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Emotional DisturbanceDISABILITY CATEGORY: Emotional Disturbance TYPES: Adjustment Disorder, Anxiety Disorders, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, Conduct Disorder, Schizophrenia, Seriously Emotionally Disturbed. DEFINITION: Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines emotional disturbance as... “…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-
[Code of Federal Regulations, Title 34, §300.7(c)(4)(i)] As defined by IDEA at §300.7(c)(4)(ii), emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. Other Definition(s): Children’s behaviors exist on a continuum, and there is no specific line that separates troubling behavior from a serious emotional problem. Rather, a problem can range from mild to serious. A child is said to have a specific “diagnosis” or “disorder” when his or her behaviors occur frequently and are severe. A diagnosis represents a “best guess” based on a child’s behaviors that he or she has a specific mental health disorder and not just a problem that all children might have from time to time. Research on the cause of emotional disorders has shown that the way the brain receives and processes information is different for children with some types of disorders than for those who do not have those problems. However, this is not true for all children with emotional disorders (Source: PACER Center). FACTS AND STATS: In the 2000-2001 school year, 473,663 children and youth with an emotional disturbance were provided special education and related services in the public schools (Twenty-fourth Annual Report to Congress, U.S. Department of Education, 2002). “At least 1 in 10, or as many as 6 million, young people may have a serious emotional disturbance that severely disrupts his or her ability to interact effectively at home, at school, and in the community.” (Source: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996) Percentage of Students with Disabilities Identified as Having Emotional Disturbance (1995-96) (Source: U.S. Department of Education, Office of Special Education Programs, Data Analysis System (DANS). Age (years) Percentage 6-7 3.5% 8-9 5.6% 10-11 7.3% 12-13 10.2% 14-15 13.1% 16-17 13.0% CAUSES: “The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behavior or emotional problems.” (Source: NICHCY) “…it is becoming clear through research that many of these conditions are caused by a combination of biological, psychological and environmental factors.” (Source: National Association of Special Education Teachers) PREVENTION: While prevention of emotional disturbance cannot be pinpointed because of a lack of understanding of the cause, there are early intervention procedures that can help a child with emotional disturbance in their daily life. Parent Questions: • The Duration of a Troublesome Behavior - Does it just go on and on with no signs that the child is going to outgrow it and progress to a new stage? • The Intensity of a Behavior - For instance, while temper tantrums are normal in almost all children, some tantrums could be so extreme that they are frightening to parents and suggest that some specific intervention might be necessary. Parents should pay particular attention to behaviors such as feelings of despair or hopelessness; lack of interest in family, friends, school or other activities once considered enjoyable; or behaviors which are dangerous to the child or to others. • The Age of the Child - While some behavior might be quite normal for a child of two, observation of other children of the youngster's age may lead to the conclusion that the behavior in question is not quite right for a five year old. Not all children reach the same emotional milestones at the same age, but extreme deviations from age-appropriate behaviors may well be cause for concern. Attempts at self-injury or threats of suicide, violent behaviors, or severe withdrawal that creates an inability to carry on normal routines must be regarded as emergencies for which parents should seek immediate attention, through a mental health or medical clinic, mental health hotline, or crisis center. Parents will also want to consider whether their child's behavior could be influenced by other factors:
CHARACTERISTICS: Some of the characteristics and behaviors seen in children who have emotional disturbances include:
Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings. Many children who do not have emotional disturbances may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. (Source: NICHCY) MEDICAL TREATMENT: Families of children with emotional disturbances may need help in understanding their children's condition and in learning how to work effectively with them. Help is available from psychiatrists, psychologists or other mental health professionals in public or private mental health settings. Children should be provided services based on their individual needs, and all persons who are involved with these children should be aware of the care they are receiving. It is important to coordinate all services between home, school, and therapeutic community with open communication. There is growing recognition that families, as well as their children, need support, respite care, intensive case management services, and multi-agency treatment plan (Source: NICHCY). PROGNOSIS: Early identification and intervention can significantly reduce the effects of abnormal psychosocial development. Careful observation of infants and toddlers as they interact with caregivers, their family or their environment is one of the most useful tools that families or physicians have, since many mental health problems cannot be diagnosed in any other way (Source: Parent Advocacy Coalition for Educational Rights). Proactive interventions focus on helping children change undesirable patterns of behavior and expand on their growing repertoire of skills. This is accomplished by organizing settings to decrease the likelihood of challenging behavior and encourage children to use new socially appropriate skills (Source: Center for Early Education and Development) EDUCATIONAL IMPLICATIONS: