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Information on ED and various evidence-based teaching/learning strategies that can be used in and out of Emotional Disturbance Manual
Section 1: Definition/ IDEA 2004
i. extended definition, including examples Excerpt from the Regulations Governing Special Education Programs for Children with Disabilities in Virginia regarding NICHCY Disability Fact Sheet- No. 5: Emotional Disturbance Fact sheet on ED from Texas Women’s University Section 2: Characteristics of ED/ Causes/ Prevalence/ General Statistics
Council for Exceptional Children: Behavior Disorders/ Emotional American Academy of Child & Adolescent Psychiatry- Facts for Obsessive-Compulsive Disorder in Children and Children with Oppositional Defiant Disorder Panic Disorder in Children and Adolescents American Academy of Child & Adolescent Psychiatry- Glossary of The Boys Projects: Gender as a Factor in Special Educational Section 3: Possible Interventions (Medical, Behavioral, Environmental,
Academic)
When to Seek Referral or Consultation with a Child and Adolescent Adjudication of Youths as Adults in the Criminal Justice System Positive Interaction Procedures: Behavioral Contract LDonline: Behavior Modification in the Classroom Functional Behavioral Assessment/ Behavior Intervention Plan Section 4: Strategies for Students, Parents and Educators
Your Child – Table of Contents and Chapter Summaries American Academy of Child & Adolescent Psychiatry- Facts for Understanding Your Mental Health Insurance The Continuum of Care for Children and Adolescents Child and Adolescent Mental Illness and Drug Abuse Education Students with Emotional/Behavioral Disorders National Agenda for Achieving Better Results for Children and Assessments for Specialized Education Needs: The Vineland Season of Birth of Students Receiving Special Education Services under a Diagnosis of Emotional and Behavioral Disorder Integrated Psychological Services in the Greeley-Evans Public Approaches to Serious Emotional Disturbance: Involving Multiple “Emotion disturbance” 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: 1. An inability to learn that cannot be explained by intellectual, sensory, or 2. An inability to build or maintain satisfactory interpersonal relationships with 3. Inappropriate types of behavior or feelings under normal circumstances; 4. A general pervasive mood of unhappiness or depression; or 5. A tendency to develop physical symptoms or fears associated with The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional 1. The term means a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree which
adversely affects education performance.
a. An inability to learn which cannot be explained by intellectual,
sensory, or health factors.
A comprehensive and differential assessment is necessary to rule out all other possible reasons for a child’s inability to learn. Also, motivational factors or behavioral difficulties, as well as social and cultural factors, must be ruled out as disrupters of student’s ability to learn. Although environmental, cultural, and economic factors may be causal factors in the student’s behavior, they cannot be used in isolation when identifying a b. An inability to build or maintain satisfactory interpersonal
relationships with peers and teachers.
1. Has no friends at home, school, or in the community, 2. Does not voluntarily play or socialize with others, 3. Avoids communicating with peers and/or teachers, 4. Is excessively aggressive or withdrawn if others intrude on his/her 6. Is withdrawn or avoids large groups of people (rule out this stemming 7. Exhibits schizophrenia: severe withdrawal, disorganization, lack of affect, distorted emotion reaction – possible auditory and/or visual 8. Regresses and withdraws by crying readily, engaging in thumb sucking, baby talk, temper tantrums, enuresis, or other forms of extreme behaviors c. Inappropriate types of behavior or feelings under normal
circumstances:
DOES NOT INCLUDE VIOLATION OF RULES/SOCIAL NORMS This does not apply to behaviors that are generally categorized under behavior disorder. To qualify under this characteristic, the behavior must be psychotic and/or overtly bizarre. Consider the cultural background of 1. Catastrophic reactions to an everyday occurrence, 3. Flat, blunt, distorted or excessive affect, 6. Manic behaviors, ie. Grandiosity, suspiciousness, pressured or rapid 7. Though disorders: speech pattern rambling from idea to idea, not logically related to content of discussion, 8. Obsession: persistent, recurrent, intrusive thoughts that appear 10. Inappropriate laughing or crying in a situation in a non-manipulative 11. Tendency to live in a fantasy world more than peer group, 12. Emotions vacillating unpredictably from one extreme to another, d. A general pervasive mood of unhappiness or depression:
The student must demonstrate actual, overt symptoms of depression.
Depression as identified by projective or other testing is insufficient for classification. Situational or reactive depression caused by an immediate, identifiable environmental stress is insufficient for classification.
