POEC - Emotional and Behavioral Disorders

Definitions of Emotional and Behavioral Disorders

Emotional and behavioral disorders is an umbrella term that includes psychological disorders impacting students’ behavior, emotions, and moods. The terminology used to describe this disability category is subject to debate. The term emotional disturbance is used in the Individuals with Disabilities Education Act (IDEA). Illinois uses the term emotional disability, and other states use various terms. However, many professionals advocate using the term emotional or behavioral disorders (Smiley et al., 2022).

The IDEA Definition

The IDEA of 2004 defines emotional disturbances thus:

1. Emotional disturbance means 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:

a. An inability to learn that cannot be explained by intellectual, sensory, or health factors.

b. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. c. Inappropriate types of behavior or feelings under normal circumstances.

d. A general pervasive mood of unhappiness or depression.

e. A tendency to develop physical symptoms or fears associated with personal or school problems.

Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted unless it is determined that they have an emotional disturbance (IDEA, Part B, Subpart A § 300.8(c)(4)(2004))

The IDEA definition is often referred to as vague (Theodore et al., 2004) and lacking any mention of specific negative behaviors (e.g., aggression) (Smiley et al., 2022).

The Council for Children with Behavioral Disorders Definition

The Council for Children with Behavioral Disorders (CCBD) is a Special Interest Division of the Council for Exceptional Children (CEC). The CCBD is an advocacy group for children with emotional and behavioral disorders and uses the following characteristics to define students with emotional disturbance:

Hyperactivity (short attention span, impulsiveness)

Aggression or self-injurious behavior (acting out, fighting)

Withdrawal (not interacting socially with others, excessive fear or anxiety)

Immaturity (inappropriate crying, temper tantrums, poor coping skills)

Learning difficulties (academically performing below grade level) (CCBD, 2022)

The CCBD also points to general categories of psychological disorders, including schizophrenia spectrum disorder, bipolar disorder, depressive disorders, anxiety disorders, obsessive–compulsive disorders, eating disorders, and disruptive, impulse-control, and conduct disorders as causes of this disability category.

The APA Definition

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association defines each of the psychological disorders associated with the term emotional and behavioral disorders. This includes schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive–compulsive disorders, feeding and eating disorders, and disruptive, impulse-control, and conduct disorders. There are too many specific psychological disorders to define and describe their diagnostic criteria for the purposes of this chapter. However, general definitions are included below.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality disorder). They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia (i.e., inability to move normally), and negative symptoms (e.g., diminished emotional expression and decreased motivation)

Bipolar and Related Disorders

Bipolar and related disorders include bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorders, bipolar and related disorder due to another medical condition, other specific bipolar and related disorder, and unspecified bipolar and related disorder. Depending on the specific disorder, students may experience episodes of mania or hypomania (i.e., periods of overactive and excited behavior), major depressive episodes, and instability of moods (DSM- 5-TR, 2022, p. 139).

Depressive Disorders

Depressive disorders include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. The common feature of all these disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function (e.g., somatic and cognitive changes in major depressive disorder and persistent depressive disorder). What differs among them are issues of duration, timing, or presumed etiology (i.e., cause) (DSM-5- TR, 2022, p. 177).

Anxiety Disorders

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior. Anxiety disorders differ from developmentally normative fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. In addition, many anxiety disorders develop in childhood and tend to persist if not treated (DSM-5-TR, 2022, p. 215).

Obsessive–Compulsive Disorders

Obsessive–compulsive disorders include obsessive–compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, substance/medication-induced obsessive–compulsive and related disorder, obsessive–compulsive and related disorder due to another medical condition, other specified obsessive– compulsive and related disorder (e.g., nail biting, lip biting, check chewing, obsessional jealousy, olfactory reference disorder), and unspecified obsessive and related disorder.

OCD is characterized by the presence of obsession, compulsion, or both. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Some other obsessive–compulsive and related disorders are characterized primarily by recurrent body-focused repetitive behaviors (e.g., hair pulling) and repeated attempts to decrease or stop the behaviors (DSM-5-TR, 2022, p. 263).