Seriously Emotionally Disturbed, or SED, is not a DSM-IV medical diagnosis, but a label that public schools may use when children, due to their behaviors, are in need of special education services. School professionals may or may not use diagnostic classification systems as part of this determination. The school’s responsibility is to provide services for students with emotional or behavioral disorders or mental illnesses under the special education category of SED (many states have chosen to use a “different” label such as Emotional or Behavioral Disorder (EBD), to describe this special education service category), when their emotional or behavioral problems are so severe that they cannot succeed without help (Source: PACER Center). The educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (Source: NICHCY) Behavior management techniques, such as positive reinforcement, token economics, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. (Source: ERIC Clearinghouse on Handicapped and Gifted Children, Reston, VA)
ORGANIZATIONS: American Academy of Child and Adolescent Psychiatry This site is designed to serve both AACAP Members, and Parents and Families. Information is provided as a public service to aid in the understanding and treatment of the developmental, behavioral, and mental disorders which affect an estimated 7 to 12 million children and adolescents at any given time in the United States. You will find information on child and adolescent psychiatry, fact sheets for parents and caregivers, AACAP membership, current research, practice guidelines, managed care information, awards and fellowship descriptions, meeting information, and much more. Center on Positive Behavioral Interventions and Supports The Center has been established by the Office of Special Education Programs, US Department of Education to give schools capacity-building information and technical assistance for identifying, adapting, and sustaining effective school-wide disciplinary practices. Federation of Families for Children's Mental Health The National family-run organization dedicated exclusively to helping children with mental health needs and their families achieve a better quality of life. We: Provide leadership to develop and sustain a nationwide network of family-run organizations, focus the passion and cultural diversity of our membership to be a potent force for changing how systems respond to children with mental health needs and their families, and help policy-makers, agencies, and providers become more effective in delivering services and supports that foster healthy emotional development for all children. National Alliance for the Mentally Ill (NAMI) NAMI (the National Alliance on Mental Illness) is the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families. Founded in 1979, NAMI has become the nation’s voice on mental illness, a national organization including NAMI organizations in every state and in over 1100 local communities across the country who join together to meet the NAMI mission through advocacy, research, support, and education. National Mental Health Information Center The National Mental Health Association is the country's oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. With more than 340 affiliates nationwide, NMHA works to improve the mental health of all Americans, especially the 54 million people with mental disorders, through advocacy, education, research and service.
RESOURCES Web sites: http://www.mental-health-matters.com Get Mental Help, Inc., the new owner of Mental Health Matters, was founded to supply information and resources to mental health consumers, professionals, students and supporters. http://cecp.air.org/resources/20th/intro.asp The Center is engaging in a series of strategic activities designed to help SED community members to develop a greater capacity to produce, access, and use information, and to collaborate. These activities are organized around four objectives to: (1) facilitate and to expand effective interagency collaboration; (2) identify and develop useful and useable information; (3) foster the exchange of such information; (4) evaluate the Center's activities. http://www.pacer.org/ebd/index.htm The Project for Parents of Children with Emotional or Behavioral Disorders, in its 19th year at PACER, was originally organized to assist parents and families in understanding their rights and responsibilities in accessing educational and mental health services for their children. The National Association of School Psychologists released the second edition of Behavioral Interventions: Creating a Safe Environment in Schools and has posted it on the web for download. The publication, created by NASP's National Mental Health and Education Center, offers tips and insight into how to handle the Individuals with Disabilities Education Act's new discipline provisions. Publications: Journal of Emotional and Behavioral Disorders The Journal of Emotional and Behavioral Disorders presents high-quality interdisciplinary scholarship in the area of emotional and behavioral disabilities. JEBD explores such critical and diverse issues as youth violence, emotional problems among minority children, long-term foster care placement, mental health services, social development, educational strategies Video - Parent Perspectives: Raising Children with Emotional Disorders Produced by PACER - Parents discuss the unique challenges of raising children who have severe emotional or behavioral problems. Provides insight into the frustrations of parents who are often perceived as the "cause" of their child's inappropriate behavior by others who may not understand the origin or nature of emotional or behavioral disorders. 21 minutes. 1991. Honorable Intentions: A Parent's Guide to Educational Planning for Children with Emotional or Behavioral Disorders A comprehensive guide for parents, advocates and others. Addresses assessment, IEPs, school discipline, mental health services, communication, resolving differences, and more. 172 pages. 2000. _________________________________
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