child disturbance
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What is BENTON VISUAL RETENTION TEST (BVRT)?n. a psychological test specifically designed to measure short-term visual memory and visual
perception. Ideally, this draw-and-recall task should be individually administered to children no
younger than age 8. Briefly, aparticipant is shown cards with 2-3 geometric designs each after
which he or she draws them from memory. Developed by U.S. psychologist Arthur LesterBenton in 1946.
BENTON VISUAL RETENTION TEST (BVRT): "The Benton Visual Retention Test (BVRT) is a
draw-and-recall task which challenges the sharpness of your short-term visual memory."
Psychology DictionaryWorld's MostComprehensive Online Psychology Dictionary
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Psychology Articles
Emotional Disturbance and How To Identify It
Eli Bower, a pioneer in
the field of early childhoodeducationof emotionally handicapped children, wrote, I often
thoughtabout [these]studentsthey did not know how to have fun, could not separate
play fromreality, could not attend to concepts outside of self, and were driven by
impulses unchecked byrealitycontrols (Bower, 1990). Like Eli Bower, professionals in
the field ofeducationand childpsychologyhave been intrigued by thispopulationsince
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before the early 20thcentury. By the late 1950s multiple communities were studying
emotionally disturbed children (Bower, 1990). By the 1970s, researchers had
conducted enough work on emotionally disturbed children to establish thespecial
educationcategory ofSeriously Emotionally Disturbedfor P.L. 94-142 (Merrell, 2007).
Today, the needs and numbers of emotionally disturbed youth are growing. In 2004,
there were about 450,000 emotionally disturbedstudentsin the national student
population(Wagner et al., 2005). Further, the U.S. Department of Education (2002)
found that these students had the highest drop out rate of anydisabilitygroup with as
much as 51 percent leaving before earning a high school diploma. Children with
emotional disturbance are said toexperienceless school success than any other
subgroup of students, with or without disabilities (Landrum, Tankersley, & Kaufman,
2003). Although much work is needed to help support these students, professionals
today cannot even agree on adefinitionof emotional disturbance. Stemming from this
rudimentary issue areancillarydebates about how to assess for emotional disturbance
and how to resolve differential diagnoses. In this paper, current definitions of emotional
disturbance will be reviewed, inherent diagnostic difficulties in the eligibility criteria will
be outlined, and bestpracticeinassessment, given these issues, will be summarized.
Currently, there are two main perspectives conceptualizing emotional disturbance,
though both acknowledge that maladaptive and distressing behaviors, emotions, and
thoughts (Cullinan, 2004) are main components. The first, the dimensional classification
system, holds the viewpoint that emotional and behavioral disorders are extreme forms
ofbehavior, emotions or cognitions that exist in all people. Those less able to regulate
themselves are more likely to have emotional disturbance. With the dimensional
perspective, situational aspects and contexts are emphasized more than in thedisease
perspective(Cullinan, 2004). The IDEIAdefinitionof emotional disturbance is a resultof the dimensional classificationperspective. The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR) is the product of those
who follow the secondperspective, known as thediseaseclassification perspective.
These people believe emotionally disturbed children have a collection of maladaptive
and distressing behaviors, emotions, or thoughts that are different from normal children.
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This perspective views thedysfunctionas within the person. Manymental health
agencies, government organizations, insurance companies, medical providers, and
other agents consider theDSM-IV-TRthe official classification system (Cullinan, 2004).
Often, services and reimbursements are contingent on the child receiving a DSM
diagnosis. For these reasons, and many more, professional in the education field
should have someknowledgeof the DSM-IV-TRcriteria.
With both classification systems loosely described, it is safe to move on to thesubjectof
definitions. While classification systems beg questions about which kind of emotional or
behavioral disorders exist, definitions only aim to determine if emotional or behavioral
disorders exist. If the definition of emotional disturbance indicates that characteristics
are present, then it can play a role in deploying financial, personnel, and other
resources to children in need of them. The federal government has employed a
regulation, most recently known as the Individual with Disabilities Education
Improvement Act (2004), to guide educators in determining whether emotional
disturbance is present. Children with emotional and behavioral disorders most likely
qualify under the category of emotional disturbance if they demonstrate the following:
Section300.8 (c)(4)(i) 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 educationalperformance:
(A) An inability to learn that cannot be explained by intellectual,sensory, or health
factors.
