Prevalence and Definitions
Individuals classified as having emotional disturbance (or behavioral disorders) represent 8.1% of all students ages 6–21 served under IDEA, or .72% of the school population (U.S. Department of Education, 2002a). However, prevalence studies have suggested that the actual percentage may be much higher. Boys outnumber girls in this category by about 3.5 to 1 (Oswald, Best, Coutinho, & Nagle, 2003).
Emotional disturbance refers to a number of different, but related, social-emotional disabilities. Individuals classified as emotionally disturbed meet several criteria established under IDEA, including the following:
- An inability to exhibit appropriate behavior under ordinary circumstances
- An inability to maintain relationships with peers or teachers
- An inappropriate affect such as depression or anxiety
- An inappropriate manifestation of physical symptoms or fears in response to school or personal difficulties
These characteristics must be manifested over an extended time period and have a negative effect on school performance (U.S. Department of Education, 2002a).
Individuals classified as emotionally disturbed represent a range of severity, and the disability itself may be temporary or permanent. Specific emotional disturbance areas include childhood schizophrenia; selective mutism (failure to speak in selected circumstances); seriously aggressive or acting-out behavior; conduct disorders; inappropriate affective disorders such as depression, social withdrawal, psychosomatic disorders, anxiety disorders, self-mutilating behaviors; and excessive fears (or phobias) (Kauffman, 2005). Individuals characterized as socially maladjusted (e.g., juvenile delinquency) are not considered emotionally disturbed according to IDEA, unless they also exhibit other evidence of emotional disturbance (U.S. Department of Education, 2002a). Students with Tourette syndrome may receive services under Other Health Impairments.
Causes of Emotional Disturbance
Most behavioral disorders or emotional disturbances have no known cause. However, possible causes include biological, family, school, and cultural factors (e.g., Hallahan & Kauffman, 2003; Kauffman, 2005).
Biological factors are genetic, biochemical, and neurological influences that interact and result in emotional disabilities. Schizophrenia, autism, attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome—a tic disorder characterized by involuntary muscular movements, vocalizations, and/or inappropriate verbal outbursts—all appear to have biological bases that interact with other factors and may contribute to emotional disturbances. However, Tourette syndrome and ADHD are not necessarily associated with emotional disturbance. Family factors (such as domestic violence) are also considered to be strong contributing factors to emotional disturbance. School factors (such as failure to accommodate for individual needs, inappropriate expectations, or inconsistency) can also contribute to an emotional disability. Finally, certain cultural environmental factors (including peer group, urbanization, and neighborhood factors) interact with the individual, the home, and the school and may also contribute to emotional disabilities (Kauffman, 2005).
Issues in Identification and Assessment of Emotional Disturbance
Individuals with emotional disabilities are difficult to objectively identify and classify. Moreover, there appears to be a reluctance on the part of school personnel to label a child “emotionally disturbed” (Kauffman, 2005). Traditional measures to identify emotional or behavioral disabilities include teacher checklists; parental checklists; classroom behavioral observations; and tests of intelligence, achievement, and psychological status. Checklists are listings of frequently observed behaviors. Teachers and parents complete checklists by indicating the types and severity of problem behaviors. Direct observations are conducted during classes, on the playground, at lunch, and in other parts of the school.
Characteristics of Emotional Disturbance
As with most students with disabilities, not all individuals with emotional disturbance will exhibit all the characteristics described here.
Most students with emotional disturbance have problems with their social behavior, often manifested as less mature or inappropriate social skills (Kauffman, 2005). Some students may be particularly aggressive with peers and adults and cause harm when playing or interacting with others. These students act out in class, do not appear to respond appropriately to discipline from teachers and may seem oblivious to class and school rules (Furlong, Morrison, & Jimerson, 2004). Students with behavioral disorders are at higher risk for substance abuse (Steele, Forehand, Armistead, & Brody, 1995).
