emotional disturbances in school kids

7/30/2019 Emotional Disturbances in School Kids

1/7

Emotional

Disturbance

Disability Fact Sheet #5 (FS5)

NICHCY Disability Fact Sheet #5June 2010

The mental health of ourchildren is a natural and impor-

tant concern for us all. The factis, many mental disorders havetheir beginnings in childhoodor adolescence, yet may goundiagnosed and untreated foryears.1

We refer to mentaldisorders using different um-brella terms such as emotionaldisturbance, behavioral disor-ders, or mental illness. Beneaththese umbrella terms, there isactually a wide range of specificconditions that differ from oneanother in their characteristicsand treatment. These include(but are not limited to):

anxiety disorders;

bipolar disorder (sometimescalled manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsivedisorder (OCD); and

psychotic disorders.

You may be reading this factsheet with one of these specificdisorders in mind, or you maybe looking for informationabout emotional disturbancesin general. In either case, keepreading to find out what differ-ent emotional distubances havein common, how they aredefined in federal law, andwhere to find more detailedinformation on specific disor-ders.

DefinitionDefinitionDefinitionDefinitionDefinition

Weve chosen to use theterm emotional disturbancein this fact sheet because that is

the term used in the nationsspecial education law, theIndividuals with DisabilitiesEducation Act (IDEA). IDEAdefines emotional disturbance asfollows:

...a condition exhibiting

one or more of the follow-ing characteristics over along period of time and toa marked degree thatadversely affects a childseducational performance:

(A) An inability to learnthat cannot be explainedby intellectual, sensory, orhealth factors.

(B) An inability to buildor maintain satisfactoryinterpersonal relation-ships with peers andteachers.

(C) Inappropriate typesof behavior or feelingsunder normal circum-stances.

(D) A general pervasivemood of unhappiness or

depression.

(E) A tendency todevelop physical symp-toms or fears associatedwith personal or schoolproblems.2

is theNational Dissemination Centerfor Children with Disabilities.

NICHCY1825 Connecticut Avenue N.W.

Washington, DC 200091.800.695.0285 (Voice / TTY)202.884.8200 (Voice / TTY)

[email protected]://nichcy.org


2/7

NICHCY: http://nichcy.org 2 Emotional Disturbance (FS5)

As defined by IDEA, emo-tional disturbance includesschizophrenia but does notapply to children who aresocially maladjusted, unless it isdetermined that they have anemotional disturbance.3

CharacteristicsCharacteristicsCharacteristicsCharacteristicsCharacteristics

As is evident in IDEAsdefinition, emotional distur-bances can affect an individualin areas beyond the emotional.Depending on the specificmental disorder involved, apersons physical, social, orcognitive skills may also beaffected. The National Allianceon Mental Illness (NAMI) puts

this very well:

Mental illnesses aremedical conditions thatdisrupt a person'sthinking, feeling, mood,ability to relate to othersand daily functioning.Just as diabetes is adisorder of the pancreas,mental illnesses aremedical conditions that

often result in a dimin-ished capacity forcoping with the ordi-nary demands of life.4

Some of the characteristicsand behaviors seen in childrenwho have an emotional distur-bance include:

Hyperactivity (short atten-tion span, impulsiveness);

Aggression or self-injuriousbehavior (acting out,fighting);

Withdrawal (not interactingsocially with others, exces-sive fear or anxiety);

Immaturity (inappropriatecrying, temper tantrums,poor coping skills); and

Learning difficulties (aca-demically performing belowgrade level).

Children with the mostserious emotional disturbances

may exhibit distorted thinking,excessive anxiety, bizarre motoracts, and abnormal moodswings.

Many children who do nothave emotional disturbancemay display some of these samebehaviors at various timesduring their development.However, when children havean emotional disturbance, these

behaviors continue over longperiods of time. Their behaviorsignals that they are not copingwith their environment orpeers.

CausesCausesCausesCausesCauses

No one knows the actualcause or causes of emotionaldisturbance, although severalfactorsheredity, brain disor-der, diet, stress, and family

functioninghave been sug-gested and vigorously re-searched. A great deal of re-search goes on every day, but todate, researchers have not foundthat any of these factors are thedirect cause of behavioral oremotional problems.

