issues such as depression (McCracken, Cantwell, & Hanna, 1993; Wehby & Symons, 1996; Wehby, Symons, & Shores, 1995). These variations in behavior often result in students with emotional disturbance being blamed for disability-related behavior or subject to negative reactions from their peers and teachers (Forness, Kavale, MacMillan, Asarnow, & Duncan, 1996; Lewis, Chard, & Scott, 1994).

Identification

IDEA requires each State to have in effect a policy ensuring all children with disabilities the right to a free appropriate public education (FAPE) (20 U.S.C. 1412 (1)). Thus, it is the obligation of State educational agencies (SEAs) and local educational agencies (LEAs) to evaluate a child who is suspected of having a disability in order to determine his or her need for special education and related services (Davila, Williams, & MacDonald, 1991). But research suggests that the identification process, as implemented, is often reactive, subjective, limited by a local lack of culturally and linguistically appropriate assessment tools, driven by institutional needs, and constrained by parental concerns about pejorative labels (U.S. House of Representatives, 1997) and inappropriate placement, as well as by the inability of some professionals to collaborate with families or with each other (McInerney et al., 1992; Osher & Hanley, 1996; Smith, 1997).

Nationally, the identification rate for emotional disturbance has remained stable at approximately 0.9 percent since OSEP began collecting these data in 1976 (Oswald & Coutinho, 1995). This rate is significantly less than the predicted prevalence of emotional disturbance within schools. For example, the U.S. Department of Education’s Second Annual Report to Congress on the Implementation of P.L. 94-142 estimated a prevalence rate of 2 percent for students with emotional disturbance (U.S. Department of Education, 1980). Similarly, many experts believe that an identification rate of 3-6 percent would be more accurate (Eber & Nelson, 1994; Friedman et al., 1996; Grosenick & Huntze, 1980; Institute of Medicine, 1989; Kauffman, 1994; Smith, Wood, & Grimes, 1988). In fact, mental health epidemiological studies suggest even higher rates of diagnosable psychological and psychiatric impairments in youth (Costello et al., 1988; Friedman et al., 1996; McInerney et al., 1992). There is also great variation in State and local identification rates. One example is the 33-fold difference between the lowest and highest State identification rates of school-aged youth for the 1996-97 school year (see figure II-10 and table AA13, p. A-40, which presents the actual rates).

Identification rates are lower for girls and young women among students identified with emotional disturbance (U.S. Department of Education, 1994). In the National Longitudinal Transition Study (NLTS), more than three-fourths (76.4 percent) of secondary students with emotional disturbance were male, the highest proportion of males to females in any of the disability categories (Marder & Cox, 1991). Lower identification rates among females have been attributed to an assessment and identification process that is subjective (Walker & Fabre, 1988; Wehby, Symons, & Hollo, 1997), and largely driven by how schools operationalize behavioral norms and standards (Gerber & Semmel, 1984; Talbott, 1997; Walker & Severson, 1990). Some researchers and theorists have proposed that the apparent underidentification of girls and young women may also be due to the different ways in which emotional disturbance is manifested in females (Zahn-Waxler, 1993). Girls and young women are more likely to exhibit internalizing problems such as anxiety and depression that do not usually interfere with classroom management, while males are more likely to demonstrate the externalizing behaviors that do disrupt the classroom. Other possible explanations include the gender-specific expectations of teachers and evaluators (Caseau, Luckasson, & Kroth, 1994; Talbott & Lloyd, 1997) and a lack of gender-appropriate diagnostic criteria (Zoccolillo, 1993). Although some screening and assessment tools are available to aid in the identification of withdrawn, isolated students and others who internalize their problems, those tools are used infrequently. Teachers, the primary gatekeepers in the identification process, are more likely to identify students who exhibit externalizing behaviors (Boggiano & Barrett, 1992; Caseau et al., 1994; Gresham, MacMillan, & Bocian, 1996; Kazdin, 1990; Walker & Severson, 1990). Interestingly, a new assessment tool (Epstein & Cullinan, 1998), incorporating national norms derived from students with emotional disturbance and from their nondisabled peers, explicitly addresses the specific, multiple characteristics of emotional disturbance in the IDEA definition. The instrument also incorporates a subscale on social maladjustment, providing for distinctions between emotional disturbance with or without social maladjustment, and vice versa.

While females appear to be underrepresented among students identified with emotional disturbance, African Americans appear to be overrepresented. Research suggests that the high identification rates for African Americans may be due both to teacher expectations regarding normative behavior (Horowitz, Bility, Plichta, Leaf, & Haynes, 1998; McLaughlin & Talbert, 1992; Metz, 1994) and to a paucity of culturally sensitive and linguistically appropriate assessment instruments (Harry, 1994). Culturally competent approaches are needed to work effectively with racially and ethnically diverse students and families (Cross, Bazron, Dennis, & Isaacs, 1989; Comer, 1996; Isaacs-Shockley, Cross, Bazron, Dennis, & Benjamin, 1996). Culturally relevant and responsive techniques can increase the efficacy of both primary prevention efforts (Comer, 1996) and targeted prereferral strategies (Zins, Coyne, & Ponti, 1988).

Although many children with emotional disturbance exhibit problems at an early age (Knitzer, 1996; Marder, 1992), students with this disability are usually identified later than those with other disabilities, despite the availability of valid and reliable screening tools. Research suggests that behavioral and emotional problems identified during adolescence can often be linked to early childhood behavioral patterns (Hinshaw et al., 1993; Walker, Colvin, & Ramsey, 1995; Walker, Shinn, O’Neil, & Ramsey, 1987; Walker et al., 1990). Early intervention appears to be both possible and cost effective (Forness et al., 1996; Hinshaw, Han, Erhardt, & Huber, 1992; Knitzer, 1996; Walker, 1995; Zigler, Taussig, & Black 1992).

Table II-7 shows the percentage of students with disabilities who were identified as having emotional disturbance in 1995-96 by age.

Table II-7

Percentage of Students with Disabilities Identified as Having Emotional Disturbance (1995-96)

Age (years)

6-7

8-9

10-11

12-13

14-15

16-17

Percentage

3.5%

5.6%

7.3%

10.2%

13.1%

13.0%

 

 

Source: U.S. Department of Education, Office of Special Education Programs, Data Analysis System (DANS).