Emotional or Behavioral Disorders Defined (page 3)
Emotional or behavioral disorders (EBD) are difficult to define. In fact, some think that people are identified as having this disability when adults in authority say so (Hallahan & Kauffman, 2006). In other words, in many cases the application of the definition is subjective. Definitions of this disability, including the one used in IDEA '04, are based on the one developed by Eli Bower (1960, 1982). Let's first look at the federal definition. IDEA '04 uses the term emotional disturbance to describe students with emotional or behavioral disorders, which is the special education category under which students whose behavioral or emotional responses are not typical are served.
Old versions of IDEA used the term serious emotional disturbance to describe this disability area, but serious was dropped in 1999 when the U.S. Department of Education created the regulations for the 1997 version of IDEA. The government did not, however, change the substance of the definition when it changed the term. Here's what it said about the deletion: "[It] is intended to have no substantive or legal significance. It is intended strictly to eliminate the pejorative connotation of the term 'serious'" (U.S. Department of Education, 1999, p. 12542). In addition, some implied parts of the federal definition are important to understand. For example, although only one characteristic listed in the IDEA '04 definition need be present for the student to qualify for special education, whatever the characteristics, me child's educational performance must be adversely affected. Because nearly all of us experience some mild maladjustment for short periods of our lives, the definition also requires that the child exhibit the characteristic for a long time and to a marked degree, or significant level of intensity.
The IDEA '04 term and definition have been criticized by many professionals (Kauffman, 2005). To them, using only the word emotional excludes students whose disability is only behavioral. The exclusion of students who are "socially maladjusted" contributes to this misunderstanding because the term is not actually defined in IDEA '04. Many educators interpret the term social maladjustment as referring to students with conduct disorders or those youth who have been adjudicated for rule violations (American Psychiatric Association, 2000). And the reference to "educational performance" has been narrowly interpreted to mean only academic performance and not behavioral or social performance, life skills, or vocational skills.
Responding to these criticisms, a coalition of 17 organizations, which calls itself the National Mental Health and Special Education Coalition, drafted another definition and continues to lobby federal and state governments to adopt it (Forness & Knitzer, 1992). It is unlikely, however, that this definition will gain universal acceptance, because some people are concerned that it would be a more inclusive definition; it might identify too many children (Kauffman, 2002 July 14, personal communication). Regardless, it is useful to see this disability from another perspective.
Emotional or behavioral disorders can be divided into three groups that are characterized by:
- Externalizing behaviors
- Internalizing behaviors
- Low incidence disorders
Some emotional or behavioral disorders manifest themselves outwardly. Externalizing behaviors constitute an acting-out style that could be described as aggressive, impulsive, coercive, and noncompliant. Other disorders are more accurately described as "inward." Internalizing behaviors are typical of an inhibited style that could be described as withdrawn, lonely, depressed, and anxious (Gresham et al., 1999). Students who exhibit externalizing and internalizing behaviors, respectively, are the two main groups of students with emotional or behavioral disorders, but they do not account for all of the conditions that result in placement in this special education category. The 4th edition of the Diagnostic and Statistical Manual (DSM-IV-TR) published by the American Psychiatric Association (APA, 2000) also describes disorders usually first diagnosed in children, but not all of these are considered disabilities by the federal government (tic disorders, mood disorder, and conduct disorders). Table 7.2 defines and explains some of the common externalizing and internalizing behaviors seen in special education students. Remember that conditions disturbing to other people are identified more often and earlier. Teachers must be alert to internalizing behaviors, which are equally serious but are not always identified, leaving children without appropriate special education services. It may be that teachers are less likely to notice internalizing behaviors because they are less likely than externalizing behaviors to interfere with instruction (Lane, 2003). Also, of course, emotional or behavioral disorders can coexist with other disabilities. Let's look at each of these types in turn.
When we think about emotional or behavioral disorders, we probably first think of behaviors that are "out of control"—aggressive behaviors expressed outwardly, usually toward other persons. Some typical examples are hyperactivity, a high level of irritating behavior that is impulsive and distractible, and persistent aggression. Young children who have serious challenging behaviors that persist are the mo likely to be referred for psychiatric services (Maag, 2000). Three common problems associated with externalizing behavior are hyperactivity, aggression, and delinquency. Hyperactivity was discussed in Chapter 6 because it is a common characteristic of ADHD. Remember that ADHD and emotional or behavioral disorders often occur in combination. So it shouldn't be surprising to find that hyperactivity is a common problem among these children as well.
Aggression may be turned toward objects, toward the self, or toward others. The DSM-IV-TR does not directly define aggression, but it does include elements of aggression in two of the disorders it describes: conduct disorders and oppositional defiant disorder. Aggressive behavior, particularly when it is observed in very young children, is worrisome. This is not just because of the behavior itself—though its hazards should not be minimized—but also because of its strong correlation with long-term problems (dropping out of school, delinquency, violence). A pattern of early aggressive acts beginning with annoying and bullying, followed by physical fighting, is a clear pathway, especially for boys, to violence in late adolescence (Talbott & Thiede, 1999).
Some 30 to 50 percent of youth in correctional facilities are individuals with disabilities (IDEA Practices, 2002). In this group, learning disabilities and emotional or behavioral disorders are about equally represented (45 and 42 percent, respectively). Delinquency, or juvenile delinquency, is defined by the criminal justice system rather than by the medical or educational establishments. Delinquency consists of the commission by juveniles of illegal acts, which could include crimes such as theft or assault. Remember that although some children who are delinquent have emotional or behavioral disorders, many do not—just as some children with emotional or behavioral disorders are delinquent but many are not. However, it is very important to understand that many of these children are at great risk for being involved with the criminal justice system (Edens & Otto, 1997). Their rates of contact with the authorities are disproportionately high. While still in high school, students with emotional or behavioral disorders are 13 times more likely to be arrested than other students with disabilities (U.S. Department of Education, 2001).
