Screening and Evaluation for Serious Emotional Disability
General education teachers should be aware of student behaviors that may indicate emotional disabilities as well as what is normal behavior for specific childhood developmental levels. In addition they should be aware of the potential ramifications of a student acquiring the label of emotionally disabled. Information sharing and in-service training can reduce misunderstandings and unnecessary concerns.
Required Screenings and Evaluations
The goal of the screening process is to identify students experiencing behavioral and/or learning problems and provide early intervention and supportive assistance within the general education program. This process of identification should be accomplished by systematic screenings at regular intervals to identify specific academic, behavioral, or developmental needs through school-wide achievement, health and sensory testing. Individual screenings may be warranted for specific problems which might require further consideration of follow-up evaluations or consideration for referral for special education services.
Specific required screening procedures for students exhibiting behavioral/emotional problems include:
- Hearing screening;
- Vision screening;
- Two scientific research-based interventions to address behavioral/emotional skill deficiency and documentation of the results of the interventions, including progress monitoring documentation;
- Summary of conference(s) with parents or documentation of attempts to conference with parents;
- Communication evaluation;
- Review of existing data;
- Social/developmental history;
- Observation across settings, to assess academic, functional and behavioral skills;
- Educational evaluation;
- Psychological evaluation, to include an intellectual evaluation;
- Behavioral/emotional evaluation which may include a behavior/emotional skill rating.
Interventions Developed by a Team
Special Education teachers and regular education teachers have valuable skills and knowledge to assist students experiencing educational difficulties. Working together they can and should be able to resolve many learning and behavioral problems without an exceptional student referral. Some school systems use the Assistance Team Model to facilitate this process. In some schools the interventions may be developed as part of the Responsiveness to Instruction and/or Positive Behavior Support problem solving efforts.
The problem solving team, using the screening data, can develop an intervention plan for the general education classroom. Frequently these classroom adjustments will result in more positive and responsible behavior by students. The team serves by:
- Assisting teachers in identifying and establishing interventions for students having educational difficulties;
- Providing an efficient, flexible, and cost effective problem-solving alternative prior to an exceptional students program referral; and
- Providing support to teachers in serving students with disabilities within the general education classroom.
Research-based interventions are strategies, teaching methodologies and supports that have been shown through one or more valid research studies to help a student improve academic, behavioral/emotional or functional skills. The interventions used prior to identification of a student must be designed to address the skill deficiency of the particular individual student. A list of web sites containing information about multiple research based interventions can be found on this site.
Intervention teams should provide preventative and problem-solving assistance to classroom teachers for students in the general education program who are experiencing behavioral and learning difficulties. These services may include modifications in curricula, instructional methodology or behavior management which have previously proven effective for other students with similar difficulties. A plan should be developed for an individual student. The team will meet after the plan is implemented [from three (3) to six (6) weeks] to review the documentation of the student's progress and to make possible adjustments to the plan. When the interventions have been effective, a period of continued monitoring should be established prior to the exit of the Team function. When the recommended interventions have not proven effective in solving the identified problems, the Team may either try additional interventions, or enter the referral process (all data collected by the team should accompany the referral). All interventions should be implemented for a minimum of 6 weeks, if not longer.
After reviewing screening data and the effects of research based interventions, the team may determine that a referral for evaluation is necessary if all of the following conditions apply:
- specific interventions implemented were not effective,
- vision and hearing and intellectual ability appear to be within normal limits, and
- it is determined that the documented maladaptive behavior appears to occur over a period of time and to a marked degree.
The evaluation of behavioral-emotional functioning shall be conducted by a certified or licensed psychologist to document maladaptive behaviors or deficits in coping skills and emotional functioning. A behavioral-emotional evaluation includes the information about the unique personal attributes of the student and describes any distinctive patterns of behavior which characterize the student's personal feelings, attitudes, moods, perceptions, thought processes, and significant personality traits. The evaluation shall include:
- interviews with the student,
- checklists or rating scales, and
- screening data and any other observational data.