1. Loss of interest in all or almost all usual activities, 2. Prominent appearance of being depressed, sad, hopeless, low, irritable, 3. Poor appetite, or significant weight gain, 4. Insomnia or hypersomnia including sleeping in class, 7. Feelings of worthlessness, self-reproach, inappropriate guilt, 8. Recurrent thoughts of death or suicide.
e. A tendency to develop physical symptoms or fears associated
with personal or school problems:
These behaviors should deviate largely from the norm.
1. Positive evidence or strong presumption that symptoms are linked to 2. Physical symptoms that are not under voluntary control which deviate 3. Persistent, irrational fear of a specific object or activity that results in 4. Intense, disabling anxiety often reaching panic proportions, 5. Fear of a catastrophe related to self or family.
2. The term includes children who have schizophrenia, but does not
include children who have social maladjustments, unless it is determined
that they have emotional disturbance.
Virginia Department of Education (1994) Regulations governing special education programs for children with disabilities in Virginia. Richmond, Virginia.
Characteristics of ED/ Cause/ Prevalence/General Statistics CHARATERISTICS
Students with ED have significant behavior patterns that depart from what is expected from others. Achenbach suggests that there are two types are emotional patterns into which children can fall. The first is “externalizers”. This group consists of aggressiveness, disruptiveness, and acting out. The other group, he calls “internalizers”, which includes children who are withdrawn, o Incapability of maintaining interactive behavior with people o Lack of capacity for pleasure, rarely experiencing truly satisfied feelings o Avoidance of people or severely withdrawn behavior o Delusional thinking (i.e. feelings of being controlled, though broadcasting, o Marked illogical thinking, incoherence, loosening of associations, magical o Behavior that is grossly disorganized or bizarre o Marked psychomotor retardation or self-stimulating behaviors o Excessive or patently inappropriate guilt o Extreme inability to control impulses directed towards self or others o Pervasive social problem at home, school and in community o Severely inadequate self-concept and blames self for those inadequacies o Reduced productivity across all areas. Not able to achieve academically, socially or vocationally due to the emotional disturbance The causes of a child’s emotional disturbance are not always known.
Sometimes it can be linked to brain damage or disorders, heredity, diet, stress, and family situations. Depression, for example, has been known to be caused by a chemical imbalance in the brain’s neurotransmitters. A cause is rarely known There are some risk factors though that are linked with ED such as a history or childhood verbal, physical or sexual abuse, a family history of schizophrenia, a family history of personality disorders, a childhood head injury PREVELANCE
In Fall 2003, 483,684 students were being served in special education under the IDEA category of Emotional Disturbance. That number was 8% of the total population of students being served in special education. (27th Annual Report to Congress from the U.S. Department of Education, 2005) GENERAL STATISTICS
Disability distribution by race/ethnicity of students 6 to 21 years of age receiving special education or related service: Those being served under the ED category: NUMBER OF STUDENTS WITH SERIOUS EMOTIONAL DISTURBANCE SERVED UNDER IDEA, PART B BY AGE GROUP ON DECEMBER 1, 1995 ----------------------------------------------------------------------- ALABAMA 2,065 3,202 201 5,468ALASKA 224 486 38 748AMERICAN SAMOA 0 1 0 1ARIZONA 1,676 2,673 229 4,578ARKANSAS 135 275 17 427BUR. OF INDIAN AFFAIRS . . . .