(B) An inability to build or maintain satisfactoryinterpersonalrelationships with peers
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and teachers.
(C) Inappropriate types ofbehavioror feelings under normal circumstances.
(D) A general pervasive mood of unhappiness ordepression.
(E) A tendency to develop physical symptoms or fears associated with personal or
school problems.
(ii) Emotional disturbance includesschizophrenia. The term does not apply to children
who are socially maladjusted, unless it is determined that they have an emotional
disturbance under paragraph (c)(4)(i) of thissection.
As it stands, the definition of emotional disturbance does not translate into any specific
diagnosis in the DSM-IV-TR. It works as a legal term that initiates a multitude of
mandated services to meet the needs of emotionally disturbed children (U.S.
Department of Health and Human Services ,1999). However, a DSM-IV-TRdiagnosis
of an emotional or behavioraldisordercan help determine whether a child qualifies to
receivespecial educationservices for emotional disturbance because it provides a
taxonomyof mental disorders and symptoms that can be used to describe conditions
that persist over a long period of time and adversely affect educationalperformance
(House, 1999). Further, its reputation and wide use by other organizations and fields
can help school psychologists communicate withmental healthprofessionals and other
non-school service providers in common terms, and help access financial resources for
the child and family.
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Diagnostic Difficulties Inherent in Eligibility Criteria
The federal definition has been thoroughly criticized throughout the years (Kauffman,
2001). The definitions vagueness andsubjectivity, as well as peoples personalphilosophies toward the label of emotional disturbance, have made this category very
unpopular (Wagner et al., 2005). The first attack on the definition typically focuses on
the definitions vague and unclear terms. They are not operational orobjective, and
therefore are difficult concepts to measure. Many important features are perplexing,
withphraseslike long period of time, marked degree, adversely affects educational
performance, and socially maladjusted. Additionally, criteria A, which states the child
must exhibit, an inability to learn and/or inappropriate types of feelings or behaviors
under normal circumstances have been found to be vague (Cullinan, 2004). Critics
also do not like the seeming circular logic and/or illogic behind many of the definitions
features. For instance, an example of a contradictory statement appears when one
compares criteria B saying children must show, interpersonalrelationshipproblems,
yet cannot be socially maladjusted. Children who are socially maladjusted often have
problems relating to other people, which make this statement confusing.
Redundantphrasesabout the behaviors or emotions being adverselyaffectivehas also
received disapproval, especially since this phrase is unclear and diffuse and hard to
measure objectively (Cullinan, 2004). Lastly, theconfusionaboutsocial maladjustment
disqualifying a child from the emotional disturbance category, unless the child exhibits
bothsocial maladjustmentand emotional disturbance has been enraging to some critics
(Cullinan, 2004). This glaring issues have made critics question the source of many of
these criteria, saying they seem to have been arbitrarily chosen and lack support from
scientificresearch. At the same time, there are said to be otherbehaviorproblems not
found in the emotional disturbance definition for whichresearchsupport exists (Cullinan,2004). There are also holes in the definition, which leave many educators frustrated
with their idiosyncratic situations. For example, the definition makes no mention of what
to do with children who are exhibiting signs of emotional disturbance, but have not had
their education adversely affected. These childrens outbursts and disruptions may be
harming their classmates educations, and would probably subside with targeted
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behavioral interventions, but are left untreated because they do not meet criteria. Yes,
many diagnostic difficulties stem from the federal definitions lack of acumen in the area
of emotional and behavioral disorders, which force educators to makesubjective
decisions, and place some in legally precarious situations.
Critics have been particularlycriticalof the phrase socially maladjusted. The terms
ambiguityis emphasized by the many diverse interpretations that exist (Center, 1990).
Policymakers, lawyers, and other stakeholders have managed to handcraft their own
term in order to do their jobs. Traditionally, it entails apatternof behavioral problems
that arethoughtto be willful, goal oriented, and possibly reinforced as part of ones
immediate socialreference group. It is typically seen asantisocialin nature, and typified
by the type of behaviors exhibited in the DSM-IV-TRdiagnostic categoriesConduct
Disorder. To add to theconfusion, the current federal definition allows students who are
considered to be socially maladjusted to receive special education services it if is
determined that they are also emotionally disturbed. In commenting on this and related
statements in federal definition discussion of socialmaladjustment, Kauffman (1999)
remarked the final addendum regarding socialmaladjustmentis incomprehensible.