According to NAMI, mentalillnesses can affect persons ofany age, race, religion, orincome. Further:

Mental illnesses are notthe result of personalweakness, lack ofcharacter, or poorupbringing. Mentalillnesses are treatable.Most people diagnosedwith a serious mentalillness can experiencerelief from their symp-toms by actively partici-pating in an individualtreatment plan.5

FFFFFrequencyrequencyrequencyrequencyrequency

According to the CDC(Centers for Disease Controland Prevention), approximately8.3 million children (14.5%)aged 417 years have parentswhove talked with a health careprovider or school staff aboutthe childs emotional or behav-ioral difficulties.6 Nearly 2.9million children have beenprescribed medication for these

difficulties.7

Help forHelp forHelp forHelp forHelp for

School-Aged ChildrenSchool-Aged ChildrenSchool-Aged ChildrenSchool-Aged ChildrenSchool-Aged Children

IDEA requires thatspecialeducation and related servicesbe made available free of chargeto every eligible child with adisability, includingpreschoolers (ages 3-21). Theseservices are specially designed

to address the childs individualneeds associated with thedisabilityin this case, emo-tional disturbance, as definedby IDEA (and further specifiedby states). In the 2003-2004school year, more than 484,000children and youth with emo-tional disturbance received


3/7

these services to address theirindividual needs related toemotional disturbance.8

Determining a childseligibility for special educationand related services begins witha full and individual evaluationof the child. Under IDEA, thisevaluation is provided free ofcharge in public schools.

There is a lot to know aboutthe special education process,much of which you can learn atNICHCY. We invite you to readthe wide range of publicationswe offer on the topic, especiallythose listed in the box below.

A Look at SpecificA Look at SpecificA Look at SpecificA Look at SpecificA Look at SpecificEmotional DisturbancesEmotional DisturbancesEmotional DisturbancesEmotional DisturbancesEmotional Disturbances

As we mentioned, emo-tional disturbance is a com-monly used umbrella term for anumber of different mentaldisorders. Lets take a brief lookat some of the most common ofthese.

Anxiety DisordersAnxiety DisordersAnxiety DisordersAnxiety DisordersAnxiety Disorders

We all experience anxietyfrom time to time, but for manypeople, including children,anxiety can be excessive, persis-tent, seemingly uncontrollable,and overwhelming. An irratio-nal fear of everyday situationsmay be involved. This high levelof anxiety is a definite warningsign that a person may have ananxiety disorder.

As with the term emotionaldisturbance, anxiety disorderis an umbrella term that actu-ally refers to several distinctdisabilities that share the corecharacteristic of irrational fear:generalized anxiety disorder(GAD), obsessive-compulsivedisorder (OCD), panic disorder,

posttraumatic stress disorder(PTSD), social anxiety disorder(also called social phobia), andspecific phobias.9

According to the AnxietyDisorders Association ofAmerica, anxiety disorders arethe most common psychiatricillnesses affecting children andadults.10 They are also highlytreatable. Unfortunately, onlyabout 1/3 of those affectedreceive treatment.11

Bipolar DisorderBipolar DisorderBipolar DisorderBipolar DisorderBipolar Disorder

Also known as manic-depressive illness, bipolardisorder is a serious medical

condition that causes dramaticmood swings from overlyhigh and/or irritable to sadand hopeless, and then backagain, often with periods ofnormal mood in between.Severe changes in energy andbehavior go along with thesechanges in mood.12

For most people withbipolar disorder, these mood

swings and related symptomscan be stabilized over timeusing an approach that com-bines medication and psychoso-cial treatment.13

Conduct DisorderConduct DisorderConduct DisorderConduct DisorderConduct Disorder

Conduct disorderrefers to agroup of behavioral and emo-tional problems in youngsters.Children and adolescents with

this disorder have great diffi-culty following rules andbehaving in a socially accept-able way.14 This may includesome of the following behav-iors:

aggression to people andanimals;

destruction of property;

deceitfulness, lying, or

stealing; or

truancy or other seriousviolations of rules.15

Read More about theRead More about theRead More about theRead More about theRead More about the

Special Education Process at NICHCYSpecial Education Process at NICHCYSpecial Education Process at NICHCYSpecial Education Process at NICHCYSpecial Education Process at NICHCY

10 Basic Steps in Special Educationhttp://nichcy.org/schoolage/steps/

Questions Often Asked by Parents about Special Education Serviceshttp://nichcy.org/publications/lg1