Other students may exhibit social behavior similar to that of younger children and act socially immature. Some students may withdraw from others and appear socially isolated. Although withdrawn students may not call as much attention to themselves as conduct-disordered students they nonetheless may require intensive interventions (Gresham & Kern, 2004). These students may exhibit symptoms of depression. Social isolates do not interact with any peers or adults, and in the most severe cases may exhibit selective (or elective) mutism. Individuals with selective mutism have the physical ability to talk but nevertheless do not speak in appropriate situations (Brigham & Cole, 1999). All of these emotional or behavioral disorders share the characteristic of an inability to interact appropriately with others, including peers, teachers, siblings, and parents, which negatively affects school performance (Cullinan, 2004).
Students with emotional disturbance may also inappropriately attribute their behavioral or social problems to causes outside themselves, saying things such as, “Teachers are out to get me,” or “Other kids always get me into trouble.” By doing this, these students are able to avoid acknowledging or evaluating their own behavior and their own role in behavior problems.
Some students with emotional disturbances have serious affective disorders. Affective disorders can take many forms, but the most commonly recognized forms include depression, severe anxiety disorders, phobias, and psychosomatic disorders (Kauffman, 2005). Individuals with many of these disorders may be treated with different medications.
Research has indicated that students may function two or more years below grade level in reading, math, writing, and spelling (Lane, 2004; Reid, Gonzalez, Nordness, Trout, & Epstein, 2004; see the Research Highlight feature). These deficiencies may be related to the emotional disabilities. For example, if students have severe anxieties, they may be unable to attend, listen, and learn in school. Some students lack social skills that are necessary for school success (Kavale, Mathur, & Mostert, 2004). Others may exhibit severe deficiencies in metacognitive skills, memory skills, and attention, which may in turn lead to academic underachievement (Montague, Fiore, Hocutt, McKinney, & Harris, 1996). Students with emotional disturbance are at risk for dropping out of school, hindering their future life possibilities. Nevertheless, some students with emotional or behavioral disabilities attain average, or even above-average academic achievement.
Classroom Adaptations for Students with Emotional Disabilities
General adaptations can facilitate the inclusion of students with emotional and behavioral disorders into general education classes. Some specific adaptations to promote successful inclusion are presented next.
Preparing the Class
Prepare your class for students with emotional disabilities. Set up models for tolerance and acceptance. Provide opportunities for students with emotional disabilities to assume class responsibilities, such as distributing papers. Give examples of ways general education peers can help students with emotional disabilities, such as how to ignore inappropriate behaviors. Some students may be able to serve as peer tutors or assistants to help support and reinforce appropriate behaviors from students with emotional disabilities. However, select peers carefully; not all peers would be good choices. Remember that sometimes emotionally disturbed students will do better working alone even when the rest of the class is working in small groups. Chapter 8 provides additional information on using classroom peers.
Illustrate the rules with clear examples and specify rewards for following rules as well as consequences when rules are disobeyed. Be consistent when enforcing rules, but make sure the overall classroom atmosphere is positive, not punitive. Provide models of acceptable behaviors to avoid confusion or misinterpretation on the part of students:
“Here’s one thing you can say if you think another student is sitting too close to you. . . .”
“Here is something you should not say. . . .”
Maintain a positive relationship with students with emotional disabilities by responding to them as human beings, rather than responding simply to their overt behavior, which often may be unpleasant. Use positive comments frequently to reinforce good behavior when you see it. Say things like the following:
- “Jeff, I appreciate the way you tried hard in class today. I know that math is not your favorite subject.”
- “Leslie, I am glad that you volunteered an answer in class today. Thank you for doing that.”
Positive comments can be varied so they are suitable for either elementary-, middle-, or secondary-level students.
Before reprimanding negative social behavior, say, “Stop and think about what you just did. What should you have done? Now, try to do it more appropriately.”
Be tolerant, and use judgment in allocating times for enforcing compliance, times for cooling off, and times for allowing divergent responding. For example, one fifth-grade teacher, Mrs. Bahs, allowed a student with emotional disabilities to remain at his desk even though she had asked all students to move to the floor in the front of the room to view a new class iguana. In this way, she was able to prevent a confrontation, and allow the student to participate in his own way.
Some students may have specific fears and anxieties, such as the dark, water, or getting dirty. Be aware of those fears by communicating with special education teachers, parents, and the students themselves. If class activities seem to bring out those fears in some students, have alternative activities available that they can work on independently.