Feeding and Eating Disorders

Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning. Disorders include pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder (DSM-5-TR, 2022, p. 371).

Disruptive, Impulse-Control, and Conduct Disorders

Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors. While other psychological disorders may also involve problems in emotional or behavioral regulation, these disorders are unique in that they are manifested in behaviors that violate the rights of others (e.g., aggression, destruction of property) or that bring the individual into significant conflict with societal norms or authority figures. Disorders include oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, kleptomania, and other specific and unspecified disruptive, impulse-control, and conduct disorders (DSM-5-TR, 2022, p. 521).

This is the primary classification system used for students with emotional or behavioral disorders. Although clinicians such as clinical psychologists, school psychologists, psychiatrists, and social workers have training in this medical classification system, students are often referred to clinical psychologists or psychiatrists to receive an official medical diagnosis. Educators are not trained to diagnose or treat psychological disorders.

The Illinois Definition of Emotional Disability

“Emotional Disability (includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance) means 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:

An inability to learn that 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; or

A tendency to develop physical symptoms or fears associated with personal or school problems

Prevalence of Emotional and Behavioral Disorders

Among students receiving special education services, 5% are identified as having an intellectual disability (National Center for Education Statistics, 2022). In addition, national data on children’s mental health indicate that the number of children who experience anxiety and depressive disorders has increased over time (Bitsko et al., 2013) and that these disorders often co-occur with disruptive, impulse-control, and conduct disorders (Ghandour et al., 2018). The number of children identified for special education and related services in this disability category is considered significantly lower than the actual number of children estimated to need these services. Experts believe that the negative stigma associated with the term emotional disturbance may be one reason for fewer referrals, especially for younger children. In addition, not all students diagnosed with these psychological disorders perform poorly or are disruptive to the educational environment (Smiley et al., 2022).

Gender and race may also influence referrals for special education and related services. Research suggests that males are more likely to have externalizing disorders, which are characterized by poor impulse control that may contribute to rule-breaking, aggression, impulsivity, and inattention. Females are more likely to have internalizing disorders, which are characterized by anxiety, depressive, and somatic symptoms (e.g., physical pain) (Romano et al., 2001; Sachs-Ericsson & Ciarlo, 2000). Externalizing disorders may be more noticeable in a classroom setting, resulting in more referrals for these students. In addition, Black students are twice as likely to be identified as having an emotional or behavioral disorder than all other racial groups combined

Causes of Emotional and Behavioral Disorders

Research indicates that both environmental and genetic factors play a role in the development of emotional and behavioral disorders. Environmental factors include adverse childhood experiences. Adverse childhood experiences are potentially traumatic events that occur in childhood, including abuse, neglect, and household dysfunction (e.g., violence in the home). These traumatic childhood experiences have been linked to the development of anxiety and depression (Elmore & Crouch, 2020). In addition, negative school experiences such as bullying and the systematic oppression of specific racial or ethnic groups may also lead to the development of emotional or behavioral disorders (CDC, 2015).

Certain emotional and behavioral disorders are linked to genetics. For example, children of a parent with a depressive, bipolar, or schizoaffective disorder are at a higher risk for developing anxiety, depressive, or schizoaffective disorders than the general public (DSM-5-TR, 2022). However, these genetic and environmental factors only increase a student’s risk of developing an emotional or behavioral disorder. Experiencing one or more of these factors does not mean a student will develop an emotional or behavioral disorder. In addition, environmental and genetic factors are often interrelated, making it difficult for clinicians to identify a single cause (

Characteristics of Students with Emotional and Behavioral Disorders

Students with emotional and behavioral disorders exhibit a wide range of characteristics. This has important implications for educators and clinicians, who must be aware of characteristics that typically go unnoticed, such as social withdrawal. Most of these characteristics fall into the following categories.