Evaluating Children for Disabilityhttp://nichcy.org/schoolage/evaluation/

Developing Your Childs IEPhttp://nichcy.org/publications/pa12



4/7

Although conduct disorderis one of the most difficultbehavior disorders to treat,young people often benefitfrom a range of services thatinclude:

training for parents on howto handle child or adoles-cent behavior;

family therapy;

training in problem solvingskills for children or adoles-cents; and

community-based servicesthat focus on the youngperson within the context offamily and communityinfluences.16

Eating DisordersEating DisordersEating DisordersEating DisordersEating Disorders

Eating disorders are charac-terized by extremes in eatingbehavioreither too much ortoo littleor feelings of extremedistress or concern about bodyweight or shape.Females aremuch more likely than males todevelop an eating disorder.17

Anorexia nervosa andbulimia nervosa are the twomost common types of eatingdisorders. Anorexia nervosa ischaracterized by self-starvationand dramatic loss of weight.Bulimia nervosa involves a cycleof binge eating, then self-induced vomiting or purging.Both of these disorders arepotentially life-threatening.18

Binge eating is also consid-ered an eating disorder. Itscharacterized by eating excessiveamounts of food, while feelingunable to control how much orwhat is eaten. Unlike withbulimia, people who binge eat

usually do not purge afterwardby vomiting or using laxatives.19

According to the NationalEating Disorders Association:

The most effective andlong-lasting treatment foran eating disorder is someform of psychotherapy orcounseling, coupled with

careful attention tomedical and nutritionalneeds. Some medicationshave been shown to behelpful. Ideally, whatevertreatment is offeredshould be tailored to theindividual, and this willvary according to both theseverity of the disorderand the patients indi-vidual problems, needs,

and strengths.20

Obsessive-Compulsive DisorderObsessive-Compulsive DisorderObsessive-Compulsive DisorderObsessive-Compulsive DisorderObsessive-Compulsive Disorder

Often referred to as OCD,obsessive-compulsive disorderis actually considered an anxietydisorder (which was discussedearlier in this fact sheet). OCDis characterized by recurrent,unwanted thoughts (obses-sions) and/or repetitive behav-

iors (compulsions). Repetitivebehaviors (handwashing,counting, checking, or cleaning)are often performed with thehope of preventing obsessivethoughts or making them go

away. Performing these so-called rituals, however,provides only temporary relief,and notperforming themmarkedly increases anxiety.21

A large body of scientificevidence suggests that OCDresults from a chemical imbal-ance in the brain.22 Treatmentfor most people with OCDshould include one or more ofthe following:

a therapist trained inbehavior therapy;

Cognitive Behavior Therapy(CBT)

medication (usually anantidepressant).23

Psychotic DisordersPsychotic DisordersPsychotic DisordersPsychotic DisordersPsychotic Disorders

Psychotic disorders isanother umbrella term used torefer to severe mental disordersthat cause abnormal thinkingand perceptions. Two of themain symptoms are delusionsand hallucinations. Delusionsare false beliefs, such as think-

ing that someone is plottingagainst you. Hallucinations arefalse perceptions, such ashearing, seeing, or feelingsomething that is not there.Schizophrenia is one type ofpsychotic disorder.24 There areothers as well.

Treatment for psychoticdisorders will differ from personto person, depending on the

specific disorder involved. Mostare treated with a combinationof medications and psycho-therapy (a type of counseling).25



5/7

More aboutMore aboutMore aboutMore aboutMore about

SchoolSchoolSchoolSchoolSchool

As mentioned, emotionaldisturbance is one of thecategories of disability specifiedin IDEA. This means that a

child with an emotional distur-bance may be eligible forspecial education and relatedservices in public school. Theseservices can be of tremendoushelp to students who have anemotional disturbance.

Typically, educationalprograms for children with anemotional disturbance need toinclude attention to providingemotional and behavioralsupport as well as helping themto master academics, developsocial skills, and increase self-awareness, self-control, and self-esteem. A large body of researchexists regarding methods ofproviding students with positivebehavioral support (PBS) in theschool environment, so thatproblem behaviors are mini-mized and positive, appropriate

behaviors are fostered. (See theresource section at the end ofthis fact sheet for more informa-tion on PBS.) It is also impor-tant to know that, within theschool setting:

For a child whose behaviorimpedes learning (includingthe learning of others), theteam developing the childsIndividualized EducationProgram (IEP) needs toconsider, if appropriate,strategies to address thatbehavior, including positivebehavioral interventions,strategies, and supports.