A comprehensive educational evaluation conducted by a certified psychologist, special educator, or other trained professional shall include an assessment of:
- the learning environment, including curriculum and task demands;
- academic strengths and weaknesses, including written and oral language and information from individualized achievement assessment;
- present levels of academic functioning; and
- vocational needs (for students age 14 and older).
A psychological evaluation shall be conducted by a certified or licensed psychologist. This evaluation includes interviews with the student, learning history, and behavioral observations with special consideration given to evaluation of disorders of thought, memory, judgment, and /or time-place orientation as appropriate. An individual intellectual evaluation shall be given when academic or learning deficits or giftedness is suspected.
Social /Developmental History
A social/developmental history documents normal and abnormal developmental events and includes a review of information obtained during the screening process. The history may be completed by a certified social worker, special educator, psychologist, counselor or other appropriate person.
A communication evaluation shall be conducted by a speech/language pathologist. This evaluation includes assessment of the student’s expressive language skills, receptive language skills and pragmatics or social language use.
INDIVIDUALIZED EDUCATION PROGRAM TEAM
The Individualized Education Program Team (IEP Team) is responsible for making decisions about initial evaluations (if appropriate) and reevaluations; the individualized education program (IEP); and placement, including alternative education setting. Relevant members of the child’s IEP team (as determined by the parent and the LEA) may also make decisions about discipline, including whether there was a direct and substantial relationship between the conduct in question and the child’s disability when the conduct will result in a suspension of more than ten days at a time.
At least one member of the IEP Team should be the same sex and same race as the student being referred.
Members of the IEP Team must include:
- the parent(s) of the child;
- not less than one regular education teacher of the child (if the child is, or may be participating in the regular education environment);
- not less than one special education teacher of that child, or where appropriate, not less than one special education provider of the child;
- a representative of the local education agency who is qualified to provide, or supervise the provision of specially designed instruction to meet the unique needs of children with disabilities, is knowledgeable about the general curriculum, and is knowledgeable about the availability of resources of the local educational agency;
- an individual who can interpret the instructional implications of evaluation results, who may be a member of the team described above;
- at the discretion of the parent or the local education agency, other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate;
- the child when transition services are discussed and whenever else appropriate;
- when discussion of transition services will occur, a representative of any other agency that is likely to be responsible for providing or paying for transition services.
DEFINITION AND CRITERIA FOR ELIGIBILITY DETERMINATION
In North Carolina, students who are disabled by emotional and behavioral problems are classified as having a serious emotional disability. The term serious emotional disability (ED) is synonymous with serious emotional disturbance (SED) which is defined as follows in the Individuals with Disabilities Education Act:
Serious Emotional Disturbance
CFR 300.8 (c) (4)
(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; or
(E) A tendency to develop physical symptoms or fears associated with personal or school problems.
This definition, with the exception of the exclusionary clause for social maladjustment, began with the work of Eli Bower in the 1950's. Initially, in July of 1972, it appeared essentially in its present form as an implementing regulation of Public Law 91-230. With the passage of Public Law 94-142 in 1975, serious emotional disturbance was established as a special education category. The undefined exclusion of socially maladjusted students and ambiguous language have presented a problem for school personnel since 1975. These ambiguities have led to alternative interpretations and disparate treatment of students and youth across jurisdictions (Cline, 1990). In a position paper on the definition, the Council for Students with Behavioral Disorders posits that students with emotional disturbances are underserved primarily due to poorly defined and restrictive federal eligibility criteria (1987).
Serious Emotional Disability
.1500-2.4 (b) (5) Procedures Governing Programs and Services for Students with Special Needs
(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.