CALIFORNIA 4,986 11,687 1,347 18,020COLORADO 3,001 5,103 387 8,491CONNECTICUT 2,929 7,353 885 11,167DELAWARE 225 374 118 717DISTRICT OF COLUMBIA 252 468 80 800FLORIDA 13,378 18,792 1,712 33,882GEORGIA 10,528 11,152 565 22,245GUAM 2 5 3 10HAWAII 438 931 74 1,443IDAHO 185 353 23 561ILLINOIS 8,031 18,175 1,718 27,924INDIANA 2,796 5,370 391 8,557IOWA 2,744 4,983 427 8,154KANSAS 1,575 3,044 219 4,838KENTUCKY 1,732 2,873 132 4,737LOUISIANA 1,843 3,884 238 5,965MAINE 1,607 2,508 236 4,351MARYLAND 2,041 4,222 412 6,675MASSACHUSETTS 4,390 6,828 1,026 12,244MICHIGAN 5,754 10,433 835 17,022MINNESOTA 5,538 10,576 658 16,772MISSISSIPPI 98 187 12 297MISSOURI 3,429 5,767 334 9,530MONTANA 294 786 46 1,126NEBRASKA 1,116 1,594 115 2,825NEVADA 464 847 57 1,368NEW HAMPSHIRE 550 1,365 135 2,050 NEW JERSEY 2,507 9,690 1,379 13,576NEW MEXICO 1,097 2,126 120 3,343NEW YORK 14,640 26,595 3,051 44,286NORTH CAROLINA 3,879 5,415 260 9,554NORTH DAKOTA 216 430 42 688NORTHERN MARIANAS 0 2 0 2OHIO 3,536 7,566 579 11,681OKLAHOMA 911 1,560 97 2,568OREGON 1,379 2,042 171 3,592PALAU 1 0 0 1PENNSYLVANIA 5,080 11,455 1,194 17,729PUERTO RICO 464 379 40 883RHODE ISLAND 540 1,157 236 1,933SOUTH CAROLINA 1,938 3,008 175 5,121SOUTH DAKOTA 225 359 22 606TENNESSEE 945 2,409 172 3,526TEXAS 11,215 21,057 1,621 33,893UTAH 2,173 2,525 151 4,849VERMONT 479 924 83 1,486VIRGIN ISLANDS 20 25 8 53VIRGINIA 3,740 7,336 717 11,793WASHINGTON 2,103 3,169 236 5,508WEST VIRGINIA 560 1,323 104 1,987WISCONSIN 5,170 9,857 894 15,921WYOMING 262 588 46 896 OUTLYING AREAS 147,106 267,294 24,068 438,468 D.C. & P.R. 147,083 267,261 24,057 438,401 SOURCE: U.S. DEPARTMENT OF EDUCATION, OFFICE OF SPECIAL EDUCATION Statistics from the National Mental Heath Association: GENERAL PUBLIC
More than 54 million Americans have a mental disorder in any given year, although fewer than 8 million seek treatment (SGRMH, 1999).
Depression and anxiety disorders — the two most common mental illnesses — each affect 19 million American adults annually (NIMH, 1999).
Approximately 12 million women in the United States experience depression every year — roughly twice the rate of men (NIMH, 1999).
One percent of the population (more than 2.5 million Americans) has schizophrenia (Schizophrenia Bulletin, 1998).
Bipolar disorder, also known as manic-depressive illness, affects more than 2 million Americans (NIMH, 2000).
Each year, eating disorders such as anorexia nervosa and bulimia nervosa affect millions of Americans, 85-90 percent of whom are teens Depression greatly increases the risk of developing heart disease. People with depression are four times more likely to have a heart attack than those with no history of depression (NIMH, 1998).
Approximately 15 percent of all adults who have a mental illness in any given year also experience a co-occurring substance abuse disorder, which complicates treatment (SGRMH, 1999).
Up to one-half of all visits to primary care physicians are due to conditions that are caused or exacerbated by mental or emotional problems (CFHC, MINORITIES
Adults Caucasians who have either depression or an anxiety disorder are more likely to receive treatment than adult African Americans with the same disorders even though the disorders occur in both groups at about the same rate, taking into account socioeconomic factors (SGRMH, 1999).
The rate of illicit drug use is 10.6 percent among Native Americans, 7.7 percent among African Americans, 6.8 percent among Hispanics (all races), 6.6 percent among Caucasians, and 3.2 percent among Asian About twice as many African Americans went without health insurance in 1998 and 1999 than did Caucasians (USCB, 1999).
More than half of all African-Americans and Native Americans are anticipated to use public insurance to pay for inpatient mental health treatment, compared to 34 percent of Caucasians (SAMHSA, 1998).
Misdiagnosis and inadequate treatment often occurs in minority communities. Factors that can contribute include a general mistrust of medical health professionals, cultural barriers, co-occurring disorders, socioeconomic factors, and primary reliance on family and the religious community during times of distress (NMHA, 2000).
CHILDREN AND FAMILIES
One in five children have a diagnosable mental, emotional or behavioral disorder. And up to one in 10 may suffer from a serious emotional disturbance. Seventy percent of children, however, do not receive mental Attention deficit hyperactivity disorder is one of the most common mental disorders in children, affecting 3 to 5 percent of school-age children (NIMH, As many as one in every 33 children and one in eight adolescents may Once a child experiences an episode of depression, he or she is at risk of having another episode within the next five years (CMHS, 1998).
