Information on Five Challenging Disabilities-Emotional Disturbance

IDEA 2004's definition of emotional disturbance also includes the category of schizophrenia, a severe emotional disorder, although this disorder is rarely diagnosed in children.

Associated Characteristics   Fears, anxieties, and aggressive behaviors are common reactions of children to specific events such as worries related to school success or peer pressure. However, children with emotional disturbance display more severe and more frequent emotional responses to most situations. While some children exhibit externalizing behaviors (for example, acting out, aggression, or behavioral problems), other children respond primarily by internalizing their feelings (through depression, anxiety, or physical discomfort). Some children display a mix of both externalizing (aggression) and internalizing (anxiety/depression) responses. Children with emotional disturbance often display immaturity in emotional development, evidenced by poor coping skills and poor ability to regulate their emotions in response to environmental stressors.

Externalizing Behaviors   Children who act out display behaviors that may be disruptive in the classroom and that may result in social problems such as rejection by peers. Some children may bully and intimidate their more vulnerable peers. Their impulsivity may cause them to act before they think about the consequences of their actions. Researchers suggest that many aggressive children interpret ambivalent cues as intentionally aggressive and respond with an aggressively defensive response. Social skills training on how to interpret social cues more accurately can be of benefit to these children.

Internalizing Behaviors   Children who are anxious may often withdraw or avoid situations that are stressful. Physical complaints and discomfort (headaches, stomach aches) may result in visits to the school nurse or family doctor, but often no physical reason for the complaints can be determined. For some children, anxiety may increase as exams or standardized testing sessions approach. Although fears are common in children, some children may experience debilitating fears or phobias and arrange their lives around rituals (for example, repeated counting, checking, or hand washing). A list of symptoms associated with anxiety and depressive disorders can be found in Appendix B. Other anxious responses might manifest in school refusals (a child refusing to attend school) after a lengthy illness or in times of stress about separating from a parent, especially after an accident or an event that triggers fear of loss.

Childhood depression is often difficult to detect because young children do not have the ability to understand or express the nature of the complex feelings that are involved. Children who are depressed may appear more irritable than sad and may act out their depressed feelings aggressively. Some children exhibit rapid mood swings that are characterized by heightened emotional reactivity and irritability—a condition known as bipolar disorder.

Severe Emotional Disturbance   Some children may experience emotional disturbance that is significantly more severe than their peers who have mild to moderate emotional problems. If emotional disturbance results in fears about the safety of either the child (self-destructive behaviors) or the child's peers (threats to others), an alternative educational placement may be required, either on a temporary basis (for example, a forty-five-day program) or on a more permanent basis (for example, residential placement).

Educational Planning   Educational planning for children with emotional disturbance will need to incorporate emotional and behavioral support systems into the IEP. An FBA and BIP such as those presented in Table 3.1 may need to be implemented before it will be possible to address specific learning goals. Positive behavioral interventions may be written into the IEP to assist the child in a regular or special class program. Related services such as individual or group counseling, self-esteem and anger management programs, or social skills programs might also be recommended to assist in developing more positive and appropriate behavioral patterns. Programs may be accessed through the school or in the community. Specific interventions to improve self-esteem, social competence, and social skills can be found in Chapter Thirteen. Often, a multi-agency support system can be developed to provide comprehensive support services for families in need.

Remember that educational performance can be adversely affected by an inability to learn or to establish positive interpersonal relationships. Medical management may be necessary to stabilize a child's mood swings or aggressive impulses.