Special Education Eligibility Determinations
Eligibility criteria for all of the categories of disabilities defined in state and federal law contain language which either specifically states or implies that conditions exist which "adversely affect educational performance." It is critical that professionals who make decisions about the eligibility of students with potential emotional disabilities understand the distinctions among educational performance, academic progress, and social competence.Educational performance is a comprehensive term which includes both academic progress and social competence. It reflects the total involvement of the student in the school environment. In addition to academic progress and social competence, it includes access to and participation in school activities, emotional development, and communication skills. Social skills and adaptive behaviors which enable students to meet environmental demands and assume responsibility for his/her and others' welfare are elements of social competence which is one aspect of educational performance. Since social development is a necessary and critical component of a student's educational performance, deficits in social competence which impair one's ability to form and maintain interpersonal relationships with adults and peers may qualify the student for emotional disability services regardless of academic achievement if other identifying criteria are met.
Academic progress is less comprehensive than educational performance and refers to a student's progress in core academic subjects as measured by achievement tests, report cards, work samples, curriculum-based assessments, etc. Standardized and informal measures of academic performance are critical tools in evaluating student progress in the core academic subjects but are not adequate measures of educational performance.
Social competence is the area which encompasses a student's specific behavioral repertoire of adaptive and maladaptive behavior, adaptive functioning skills, and social skills development. Assessment of a respective student's social competence may include measures of adaptive functioning, social skills, and specific target behaviors as well as interviews and behavioral observations. Other psychometric constructs such as behavioral ratings, sociometrics, self-reports, and projective may also be helpful.
As specified in the definitions of serious emotional disturbance (SED) in the Individuals with Disabilities Education Act (IDEA), and serious emotional disability (BED) in North Carolina's Policies Governing Services for Children with Disabilities, students must exhibit at least one of the five commonly accepted identifying characteristics. These one or more characteristics must be present along with all four additional criteria. The following descriptors provide some clarification of the somewhat ambiguous language used in the definition in order to assist the IEP teams in making eligibility determinations:
"An inability to make educational progress that cannot be explained by intellectual, sensory, or health factors"
The primary issue is to determine if the student is making educational progress according to his or her learning potential. An inability to make educational progress may occur when a student’s actual learning is significantly less than expected for that child. It is possible for a student of superior intellectual aptitude, who is achieving according to grade level expectations but below his/her potential, to be identified as having an emotional disability.
Once a determination has been made that there is a lack of educational progress, the team must determine that this condition "can not be explained by intellectual, sensory, or health factors." Some degree of contribution from one of these factors may be present, but it must be determined that such factor(s) are not the primary problem. (e.g. Students who have been identified behavioral-emotional disabled may have a specific learning disability or a developmental disability. However, it must be determined that such disabilities are not the primary cause of the learning problem.) The eligibility determination should indicate that the severity of the emotional disability is such that the student would not be more appropriately served in the general education program.
"An inability to build and maintain satisfactory interpersonal relationships with peers and teachers"
For a student to qualify for special education under this characteristic, sufficient evidence from multiple sources should support that the student's deficits in social competence impair his/her ability to build and maintain satisfactory interpersonal relationships with others. This characteristic must be present at an unacceptable level across various environments. Students do not qualify for special education because they have problems with a particular teacher, peer, or group.
This characteristic is not present in students who have appropriate relationships with peers in their subcultures yet do not follow broader community norms. Examples of behavioral characteristics which impair the ability of students with emotional disabilities to build and maintain satisfactory relationships include but are not limited to extreme social withdrawal, poor reality testing, social or interpersonal deficits, aggressive and authority challenging behaviors, and oppositional tendencies.
"Inappropriate types of behaviors or feelings under normal circumstances"
To meet the criteria for this identifying characteristic, student behavior must be inappropriate under normal circumstances and across time. Behaviors may include, but not be limited to, overreaction to environmental stimuli, obsessive or compulsive behaviors, bizarre verbalizations, inappropriate sexualized behaviors or fetishes.
Feelings, by definition, are not objectively observable or measurable. Feelings of students can only be determined through inferences drawn from observable behaviors and interactions with the student. When making eligibility determinations based on feelings alone, there should be a strong consensus among team members that there is documented evidence of persistent and significantly inappropriate feelings demonstrated by observed behavior inappropriate for the particular context. Clinical interviews, objective and projective psychological tests, and other measures can be useful as assessment information to support behavioral observations which may indicate inappropriate feelings.