Teenage girls are more likely to develop depression than teenage boys Children and teens who have a chronic illness, endure abuse or neglect, or experience other trauma have an increased risk of depression (NIMH, Suicide is the third leading cause of death for 15- to 24-year-olds and the sixth leading cause of death for 5- to 14-year-olds. The number of attempted suicides is even higher (AACAP, 1997).
Studies have confirmed the short-term efficacy and safety of treatments for depression in youth (NIMH, 2000).
Alcohol, marijuana, inhalants and club drugs are the most frequently used drugs among middle- and high-school youth (SAMHSA, 2000) Research has shown that use of club drugs such as Ecstasy and GHB can cause serious health problems and, in some cases, death. Used in combination with alcohol, these drugs pose even more danger (NIDA, Children and adolescents increasingly believe that regular alcohol and drug use is not dangerous (SAMHSA, 2000).
Among middle- and high-school students, less than 20 percent of young people between the ages of 12 and 17 report using alcohol in the previous month, and less than 4 percent report drinking heavily in the previous Young people are beginning to drink at younger ages. This is troubling particularly because young people who begin drinking or using drugs before age 15 are four times more likely to become addicted than those Children of alcohol- and drug-addicted parents are up to four times more likely to develop substance abuse and mental health problems than other Twenty percent of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder. Up to an additional 30 percent of youth in these facilities have substance abuse disorders or co-occurring substance abuse disorders (OJJDP, OLDER ADULTS
Late-life depression affects about 6 million adults, but only 10 percent ever Older Americans are more likely to commit suicide than any other age group. Although they constitute only 13 percent of the U.S. population, individuals age 65 and older account for 20 percent of all suicides (NIMH, At least 10 to 20 percent of widows and widowers develop clinically significant depression within one year of their spouse’s death (SGRMH, Among adults age 55 and older, 11.4 percent meet the criteria for having Alcohol abuse and dependence is four times as prevalent among men over the age of 65 than among women in the same age group (SGRMH, Key to Abbreviations
AACAP = American Academy of Child and Adolescent Psychiatry CFHC = Collaborative Family Healthcare Coalition NACOA = National Association for Children of Alcoholics NIMH = National Institute of Mental Health OJJDP = Office of Juvenile Justice and Delinquency Prevention SAMHSA = Substance Abuse and Mental Health ServicesAdministration.
SGRMH = Surgeon General’s Report on Mental Health USCCYF = U.S. Select Committee on Children, Youth andFamilies 76.4% of students served under the ED category are MALE.
There are an equal proportion of males and females enrolled in schools at anygiven time.
Possible Interventions (Medical, Behavioral, Environmental, Medication is available upon a doctor’s diagnosis and prescription. Here is a listof common treatable disorders and the medications commonly prescribed: alprazolam (Xanax) panic, generalized anxiety, phobias, social phobias
clonazepam (Klonopin) panic, phobias, social phobia
diazepam (Valium) generalized anxiety, panic, phobias
lorazepam (Ativan) generalized anxiety, panic, phobias
oxazepam (Serax) generalized anxiety, phobias
chlordiazepoxide (Librium) generalized anxiety, phobias
propranolol (Inderal) social phobia
atenolol (Tenormin) social phobia
imipramine (Tofranil) panic, depression, generalized anxiety
desipramine (Norpramin, Pertofrane and others) panic, depression
nortriptyline (Aventyl or Pamelor) panic, depression
amitriptyline (Elavil) panic, depression
doxepin (Sinequan or Adapin) panic, depression
clomipramine (Anafranil) panic, OCD, depression
venlafaxine (Effexor) OCD, depression
phenelzine (Nardil) panic, social phobia, depression
tranylcypromine (Parnate) panic, depression
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) fluoxetine (Prozac) OCD, depression, panic, social phobia
fluvoxamine (Luvox) OCD, depression, panic, social phobia
sertraline (Zoloft) OCD, depression, panic, social phobia
paroxetine (Paxil) OCD, depression, panic, social phobia
buspirone (BuSpar) generalized anxiety, OCD
Valproate (Depakote) panic
These medications can also help alleviate some of the symptoms associated withpersonality disorders.
BEHAVIORAL
o Positive behavior intervention/ supports o Explicit classroom expectations and consequences ENVIRONMENTAL
o Time-out room/area where they can cool down o Place them in a seat that they determine is safe o Access to passes to the guidance counselor or school psychologist o Reduce stressful or anxiety promoting behaviors around the student ACADEMIC
o Related services, such as therapy, counseling, anger management o Teachers who are aware of the student’s needs o Structured classroom that provides safety in the routine

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