For now, professionals conducting school-related assessments of children and
adolescents with behavioral, social, and emotional problems should be aware that there
are no psychometrically valid and defensibleassessmentprocedures that can be used
to make the emotional disturbance versus Social Maladjustment distinction (Merrell,
2007).
Alternative Definitions
Dissatisfied with the federal definition, the Council for Children with Behavioral
Disorders and other professional andadvocacygroups have cooperated to try to
change it. Operating as the National Mental Health and Special Education Coalition,
they proposed and alternative definition and petitioned Congress so far unsuccessfully
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to substitute it for the existing one (Forness & Knitzer, 1992). The Coalition proposed
definition is as follows:
(i) The term emotional or behavioraldisordermeans adisabilitycharacterized by
behavioral or emotional responses in school so different from appropriate age,
culture, or ethnic norms that they adversely affect educational performance.
Educational performance includesacademic, social, vocational, and personal
skills. Such a disability (A) is more than a temporarily, expectedresponseto
stressful events in theenvironment; (B) is consistently exhibited in two different
settings, at least one of which is school-related; and (C) is unresponsive to direct
interventionin general education or the childs condition is such that general
education interventions would be insufficient.
(ii) Emotional and behavioral disorders can coexist with other disabilities
(iii) This category may include children or youth withschizophrenic disorders,
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affectivedisorders,anxietydisorders, or other sustained disorders ofconductor
adjustmentwhen they adversely affect educational performance in accordance
with section (i). (Forness & Knitzer, 1992)
This definition seems many of the same mistakes as its predecessor. For one, the
Coalition proposal contains ambiguous terminology. Second, insufficientattentionwas
given to creatingobjectiveand measureable terms. As with the IDEIA definition,
significant parts of the Coalition proposal should be carefully operationalized and
measured in order to judge itspsychometricmerits (Forness & Knitzer, 1992)
Assessing for Emotional Disturbance
A promising and innovativeapproachto assessment and classification of social-
emotional problems of children and adolescents is multiple gating. By using a
sequential series of systematic and increasingly time-consumingscreeningprocedures,multiple-gating methods allow for narrowing a large population down to asmall groupof
candidates who are likely to exhibit behavioral and emotional problems to the point of
needing further assessment andintervention(Merrell, 2007). In formulating an
assessment plan for an individual child, the schoolpsychologistconsiders four
perspectives on emotional and behavioral disorders. One perspective views child
pathologyas the basis for the disorder, and seeks to identify emotional and behavioral
problems that are symptoms or characteristics ofpsychopathology. A second
perspective focuses on behavioral-environmental interactions as the basis for the
disorder. Instead of identifying symptoms or characteristics ofpsychopathologyin the
child, this perspective emphasizes reciprocal interactions between the childsbehavior
and theenvironment(Ysseldyke, Christenson, & Thurlow, 1987). A third perspective
seeks to identify thefunctionalrelationshipbetween environmental events andproblem
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behavior. It assumes that behavior occurs within acontextofantecedentand
consequentevents and that most behavior is afunctionof the reinforcing aspect
ofconsequentevents. The fourth perspective emphasizes the effectiveness of
interventions for emotional or behavioral disorders, directly linking assessment of
problems to intervention planning. This viewpoint defines emotional or behavioral
disorders by the extent to which the childs behavior proves to be resistant to
interventions (McConaughy & Ritter, 2002)
It is significant to remember that doing an assessment on this population does notnecessitate discovering theetiologyof the problem. Rather, it should focus more on
revealing the obstacles that obstruct the childsoptimal functioning. Due to the nature
of emotional and behavioral difficulties these children have in school, school
psychologists are oftenfamiliarwith these cases long before these children are referred
for a special education assessment. All known relevant history with the child and his
school-related difficulties should be considered in the special education assessment.
Additionally, it is important to collect data about the child from various people and
settings, as childrens behavior and emotions often change from one setting to another,
and with one person versus another (McConaughy & Ritter, 2002).