"A general pervasive mood of unhappiness or depression"
Depression or other affective conditions may be recognized by the behavior of the student. Characteristics such as of withdrawal from friends, frequent crying, markedly diminished interest in activities, depressive affect, and anxiety, or it may be masked by angry, aggressive, or agitated behaviors are common indicators of depression.
Suicidal and homicidal ideations, obsessions with morbid themes, and sleep disturbances are also common characteristics of depression. If disturbed moods and thoughts are situationally specific, they do not constitute a general mood of unhappiness or depression unless they become a generalized to all aspects of the person’s life. Alternative or additional solutions or services such as school counseling or mental health services to assist the student in the treatment of mood disorders should be considered.
"A tendency to develop physical symptoms or fears associated with personal or school problems"
It is quite common for students to react to stress or tension with physical symptoms at one time or another. This identifying characteristic must occur "to a marked degree" and "over a long period of time." The condition must be chronic and not an acute reaction to a particularly stressful event. These symptoms must provide a significant interference with learning.
There are many physical responses in students which may be caused by emotional distress. These reactions can/may be considered as long as there is reasonable evidence that such physical manifestations have a psychosomatic origin. Efforts to reduce the symptoms of these fears or phobias such as systematic desensitization, relaxation techniques, and medication are appropriate prior to consideration of a referral for special education.
Four Additional Considerations
The condition must be exhibited over a long period of time.
The determination of what is a long period of time is subject to the professional judgment of the team. The referred student must exhibit one or more of the five characteristics of emotional disability in such duration as to be considered chronic. Chronicity is determined by behavioral manifestations which have sustained patterns, high frequency occurrences over shorter periods, or multiple acute incidences. The behavioral history of the student should indicate that the behavioral pattern is not a response to a situational crisis or a reaction to a transitory situation. This qualifier is intended to exclude behavioral and emotional disturbances which would be expected to subside over time under normal circumstances. The developmental level of the referred student should be factored in when considering what constitutes a long period of time. Sources of information which may help are developmental history, social history, school history, or other anecdotal information regarding the student's behavior in the school, home, or community.
The condition must be exhibited to a marked degree.
Students who present behavioral difficulties in the general education program may not qualify for special education services as having an emotional disability unless the behavior is clearly more severe or more persistent than that of other students. The dysfunctional behaviors which characterize students with behavioral and emotional disabilities are to a lesser degree evidenced by many students in the general education program from time to time. To qualify for special education these behaviors must be exhibited at a far greater rate and/or intensity than evidenced by a typical peer group. This significant difference should be observable and be manifested in multiple environments rather than specific to one particular situation or classroom.
In determining a marked degree, attention should be given to the following characteristics of a specific problem behavior:
Frequency - the number of occurrences of a given behavior over a given period of time, and
Intensity - the relative strength, disruptiveness or intrusiveness of a given behavioral occurrence.
Duration - the average amount of time that the student engages in a given behavioral occurrence,
The disability must have an adverse effect on educational performance.
The student is not performing educational tasks according to his or her learning potential and age. Assessment of a student's problematic behavior should occur across a variety of settings which constitute the comprehensive educational environment of the student. Consideration should be given to a variety of instructional groupings, including non-academic and extra-curricula groups.
The disability must require specially designed instruction.
The school system has a responsibility to utilize existing resources and strategies in the general education setting prior to initiating a special education referral. Specific research-based interventions must be implemented and documented in the general education setting. This supportive educational assistance should be provided for a sufficient period of time (e.g. 6-8 weeks) to modify the targeted behavior and should be evaluated to determine its effectiveness. The student is considered to need specially designed instruction if he or she continues to manifest behaviors consistent with the definition in spite of the interventions.
