Differentiating Between Emotional Disturbance and Social Maladjustments in Students with Challenging...

Differentiating Between Emotional Disturbance and Social Maladjustments in Students with Challenging

Behaviors

Objective: To gain an overview of the problems posed by

differentiating between SED and SM

Federal Definition of Emotional Disturbance

The term means a condition exhibiting one ormore of the following characteristics over a longperiod of time and to a marked degree thatadversely affects a child’s educationalperformance;

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

Federal Definition of Emotional Disturbance

[2] An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

[3] Inappropriate types of behaviors or feelings under normal circumstances.

[4] A general pervasive mood of unhappiness or depression.

[5] A tendency to develop physical symptoms or fears associated with personal or school problems.

Serious Emotional Disturbance Defined

Perception of Self:Self-critical and naive; self-devaluing.

Perception of Reality:Fantasy; disorders of thinking or reasoning.

Peer Relations/Social Situations:May be fearful; may be anxious; withdrawn; may consist of seeking negative attention or seeking approval.

Serious Emotional Disturbance Defined

Adaptive Behavior:Consistently poor across settings; behavior appears to be non-purposive (function of the behaviors is seen as an attempt of expression of internal discomfort); self-destructive behavior.

Affective Responses:May be pervasive negative mood; impulsive or aggressive outbursts toward self or others an end in itself; somatic complaints

Other researchers (Clarizio, 1987; Kelly, 1986) found that conscience development and domain of psychological activity were characteristics that school psychologists believed differentiated students with SED and SM.

Socially Maladjusted Defined

Socially maladjustment has not been defined in theFederal regulations, and has infrequently beendefined in the literature. In order to make this socialmaladjustment distinction, professionals havefrequently consulted the criteria for conduct disorderand oppositional defiant disorder in the DSM.

Socially Maladjusted Defined

Perception of Self:Pleasure seeking; has a right behavior; little

remorse; self-reliant. Perception of Reality:Streetwise; knowledge of appropriate social behavior and norms but chooses to disregard.

Peer Relations/Social Situations:Disrespect and intimidation of “outsiders,” may be more socialized with the “in group.

Socially maladjusted students are those whose social, not emotional, behaviors inhibit meaningful, normative growth and development. Specifically, they consistently disregard or defy authority, refuse to meet minimum standards of conduct required in regular schools and classrooms, have problems relating to society’s normative expectations…They are chronic social offenders (Raiser & Van Nagel, 1980 cited by Zabel, 1986 ).

Socially Maladjusted Defined

Adaptive Behavior:Situation specific (varies from situation to situation); purposive behavior to gain tangible rewards or responses are a means to an end.

Affective Responses:May be hostile or noncompliant or cool and relaxed; aggressive responses are a means to an end; little remorse for their misbehavior.

The Problem

The task of distinguishing between children withEmotional Disturbance (ED and SED) and childrenwith Social Maladjustment (SM) continues to presenta huge problem for educators because the definitionof social maladjustment has not been agreed upon(Clarizio, 1992; Skiba & Grizzle, 1992;Forness,Kavale& Lopez, 1993).

The Problem

This statement still holds true as evidencedin the reauthorization of IDEA in 1997. Thelegislation remained silent on a definition ofsocial maladjustment yet dictated thatstudents with only social maladjustment notqualify for special education.

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In making a differential diagnosis for social maladjustment, clinical criteria may be taken into consideration. Disorders typically viewed as internalizing, e.g. affective disorders, elective mutism, separation anxiety disorder, may qualify as Emotional Impairment (EI), whereas, disorders viewed as externalizing, e.g. conduct disorders, oppositional disorder or antisocial personality disorder, may indicate Social Maladjustment (SM). It is extremely important, however, when making a differential diagnosis to remember that the external behavior may look the same but the underlying reason, etiology and intent of the behavior may be very different. Therefore, a comprehensive evaluation by the MDT team is in order.

Educational options for Emotionally Impaired and Socially Maladjusted students often parallel. Both groups require small class size that is focused on individualized programming with a modified curriculum to meet the needs of students. Programming should consider such options as: work study, adjusted school hours, vocational programming, shortened academic periods and alternative school placement. A major difference can be seen in the effectiveness of the interventions used. Strategies used to discipline emotionally impaired students often fail when attempted with socially maladjusted students.

The primary argument used to support the exclusion of socially maladjusted students from placement in emotionally impaired programs is that students with social maladjustment are not truly disabled. These children are believed to engage in deliberate acts of self-interest to gain attention or to intimidate others, while experiencing no distress or self-devaluation about their own internalized distress about their behavior (Clarizio, 1992; Kelly, 1993; Slenkovitch, 1986).

Arguments For Differentiation Between Socially Maladjusted

and Emotionally Disturbed:Special Education classification for social rule breaking excuses responsibility for behavior

and is not reflective of society’s rules beyond the educational environment.