Many students in your classes, especially students with emotional disturbance, can benefit from general social skills instruction. For example, review more acceptable ways of asking and answering questions and more suitable ways of resolving conflicts at appropriate times.
Teach students to monitor their own behavior and to make positive attributions. Teach students how to attribute their successes to positive strategies and effort on their part, rather than to luck or other external forces. Teach them likewise to attribute their failures to things under their control, like their own behavior, and not to external factors, such as, “The teacher hates me.” Model effective positive attributions by saying, for example: “I used the ‘stop and think’ strategy before acting, so I stayed out of trouble!” (see Polsgrove & Smith, 2004).
Use behavioral contracts with students with emotional disabilities. Behavioral contracts are individually negotiated contracts between the teacher and student.
Consider additional classroom adaptations, including the following:
- Adapt the physical environment by considering seating arrangements and by keeping potentially harmful objects or substances away from easy access. Consider the degree of proximity to teachers, aides, and students with whom the target student interacts negatively.
- Adapt materials, when needed, using the suggestions listed for students with learning disabilities and mental retardation. Devise self-monitoring checklists that students can use to check off activities as they complete them. Break assignments into short segments to avoid overwhelming students.
- Adapt instruction, using the teacher effectiveness variables and teacher presentation variables to ensure that content is covered adequately. Teach the classroom social skills necessary for success.
- Help students focus by teaching clearly and enthusiastically, providing additional review, and teaching self-monitoring for attention.
- Adapt evaluation by providing distraction-free environments for exams, providing extended time allocations during testing periods, and ensuring that students have the skills to take tests efficiently (Scruggs & Marsing, 1988; Shriner & Wehby, 2004).
Academic Status of Students with Emotional/Behavioral Disabilities
Reid, Gonzalez, Nordness, Trout, and Epstein (2004) synthesized the results of 25 studies examining the academic status of students with emotional/behavioral disabilities (EBD) from 1961 to 2000. The final sample of students across all studies included 2,486 students with EBD with an average age of 11.22 years and an average IQ of 94.89. From the studies reporting demographic data, 80% of the sample were boys, 69% Caucasian, 27% African American, 3% Hispanic, and 1% mixed racial and ethnic backgrounds. These studies yielded 101 effect sizes with a mean effect size of .69 (SD .40). This means that on average, students with EBD were performing significantly lower than their same-aged peers without disabilities on all reported academic measures.
Findings were examined across a number of possible mediating variables including academic subject area, setting, age, and method of identification. These variables were examined to determine whether one or more might account for the lower performance of students with EBD. Students with EBD performed significantly lower than their peers across reading, math, spelling, and written expression, with the relatively lowest areas in math and spelling. These academic performance differences are similar to those that have been reported previously in research syntheses for students with learning disabilities.
When students with EBD were classified into younger (less than 12 years) and older (greater than 12) groups, it was found that both age groups performed significantly lower than normally-achieving peers. Students in residential and self-contained settings performed significantly lower on academic areas than students in other settings. This is not surprising, since those settings are more restrictive in nature and students placed there would most likely have more serious difficulties. It was also reported that the method of identification of emotional disturbance did not appear to account for the lower performance of students with EBD.
The authors concluded that students with emotional/behavioral disabilities, as a group, exhibit significant and general academic deficits. However, additional research is needed to further our understanding of the academic performance differences of students with EBD. In addition, it was recommended that future researchers more carefully define their samples of students with EBD, to help provide a better understanding of this population.
In the Classroom: General Accommodations for Students with Emotional Disabilities
- Establish open, accepting environment.
- Clearly state class rules and consequences.
- Emphasize positive behaviors and program for success.
- Reinforce positive behavior.
- Supply extra opportunities for success.
- Be tolerant.
- Use good judgment.
- Teach social skills.
- Teach self-control, self-monitoring, and conflict resolution.
- Teach academic survival skills.
- Teach positive attributions.
- Carefully select partners.
- Have alternative activities available.
- Design activity checklists.
- Use carefully selected peers as assistants.
- Have groups of “one.”
- Use behavioral contracts.
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