The social maladjustment exclusionary clause in the federal definition of serious emotional disturbance has caused considerable confusion and controversy for those educators assigned the responsibility of making eligibility determinations for special education services. The merits and problems associated with the exclusion have been widely debated (Bower, 1982; Clarizio, 1987; CCBD, 1987, 1990; Kauffman, 1980; Long, 1983; Neel & Rutherford, 1981; Nelson & Rutherford, 1990; Peterson, Benson, Edwards, White & Rosell, 1986; Skiba & Jackson, 1989; Merrell & Walker, 2004). Neither the Individuals with Disabilities Education Act nor its implementing regulations define the term "social maladjustment." Consequently this has led to considerable disagreement concerning the Congressional intent in formulating the exclusionary clause. (Bower, 1982; Center, 1989,1990; Clarizio, 1987; Raiser & Van Nagel, 1980; Slenkovich, 1983; Wood, Cheng, Cline, Smith & Geutzloe, 1989).
With the absence of federal guidelines, some professionals (DeYoung, 1984; Kester, 1983; Slenkovich, 1983) have advocated the utilization of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association classification system for identifying social maladjustments. This system equates internalized emotional problems with serious emotional disturbance, and externalized behavior or conduct problems with social maladjustment. Inherent in this approach is the limited reliability of the diagnostic judgements based on symptomatology for which this system is based. Several studies have indicated that the interrater reliability of the DSM ranges from .50 to .55 (Achenbach, 1985; APA, 1980; Tharinger et al., 1986; Werry, Methven, Fritzpatrick & Dixon, 1983).
Other professionals have advocated for the use of behavioral checklists or rating scales to differentiate social maladjustments from serious emotional disturbances. This approach stems from the premise that the presence of two dichotomous dimensions of behavioral disorders--internalizing and externalizing--is an adequate basis for making the distinction between serious emotional disturbance and social maladjustment. However, this suggests that conduct problems and emotional disturbances are distinct and separate categories, an approach which does not appear to be supported by historical, legal, or empirical sources.
Contrary to attempts by many to provide restrictive interpretations, the federal definition, with its wide range of defining characteristics of the group eligible for services as seriously emotionally disturbed, has served to assure heterogeneity. Practitioners in the field are aware that the vast majority of students referred and served by special education as seriously emotionally disturbed exhibit problems which are externalizing, acting out, or conduct related. They are also aware that students' conduct disorders and emotional disturbances do not fit neatly into mutually exclusive categories. It is very common for students who have conduct problems to also be found to have one or more other problems such as attention-deficit/hyperactivity or depression at the same time (Gresham, Lane & Lambros, 2000; Lahey & Loeber, 1997; Lahey, McBurnett & Loeber, 2000, Davis, Sheeber, & Hops, 2002). Therefore efforts to apply strictly defined boundaries in the diagnostic process are questionable given the realities of human behavior.
Differential diagnosis for social maladjustment has been plagued by a multitude of measurement problems. Extensive review of the methodology for distinguishing serious emotional disturbance and social maladjustment indicates that there is no assessment device or methodology which is both technically adequate and validated specifically for the purpose of distinguishing social maladjustment (Skiba & Grizzle, 1991).
Despite the fact that empirical support for using the socially maladjustment exclusion does not appear to exist, the federal definition and a clear majority of state regulations include the clause in their procedures (Wright et. al., 1990). The clause appears to exclude students from being labeled as handicapped if they present delinquent behavior which they are fully capable of controlling and for which they are provided social support.
If the practitioner in the field suspects a child has behavioral or emotional difficulties and is in need of special education services, the evaluation team must conduct a comprehensive multi-faceted evaluation that addresses all areas of the eligibility criteria in the definition. The results of such evaluation should be the primary consideration for eligibility determination. For educational purposes, medical and/or psychiatric diagnoses do not, in and of themselves, qualify a child as seriously emotionally disturbed. This eligibility determination can only be made by a properly constituted IEP team of persons knowledgeable about the student. If, after reviewing the results of an appropriate evaluation, the team is satisfied that the student meets the criteria for seriously emotionally disturbed, it is inconsequential whether the student may also be socially maladjusted. Under the federal and state definitions, if the child meets one or more of the five identifying characteristics and the four considerations, he or she is eligible for special education services regardless of the presence or lack of social maladjustment.