Questions Related to Specific Safety Problems (page 2)
Under what circumstances should an aggressive or disruptive student be evaluated for a possible behavior disorder?
A day hardly passes in many schools without at least a few students becoming involved in a fight or disrupting class. There is little reason to evaluate every student who is charged with such misconduct for a possible behavior disorder. In some cases, however, school authorities may need to consider the possibility that a student's behavior is the result of psychological or medical problems requiring the assistance of specialists. What guidelines should be used in determining when students should undergo a formal assessment?
As a diagnostic category, "behavior disordered" is relatively recent. Coleman (1992, p. 22) explains that the preferred term for years was "emotionally disturbed." In the wake of Public Law 94-142, some states replaced this term with behavior disordered because it sounded less threatening and more compatible with the educational mission of the school. Presumably, teachers could observe and attempt to correct inappropriate behavior. Emotions, on the other hand, seemed to belong more in the domain of clinical psychology.
It should be noted that consensus regarding terminology in this area does not exist. Depending on the state, special education teachers may use behavior disordered or emotionally disturbed. "Conduct disorder" is frequently employed as a diagnostic category by mental health professionals working in residential treatment centers. Conduct disorders are indicated by the presence of multiple antisocial behaviors, such as fighting and physical cruelty, over an extended period of time. Walker, Colvin, and Ramsey (1995, p. 4) note that educators sometimes refer to conduct disorders and antisocial behavior as "social maladjustment." Representatives of law enforcement agencies and the courts may use the term "sociopathic" to describe behavior patterns that pose a danger to others.
Public Law 94-142 specified that "seriously emotionally disturbed" was a condition characterized by one or more of the following aspects (Federal Register, 1981):
- an inability to learn which cannot be explained by intellectual, sensory, or health factors
- an inability to build or maintain satisfactory interpersonal relationships with peers and teachers
- inappropriate types of behavior or feelings under normal circumstances
- a general pervasive mood of unhappiness or depression
- a tendency to develop physical symptoms or fears associated with personal or school problems
Serious behavior problems requiring clinical intervention may be divided into two general categories: internalizing behaviors and externalizing behaviors (Coleman, 1992, pp. 26–28). Internalizing behaviors, such as social withdrawal and apathy, generally pose no immediate safety problem for others. Externalizing behaviors, on the other hand, may place others at risk. These behaviors include defiance, disobedience, vandalism, aggression toward others, temper tantrums, and swearing. In the most extreme cases, young people lack the ability to distinguish right from wrong. They appear to have no conscience or respect for societal rules. These individuals may be referred to as psychopathic, sociopathic, or "solitary aggressive type" (Coleman, 1992, p. 159).
In determining whether aggressive behavior should be treated as disordered behavior, it is necessary to take into account its frequency and severity. When aggressive behavior has been present for a long period of time, when it results in serious harm to people and property, and when it is coupled with other externalizing behaviors, psychological assessment by trained personnel is justified. Teachers and administrators should be prepared to provide evidence of the frequency of behaviors and their effects on others.
To help resolve some of the confusion surrounding terminology and provide guidance concerning when to assess individuals manifesting problem behavior, the National Mental Health and Special Education Coalition created a working group to develop a new definition of behavioral disorder. The result of their efforts is the following statement (Forness and Knitzer, 1992, p. 13):
The term emotional or behavioral disorder means a disability characterized by behavioral or emotional responses in school programs so different from appropriate age, cultural, or ethnic norms that they adversely affect educational performance, including academic, social, vocational or personal skills, and which:
- is more than a temporary, expected response to stressful events in the environment;
- is consistently exhibited in two different settings, at least one of which is school-related; and
- persists despite individualized interventions within the education program, unless, in the judgment of the team, the child's or youth's history indicates that such interventions would not be effective.
Labeling young people as seriously emotionally disturbed and behavior disordered, of course, can have negative consequences. The potential for misdiagnosis and the "self-fulfilling prophecy" effect is always present. To protect the interests of young people, guidelines have been established for evaluating students for special education services. As specified in Public Law 94-142, evaluations must involve nondiscriminatory testing, parental participation, multiple criteria, team decisions, and test validity. Estimates of U.S. students who meet the criteria for behavior disordered range from less than 1% to more than 10% (Coleman, 1992, pp. 30–31).
Should drugs be used to control the behaviors of students with behavior disorders?
Deciding that a student should be labeled behavior disordered does not mean that the appropriate course of action is necessarily clear. Considerable controversy exists regarding the extent to which students who are seriously emotionally disturbed and behavior disordered should be medicated when they are in school.
Three main categories of drugs are used in conjunction with IEPs involving behavior disorders. Antipsychotic drugs (tranquilizers) are reserved for the most serious cases. They do not cure disorders, but they are helpful in controlling the symptoms of psychosis, including hallucinations and delusions. Coleman (1992, p. 54) reports that, when used in small doses, these drugs can relieve tension, anxiety, and agitation as well as control aggression and self-injurious behavior.
A second category of drug that has gained popularity with therapists in recent years is antidepressants. Although their use in educational settings is not widespread, antidepressants are occasionally prescribed for school phobia and extreme sadness. Stimulants, the third type of drug, are used to treat attention deficit disorder. There are indications that drugs such as Ritalin and Dexedrine can improve attention and reduce impulsivity in many young people.
Some child psychologists and physicians have raised serious questions about the use of drug therapy with young people. Breggin (2000, p. 61), a physician, has taken the extreme position of counseling parents never to permit their children to be placed on psychoactive drugs for the control of behavior or emotions. Not only does prescribing drugs send the wrong message to young people who we want to avoid drug dependency, but some evidence exists that drugs may have the opposite effect of that which we desire. Breggin (2000, pp. 127–146) notes that some of the boys involved in school shootings were taking drugs prescribed by physicians and psychologists. He points out that antidepressants can induce a manic reaction in which a young person feels invincible and godlike, feelings that can lead to violence. Interestingly, antidepressants also can cause depression, the very condition they are supposed to alleviate (Breggin, 2000, pp. 137–138). Stimulants do not escape Breggin's broadside. He refers to research that has traced violent and psychotic behavior to the use of stimulants such as Ritalin (Breggin, 2000, pp. 138–140).
There is no question that, despite its risks, drug therapy has an appeal for many people. Parents naturally want to see their children avoid getting into trouble in school. Educators want to reduce disorderly and dangerous behavior so that teaching and learning can take place. Prescribing antipsychotics, antidepressants, and stimulants for millions of students, however, is unlikely to provide long-term solutions to either unsafe schools or the psychological problems of young people. Drug therapy may be justified as a last resort in the most serious cases, but parents and educators must be apprised of the potential for harmful side effects.
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