Standardized Rating Scales
Standardized rating scales provide quantitative information for obtaining parent,
teacher, and self-reports of childrens problems and competencies. Schoolpsychologists are encouraged to select standardized rating scales because their
systematic, easy to share, economical and efficient. Rating scales come in broad-band
forms and narrow-band forms, measuring a wide range ofpotentialproblems or very
specific areas of deficits, respectively. Examples of broad-band measures that are
helpful in Emotional Disturbance assessment include the Achenbach System of
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Empirically Based Assessment (ASEBA, Achenbach & Rescorla, 2001) or the Behavior
Assessment Scale for Children Second Edition (BASC-II; Reynolds and Kamphaus,
2004). Narrow measures can be used inconjunctionwith broad-band measures to
assess specific problems more extensively. Standardized self-reporting scales have
also been developed to obtain childrens own views of their problems and
competencies, and can be very especially useful when assessing for internalizing
disorders. In amultidimensionalassessment, evaluators should compare scores on
self-reportscales to similar scores obtained from parent and teacher rating scales
(McConaughy & Ritter, 2002).
Interviews
As with rating scales, interviews should be conducted with parents, teachers, and the
child. Most structured diagnostic interviews have parallel forms for parents and
children, and some have been adapted for teacher interviews. Interviewformats can
vary from highly structured to semi-structured andunstructuredapproaches. Examples
that can be used for assessment of this population include the National Institute of
Mental HealthDiagnostic InterviewSchedule for Children-Fourth Edition (DISC-IV;
Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000) or theDiagnostic Interviewfor
Children and Adolescents-Fourth Edition (DICA-IV, Reich, Welner, Herjanic, & MHS
Staff, 1999). Unstructuredinterviews are especially appropriate because they can be
tailored to each child, but also help the schoolpsychologistnot forget to ask about
important information (McConaughy & Ritter, 2002).
Direct Observations
Direct observations are an important data source for assessing emotional disturbance.
Several observations should be conducted and should occur in relevant settings
wherever problems are occurring. The labile nature of emotional and behavioral
disorders must always be keep at the forefront when doing these observations, and so
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theobservershould know to obtain more than oneobservationover different days and
times. Peer comparisons provides a helpful framework from which the judge the child
under assessment. Noting the antecedents and consequences are important factors to
observe. The DirectObservationForm or the Student Observation Systemare good
tools to use tostructureobservations (McConaughy & Ritter, 2002).
PersonalityAssessments
Personalityassessments provide additional information on aspects of social-emotional
functioning. Commonly used instrument are the Minnesota MultiphasicPersonality
Inventoryfor Children-Adolescents (MMPI-A; Butcher et al., 1992) andPersonalityInventoryfor Children (PIC; Wirt, Lachar, Klinedinst, Seat, & Brown, 1990). However,
discretion should be used when doing these assessments because of thesubjective
nature in theirinterpretation. Since different examiners often disagree in their
interpretations of personality measures, andreliabilityandvalidityare limited on these
measures, such procedures should not be sued as a primary source for assessment of
emotional disturbance (McConaughy & Ritter, 2008).
Social Skillsand SocialReasoning
Assessingsocial skillsis very important for assessing for emotional disturbance.
Observations of childrens behavior with peers and adults in natural settings, like the
general education classroom, or recess, can provide information about social skills and
relationships that is invaluable when reporting on apotentialemotional disturbance
case. Observing behaviors during social skills instruction or role-playing situationsprovides a more direct method for measuring specific social areas like socialproblem
solvingand socialreasoning(McConaughy & Ritter, 2008).
AcademicAssessment
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For emotional disturbance classification, there must be evidence that the childs is
sufferingacademically because of his behaviors and emotions. Standardized tests,
curriculum-based assessment, grade reports, and work samples can all provide
evidence regarding currentacademic achievement. Evaluationof broader education
performance can focus on academic behaviors, likeproductivityormotivation. Such
evaluations are needed inconjunctionwith the social and emotional assessments, and
cognitive testing, to judge whether educational performance is indeed being impacted
(McConaughy & Ritter, 2008).
Disorders with Emotional Disturbance Overlays
Mood disorders have been well described in individuals with mentalretardation.