Internalizing behaviors are typically expressed by being socially withdrawn. Examples of internalizing behaviors include
- Anorexia or bulimia
Serious eating disorders that usually occur during students' teenage years are anorexia and bulimia (Manley, Rickson, & Standeven, 2000). These disorders occur because of individuals' (typically girls') preoccupation with weight and body image, their drive for thinness, and their fear of becoming fat. Many causes for these problems have been suggested; they include the media's projection of extreme thinness as the image of beauty and health, competition among peers, perfectionism, personal insecurity, and family crisis. Regardless of the cause, teachers can help by spotting these preoccupations early and seeking assistance from the school's support team or school nurse.
It is often difficult to recognize depression in children. Among the components of depression are guilt, self-blame, feelings of rejection, lethargy, low self-esteem, and negative self-image. These tendencies are often overlooked or may be expressed in behaviors that appear to signal a different problem entirely. Because children's behavior when they are depressed often appears so different from the depressed behavior of adults, teachers and parents may have difficulty recognizing the depression. For example, a severely depressed child might attempt to harm himself by running into a busy street or hurling himself off a ledge. Adults might assume that this behavior was normal because many children accidentally do those things, or they might minimize its seriousness. In addition, children usually do not have the vocabulary, personal insight, or experience to recognize and label feelings of depression.
Finally, anxiety disorders may be demonstrated as intense anxiety upon separation from family, friends, or a familiar environment; as excessive shrinking from contact with strangers; or as unfocused, excessive worry and fear. Anxiety disorders are difficult to recognize in children. Because withdrawn children engage in very low levels of positive interactions with their peers, peer rating scales may help educators identify these disorders. Children with internalizing behavior problems, regardless of the type, tend to be underidentified, and this leaves many of them at risk of remaining untreated or receiving needed services later than they should. For those who do receive intervention support, medications such as antidepressants and antianxiety agents may be a component of a more comprehensive intervention plan. If these youngsters are taking medications, it is important for teachers and parents to work collaboratively to ensure that medication is delivered as prescribed, particularly if medication to be taken during the school day.
Examples of Externalizing and Internalizing Behavior Problems
|Externalizing Behaviors||Internalizing Behaviors|
|Violates basic rights of others||Exhibits painful shyness|
|Violates societal norms or rules||Is teased by peers|
|Has tantrums||Is neglected by peers|
|Steals; causes property loss or damage||Is depressed|
|Is hostile or defiant; argues||Is anorexic|
|Ignores teachers' reprimands||Is bulimic|
|Demonstrates obsessive/compulsive behaviors||Is socially withdrawn|
|Causes or threatens physical harm to people or animals||Tends to be suicidal|
|Uses lewd or obscene gestures||Has unfounded fears and phobias|
|Is hyperactive||Tends to have low self-esteem|
|Has excessive worries|
Low Incidence Disorders
Some disorders occur very infrequently but are quite serious when they do occur. Consider schizophrenia, which can have tragic consequences for the individuals involved and their families. Schizophrenia, sometimes considered a form of psychosis or a type of pervasive developmental disability (APA, 2000), is an extremely rare disorder in children, although approximately 1 percent of the general population over the age of 18 has been diagnosed as having schizophrenia. When it occurs, it places great demands on service systems. It usually involves bizarre delusions (such as believing one's thoughts are controlled by the police), hallucinations (such as voices telling one what to think), "loosening" of associations (disconnected thoughts), and incoherence. Schizophrenia is most prevalent between the ages of 15 and 45, and experts agree that the earlier the onset, the more severe the disturbance in adulthood (Newcomer, 1993). Children with schizophrenia have serious difficulties with schoolwork and often must live in special hospital and educational settings during part of their childhood. Their IEPs are complex and require the collaboration of members from a multidisciplinary team.
Excluded Behavior Problems
Two groups of children—the socially maladjusted and those with conduct disorders—are not eligible for special education services (unless they have another qualifying condition as well). Neither group is included in the IDEA '04 definition. Although social maladjustment is widely discussed, particularly when politicians and educators talk about discipline and violence in schools, IDEA '04 does not call it out as a special education category or as a subcategory of emotional or behavioral disorders. In me DSM-IV-TR, the APA defines conduct disorders as "a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated" (2000, p. 93). Section 504 and ADA do not have exclusions for social maladjustment, so the educational system is required to make accommodations for these students even though they do not qualify for special education services (Zirkel, 1999).
The law is clear that social maladjustment and conduct disorders are not subsets of emotional or behavioral disorders, but how to help such students, in practice, is much less clear (Costenbader & Buntaine, 1999). Why is there confusion about the educational needs of children who are socially maladjusted or who have conduct disorders? Some explanations are related to definitional issues; others are related to what people think is best for the students involved (Kauffman, 1999; Walker et al., 2001). Here are five reasons:
- No generally agreed-upon definition of social maladjustment exists.
- It is very difficult to distinguish students with externalizing emotional or behavioral disorders from students with conduct disorders.
- A more inclusive definition will increase special education enrollment to levels beyond tolerance and acceptability.
- Because the needs of students with conduct disorders are best met by specialists prepared to deal with their problems, they should be identified as special education students, even if technically they do not qualify as students with disabilities.
- Many people believe these students are just choosing to misbehave and do not have disabilities.
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