Differentiation may force the administrators to look at more comprehensive approaches to intervening with challenging behavior outside of the special education arena.

While certain behaviors present the same, the function of these behaviors are quite different.

The recurring theme in distinguishing between SM and ED is choice and purposive behavior.

Arguments For Differentiation Between Socially Maladjusted and

Emotionally Disturbed

Kelly (1988) emphasized the importance of focusing on overt behaviors and discouraged the search for “inferred pathological motives.

Arguments For Differentiation Between Socially Maladjusted

and Emotionally Disturbed Failure to discriminate between SED and SM will lead to the misappropriation

of valuable limited resources to students who are not handicapped (CCBD, 1990).

“While recognized by the Diagnostic and Statistical Manual of Mental Disorders, 4thed. (DSM-IV) as a disruptive behavioral disorders, such Conduct Disorders do not, as a matter of fact of law, meet the federal definition guidelines under the Individuals with Disabilities Education Act as a disabling condition”

(Murray & Myers, 1998).

Arguments for Differentiated Educational Programs

Increases victimization of emotionally disturbed students by conduct problem students. Combined programs are not therapeutic settings (Kelly, 1986; Zabel, 1986).

Social, ethical, and legal implications of the conduct disordered student are

often excused through the “handicapped” designation.

Arguments for Differentiated Educational Programs

Combined programs often result in permanent “short term” placements housing delinquent students in classroom settings yielding little educational benefit. (Kelly, 1990).

Minimize the importance of internalized problematic perceptions and insights (Heshusius, 1986).

Combined programs result in high teacher burnout and attrition rates (Kelly,1990).

Arguments Against Differentiation Between SM/ED

Despite which taxonomy or definition you use, inherent in them is the idea that SM or conduct-disordered students are facing educational and developmental challenges and therefore it is unethical to exclude them from services.

There is a lack of operational definitions with which to base decisions (Zabel, 1986).

Exclusion of socially maladjusted students allows schools to justify the exclusion of students whom the district simply does not want to serve (Maag& Howell, 1991).

Characteristics typically associated with SM and ED often occur together (Kovacs, Paulauskas, Gatsonis, & Richards, 1988).

Over lap of definitions

» : An inability to build or maintain satisfactory

relationships, and inappropriate behaviors of feelings under normal circumstances are two of the criteria that qualify a child as seriously emotionally disturbed. Yet the types of behaviors meeting those two criteria may also qualify a student for a DSM diagnosis of conduct disorder. When the diagnosis is then equated with social maladjustment, students who otherwise would be (and have always been) eligible for SED service are suddenly excluded.

Defining Legal Cases

A. E. By and Through Evans v. Independent School District No. 25 (1991): A conduct disordered child was ruled ineligible for SED services under the social maladjustment exclusion. The court denied SED service to a child diagnosed as borderline personality disorder, who had difficulty relating to her peers, problems with impulsivity and anxiety, and who was clearly at-risk for suicide, simply because that child was also eligible for a diagnosis of conduct disorder.

Defining Legal Cases

Doe v. Sequoia Union High School District (1987): the court ruled that substance abuse, truancy, and boredom with school do not in and of themselves constitute sufficient cause for eligibility for SED services. There was no diagnosis of conduct disorder made.

Social Maladjustment and Section 504

Letter of Finding on Irvine (CA) Unified School District (1989), the OCR concluded that the “District also erred when it neglected to consider whether ‘social maladjustment’ might be a handicapping condition under Section 504” (p. 193).

Typical Test Battery

IQ Achievement Observation Teacher and parent reports Record review (including discipline) Misc. others –visual motor, receptive

vocabulary, etc.

Typical Test Battery

Differential Test of Conduct and Emotional Problems Beck Depression Inventory Achenbach Behavior Checklist Reynolds Depression Inventory Functional Behavior Assessment (interviews,

observations, etc.) Devereux Behavior Rating Scale Kovac’s Children’s Depression Inventory Revised Children’s Manifest Anxiety ScaleBehavior Assessment System for ChildrenSocial Skills Rating SystemAdolescent Pychopathology Scale

Summary Historically, students whose primary difficulty in school consisted of

problematic behavior were not differentially identified based on the nature of the problem.

Differential diagnosis of SM and SED is made difficult by the absence of a widely accepted working definition of social maladjustment which has relevance in schools (Zabel, 1986).

Combined special education programs for SM and SED students have not proven to be the most effective or appropriate means of serving either group (Kelly, 1990, and Murray & Myers, 1998).

Summary

Legal decisions have made it clear the academic and achievement as well as behavioral, emotional, and cognitive factors must be assessed when diagnosing SED and SM.

While school psychologists continue to wrestle with this problem, the courts are increasingly stepping in to settle the issue. A.E. By and Through Evans v. Independent School District (1991), Chris D. v. Montgomery County Board (1990), and Doe v. Board of Education of the State of Connecticut (1990).

Summary

In a nutshell, the argument is one of

Legalism versus Professionalism