Researchers estimate that 5 to 15 percent of individuals with mentalretardationhave
mood disorders (Meyer & Batshaw, 2002). Syndromes of disturbed mood may be
hidden in people with mental retardation. Sleep orappetiteproblems often go
unnoticed, and fluctuations in such symptoms as noncompliance,social withdrawal,
aggressiveness,irritability, self-injury, or crying are often assumed to be components of
a persons personality rather than a psychiatric disorder. Fragile Xsyndromeis the
most frequently diagnosed inherited cause of mental retardation and has many
characteristics that may look like an emotional and/or behavioral disorder. What
frustrations a child might feel as having delayedsocialization, communication, and daily
living skills may manifest itself in aggressive outbursts, hyperactivity, inattention, or
levels ofanxietyordepressionthat appear to be emotional or behavioral disorders
(Meyer & Batshaw, 2002). The best way to differentiate between emotional disturbance
and fragile Xsyndrome, is to examine medical records or the childsmedical historyto
see if there are references made to this disorder. Cognitive testing will also identify if a
level of mental retardation is present, therefore disqualifying the child as having
emotional disturbance. Adaptive measures, interviews of parents and teachers, rating
scales, and behavioral observations of the child will also provide salient information for
making eligibility decisions.
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Children with specificlearningdisabilities often show impairments in emotional or
behavioral functioning because of their external experiences of school failure, and are
sometimes mistaken as children with emotional disturbance. Although the federal
definition for alearningdisability currently excludes learning problems that are primarily
the result of emotional disturbance, children and adolescents identified as having
learning disabilities demonstrate a high incidence of concurrent emotional and
behavioral problems (McConaughy, Mattison, & Peterson, 1994). These children can
exhibit a range of emotional and behavioral disturbances, includingconductdisorders,
withdrawal, poorself-esteem, and depression (Shapiro, Church, & Lewis, 2002). These
children often exhibit chronicfrustrationand anxiety as they attempt to meet the
demands of skills-based tasks such a phonologicaldecoding, comprehension, spelling,
and math (Shapiro, Church, & Lewis, 2002). School failure, combined with social skills
impairments, possible peerrejection, and poor-self image often results in what appears
to be emotional disturbance (Shapiro, Church, & Lewis, 2002). Although looking at a
discrepancy between cognitive potential andacademic achievementseems like a
simple way to identify whether a child qualifies for emotional disturbance or specific
learning disabled, this is anoversimplificationof bestpracticeassessment procedures
(Shapiro, Church, & Lewis, 2002). In addition to psycho-educational testing, a complete
medical, behavioral, educational, and social history should be considered when making
a classification to determine which of the two eligibilities best fits theprofileof the child
and which would offer the best services for remediation.
A third disorder that often gets confused for emotional disturbance isattentiondeficit
hyperactivity disorder. Emotional and behavioral problems can overlap or co-occur with
inattention or hyperactive problems (Barkley, 2006) that mimic emotional disturbance.
Children with this disorderdisplayhyperactive or impulsive behaviors, and can showsuch disruptive behaviors that some might say they are actually demonstrating
characteristics ofoppositional defiant disorderorconduct disorder(Stein, Efron, Schiff,
Glanzman, 2002), while others might say the child is demonstrating mood disorders.
Estimates of mood disorders in children with ADHD vary considerably. Some studies
say the comorbidity rate is as low as 14 percent, while others say it is as high as 80
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percent (Stein, Efron, Schiff, Glanzman, 2002). Peerrejectiondue to their odd
behaviors, difficulty in school, andregularpunitive interactions with adult figures often
does lead to extreme levels of anxiety and/or depression in these children (Stein, Efron,
Schiff, Glanzman, 2002). As previously stated, carefulexaminationof the childspattern
of behavior and history, may help with theevaluation. One must always consider what
is the bestinterestof the child, and what eligibility would facilitate the services he or she
needs from school and community resources more easily.
To qualify for special education services under IDEIA 2004, it is not enough that a child
exhibit a specific disability, such as emotional disturbance. An actual need for special
education must also be evident. This means that previous intervention efforts have
failed with little to no decrease in a childs target behaviors. When doing an assessment
on a child suspected todisplayemotional or behavioral disorders, it is important for an
assessor to not become overwhelmed with the myriad of unsettled issues regarding the
definition of emotional disturbance and its assessment, but use professionaljudgment
and a multimethod, data-basedapproachto decision-making. Proper assessment may
take more time due to the extensive qualitative information necessary to make a
decision, but it is only with multiple sources of data that one will find it viable to make a
decision as to the presence orabsenceof emotional disturbance.
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