Students eligible for specialeducation services under thecategory of emotionaldisturbance may have IEPsthat include psychologicalor counseling services.These are important related

services available underIDEA and are to be pro-vided by a qualified socialworker, psychologist,guidance counselor, orother qualified personnel.

Other ConsiderationsOther ConsiderationsOther ConsiderationsOther ConsiderationsOther Considerations

Children and adolescentswith an emotional disturbanceshould receive services based ontheir individual needs, andeveryone involved in theireducation or care needs to bewell-informed about the carethat they are receiving. Itsimportant to coordinate servicesbetween home, school, andcommunity, keeping the com-munication channels openbetween all parties involved.

TTTTThe Importance of Supporthe Importance of Supporthe Importance of Supporthe Importance of Supporthe Importance of Support

Families often need help inunderstanding their childsdisability and how to addressthe needs that arise from thedisability. Help is available frompsychiatrists, psychologists, andother mental health profession-als that work in the public or

private sector. There is also anetwork of mental healthsupport operating in every stateas well as locally.

To locate systems of supportin your community or state,visit the organizations wevelisted in the box on the nextpage. They can connect youwith local resources, includingsupport groups that provideconnection and understanding,information, referral, andadvocacy for those living withemotional disturbance.

ReferencesReferencesReferencesReferencesReferences

1 National Institute of MentalHealth (NIMH). (2010). Childand adolescent mental health.Available online at: http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

2 Code of Federal Regulations, Title34, 300.8(c)(4)(i)

3Code of Federal Regulations, Title34, 300.8(c)(4)(ii)

4 National Alliance on MentalIllness. (2010). What is mentalillness: Mental illness facts.Available online at:http://tinyurl.com/3ew3d

5 Ibid.


FFFFFor Science Tor Science Tor Science Tor Science Tor Science Teachers and Teachers and Teachers and Teachers and Teachers and Their Students in Grades 6-8:heir Students in Grades 6-8:heir Students in Grades 6-8:heir Students in Grades 6-8:heir Students in Grades 6-8:

TTTTThe Science of Mental Illnesshe Science of Mental Illnesshe Science of Mental Illnesshe Science of Mental Illnesshe Science of Mental Illness

This inquiry-based curriculum from the National Institutes ofHealth is designed to help students in grades 6-8 gain a betterunderstanding of the biological basis of mental illnesses andwhat mental illnesses areand what they are not.

http://science.education.nih.gov/supplements/nih5/mental/default.htm


6/7

6 Simpson, G.A., Cohen, R.A., Pastor,P.N., & Reuben, C.A. (2008, Septem-ber). Use of mental health services inthe past 12 months by children aged417 years: United States, 20052006.NCHS Data Brief, No. 8, 1-8. Availableonline at: http://www.cdc.gov/nchs/data/databriefs/db08.pdf

7 Ibid.

8 U.S. Department of Education.(2007).27th annual report to Congresson the implementation of the Individualswith Disabilities Education Act, 2005(Vol. 2). Washington, DC: Author.

9 NIMH. (2010, March).Anxietydisorders. Available online at:www.nimh.nih.gov/health/publica-tions/anxiety-disorders/complete-index.shtml

10Anxiety Disorders Association of America. (2010).Undestanding anxiety. Available online at: http://www.adaa.org/understanding-anxiety

11 Ibid.

12 NIMH. (2010, May). Bipolar disorder. Available onlineat: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

13 Ibid.

14American Academy of Adolescent and Child Psychia-try. (2004, July). Conduct disorder: Facts for families.Available online at: http://www.aacap.org/cs/root/facts_for_families/conduct_disorder

15 Ibid.

16 National Mental Health Information Center. (2003).Childrens mental health facts: Children and adolescentswith conduct disorder. Available online at: http://mentalhealth.samhsa.gov/publications/allpubs/ca-0010/default.asp

17 NIMH. (2009). Eating disorders. Available online at:http://www.nimh.nih.gov/health/publications/eating-

disorders/complete-index.shtml18 National Eating Disorders Association. (2010). Termsand definitions. Available online at: http://www.nationaleatingdisorders.org/information-resources/general-information.php

19Weight-control Information Network. (2008, June).Binge eating disorder. Available online at: http://www.win.niddk.nih.gov/publications/binge.htm

20 National Eating Disorders Association. (2010).Treatment of eating disorders. Available online at: http://tinyurl.com/25f6v76

21 NIMH. (2010, May). Obsessive-compulsive disorder,OCD. Available online at: http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