Externalizing Characteristics

Externalizing characteristics of emotional and behavioral disorders are those that can be observed and that directly affect others. For example, individuals may exhibit irritable mood, aggression, defiance, destruction of property, deceitfulness, and vindictiveness.

Internalizing Characteristics

Internalizing characteristics of emotional and behavioral disorders are often not directly observable or do not directly affect others. For example, anxiety and social withdrawal are not always visible to external observers. In addition, students with obsessive– compulsive disorders may experience recurrent unwanted thoughts and repetitive behaviors (e.g., hair pulling).

Intellectual Characteristics

The IDEA definition of emotional disturbance includes “an inability to learn that cannot be explained by intellectual, sensory, or health factors.” This statement implies that students with emotional and behavioral disorders should demonstrate average levels of intelligence. However, research indicates that these students typically score in the low-to-average range of intelligence. In addition, students with severe disorders tend to have lower levels of intelligence (Kauffman and Landru, 2018; Smiley et al., 2022).

Identifying Students with Emotional and Behavioral Disorders

In school, the response to intervention (RTI) system is used to identify students for special education and related services. Students are provided with interventions to support their educational success before the student’s eligibility for special education services has been determined. Educators and clinicians use multiple measures to determine whether a student has an emotional or behavioral disorder. Data collection may include observations, behavior rating scales, and behavior assessment systems (Smiley et al., 2022). Outside of school, clinical psychologists and psychiatrists will use the diagnostic criteria included in the DSM to determine whether a student has an emotional or behavioral disorder.

Observation

Observation may be used to document the type, frequency, and duration of problem behaviors. Observational data provides valuable information that helps educators and clinicians make eligibility decisions. Observations are also used when conducting a functional behavior assessment (FBA). An FBA is used to determine the function of a behavior. FBAs help teachers and clinicians understand the reasons (i.e., the functions) for a student’s behavior. The teacher or clinician documents what happened immediately before the behavior (i.e., antecedents) and what happened immediately after the behavior (i.e., consequences) to develop a hypothesis about the function of the behavior. Teachers and clinicians can then use this information to design an appropriate intervention for the student. This information also contributes to the evidence required to make an eligibility decision as part of the RTI process (Smiley et al., 2022).

Behavior Rating Scales

Behavior rating scales are used to document the nature and severity of certain observable behaviors. Behavior rating scales include a list of behaviors such as “has temper tantrums” and “argues a lot” that are grouped together to measure different emotional and behavior problems, such as aggressive behavior. Each item is rated using a scale. For example, the behavior never, occasionally, or frequently occurs. The Devereux Behavior Rating Scale (DBRS-SF) is an example of a behavior rating scale. The DBRS-SF has two forms, one for ages 5 to 12 and one for ages 13 to 18. It may be used by educators, school psychologists, guidance counselors, or other clinicians and includes 40 items grouped according to four factors: interpersonal problems, inappropriate behaviors/feelings, depression, and physical symptoms/fears. These are the same areas included in the IDEA definition (Smiley et al., 2022).

Behavior Assessment Systems

Behavior rating scales may also be used as part of a behavior assessment system. For example, behavior assessment systems might include an educator rating scale, a parent/guardian rating scale, a peer rating scale, a self-report scale, an observational component, and an interview component. The advantage of behavior assessment systems is that they provide ratings of the student from multiple people who are familiar with the student’s behavior in different settings. Frequently used behavior assessment systems include the Achenbach System of Empirically Based Assessment (ASEBA) and the Behavior Assessment System for Children– Third Edition (BASC-3). The ASEBA measures areas such as anxiety and depression, thought problems, and aggression. The BASC-3 includes areas such as depression, interpersonal relations, and attention problems (Smiley et al., 2022).

In addition to the RTI system, the school may engage additional services from mental health professionals (e.g., psychiatrists) in their community to provide additional evidence that may be used to determine a student’s eligibility for special education and related services. School social workers may also connect students and their families to additional community resources to support the health of the family as a whole (e.g., family counseling).