22 National Alliance for Mental Illness. (2003).Mentalillnesses: Obsessive-compulsive disorder. Available onlineat: http://tinyurl.com/2h2xne

23

International OCD Foundation. (n.d.). Treatment ofOCD. Available online at: www.ocfoundation.org/treatment.aspx

24 Medline Plus. (2010, April). Psychotic disorders.Available online at: http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html

25 MedicineNet.com. (n.d.). Psychotic disorders (cont.).Available online at: http://www.medicinenet.com/psychotic_disorders/page2.htm


FFFFFinding Support Locallyinding Support Locallyinding Support Locallyinding Support Locallyinding Support Locally

Support groups can be extremely helpful to individuals andfamilies living with emotional disturbance. To find a state or localsupport group, visit:

Mental Health America | 1.800.969.6642

http://www.mentalhealthamerica.net/farcry/go/searchMHA

NAMI | National Alliance on Mental Illness | 1.800.950.NAMIhttp://www.nami.org/template.cfm?section=Your_Local_Nami

National Mental Health Consumers Self-Help Clearinghouse1.800.553.4539 | http://www.cdsdirectory.org/

There are also support groups available from organizations thataddress specific mental disorders under the umbrella term ofemotional disturbance. See the resources page to identify some ofthese groups.

This publication is made possible throughCooperative Agreement #H326N080003 between FHI360 and the Office of Special Education Programs, U.S.Department of Education. The contents of this docu-ment do not necessarily reflect the views or policies ofthe Department of Education, nor does mention oftrade names, commercial products, or organizationsimply endorsement by the U.S. Government.


7/7


AACAP | American Academy of Child andAdolescent Psychiatry| AACAP offers Facts forFamilies, a series in English and Spanish thatincludes many briefs on specific mental disorders,

including the ones mentioned in this publication.

Fact sheets in English:http://www.aacap.org/cs/root/facts_for_families/facts_for_families_keyword_alphabetical

Fact sheets in Spanish:http://www.aacap.org/cs/root/facts_for_families/

informacion_para_la_familia

AACAP also operates different Resource Centers,which offer consumer-friendly definitions, answersto frequently asked questions, clinical resources,

expert videos, Facts for Families, and much more.Visit the Resource Center home page if you areconcerned with one of the following:

Anxiety Disorders

Autism

Bipolar Disorder

National Alliance on Mental Illness (NAMI) |NAMI is an excellent source of information andconnection on mental illness, including the indi-vidual disorders mentioned in this fact sheet.

NAMIs website and toll-free helpline are availablein English and Spanish.

Toll-free Helpline1.800.950.6264

American Psychological Association | The APA isalso a fountain of information and support onspecific emotional disturbances.

English | www.apa.org/index.aspx

Spanish | www.apa.org/centrodeapoyo/index.aspx

National Institute of Mental Health | NIMH isclearly a source of authoritative information on

specific mental disorders. Phone: 1.866.615.6464.TTY: 1.866.415.8051

English | http://www.nimh.nih.gov/health/index.shtml

Spanish | http://www.nimh.nih.gov/health/publications/espanol/index.shtml

Resources of More InformationResources of More InformationResources of More InformationResources of More InformationResources of More Information

Resource Center home pagehttp://www.aacap.org/cs/resource.centers

Conduct Disorder

Depression

Oppositional DefiantDisorder

Website in Englishhttp://www.nami.org

Website in Spanishhttp://tinyurl.com/28rweba

Detailed information on specific emotional distur-bances, or related issues such as positive behaviorsupports, is also available from these sources:

Anxiety Disorders Association of Americahttp://www.adaa.org

Center on Positive Behavioral Interventions andSupports | The PBIS Center provides research-basedinformation on how to provide behavioral supportsto children who need them. | www.pbis.org

Conduct Disorders | A soft place to land forbattle-weary parentshttp://www.conductdisorders.com/

Encyclopedia of Mental Disordershttp://www.minddisorders.com/index.html

National Eating Disorders Association1.800.931.2237 | www.nationaleatingdisorders.org

Something Fishy| (eating disorders)1.866.690.7239 | http://www.something-fishy.org

SAMHSAs National Mental Health InformationCenter| The Center provides information andreferrals on mental health services to the publicthrough its toll-free number and website.

Toll-free infoline | 1.800.789.2647

Website | http://store.samhsa.gov/home

emotional disturbances in school kids

Documents