How Are Children With Serious Emotional Disturbance Supported Within Public School Systems Across America?

It is estimated that almost one fourth of the 74.5 million children in the United States have a psychiatric disorder or have previously been diagnosed with one. This represents more than the number of American children with cancer, diabetes, and AIDS combined.¹ Preschool and school-age children (ages 3–21) with emotional disturbances make up one group of children with special needs who are covered by the Individuals with Disabilities Education Act (IDEA). The act, first made into law in 1975 and amended by Congress in 1997 and 2004, requires that schools provide free education to students with a disability, and that the education be tailored to students’ individual needs.²

Under the law, an emotional disturbance is defined as

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:

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


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


3. Inappropriate types of behavior 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 [Code of Federal Regulations, Title 34, §300.8(c)(4)(i)]

Notably, these characteristics alone are insufficient for a child to be eligible for special services under IDEA. As stated above, the condition must also adversely affect the child’s ability to learn. For example, a child with an anxiety disorder diagnosis may perform well in school and thus not be eligible for services under IDEA.³

If a child is suspected of meeting the above criteria, a referral for evaluation may be made by school personnel or requested from the parent. In either case, a parent or guardian must provide explicit consent for an evaluation to take place. The evaluation will be used to determine the child’s eligibility, educational needs, and services available to address those needs. Under IDEA, this evaluation is provided in public schools free of charge.

Once it is confirmed that a child is eligible for services, a team consisting of the child’s parents and school professionals work together to determine and put into writing an individualized education program (IEP). IEPs are intended to address learning deficits and provide school personnel with a plan for providing services, accommodations, and modifications designed to assist the child in learning academic materials. The IDEA law additionally requires that all service providers, including teachers and school professionals, be familiar with the child’s IEP and their roles in providing the services as described therein.

In carrying out the child’s IEP, teachers and service providers make available adaptations, accommodations, modifications, and supports to the child. There are many different types of supports that can be offered to children with an emotional disturbance.

Special Education
Special education is “specially designed instruction,” defined by IDEA as appropriately adapting the content, methodology, or delivery of instruction to address the unique needs of the child that result from the child’s disability, and to ensure the child has access to the general curriculum, so the child can meet educational standards.

Adapting Instruction
Sometimes a student may need to have changes made in classwork or routines because of his or her disability. Modifications can be made to what a child is taught or how the child works at school. Modifications are most often made in the following areas:

1. Scheduling (for example, giving the child more time to complete an assignment or test)


2. Setting (e.g., working one-on-one with the teacher rather than in a group)


3. Materials (e.g., books on CD)


4. Instruction (e.g., using a student/peer tutor)


5. Student response (e.g., allowing answers to be given orally rather than in writing)

Related Services
Related services support children’s special education, and may include transportation, developmental, corrective, and other supportive services necessary to assist a child with a disability to benefit from special education. Some examples are psychological services, counseling services, social work services provided in schools, and recreation, including therapeutic recreation.

Supplementary Aids and Services
These types of additional services and supports may include a one-on-one aide, peer tutors, or training for staff, students, or parents.

Program Modifications or
Supports for School Staff
Supports are also available for the school staff members who work with the child. These supports would also be written into the child’s IEP. These may include attending a conference or training related to the child’s needs, having an aide in the classroom, or getting help from another staff member or administrative person.³

The school’s adherence to the IEP and the child’s progress within the program must be monitored, measured, and periodically reported to the parents.
More than 354,000 children and youths with emotional disturbance received services under IDEA in the 2013–14 school year to address their individual needs.⁴

However, many researchers and educators have pointed out some of the challenges to providing educational support for children with emotional/behavioral disorders, despite the IDEA’s best intentions. For example, Lewis and colleagues (2010⁵) state that the IDEA specifies a medical model, rather than an educational model, in determining a diagnosis. Additionally, they argue that the current definition of severely emotionally disturbed significantly under-identifies the number of children who require additional supports or services.⁶ Currently, fewer than 1 percent of students in the United States are identified as having an emotional or behavioral disorder, although the generally accepted prevalence rates among students in kindergarten through 12th grade range from 5 percent to 7 percent.

Although a large proportion of students receiving services for emotional/behavioral disorders spend some time in a general education classroom, they tend to do so significantly less often than students with other disabilities. One study found that 30.0 percent of elementary and 32.9 percent of middle school students with emotional/behavioral disturbances spend some time in special education classrooms, compared with 13.7 percent of elementary and 17.8 percent of middle school students with other disabilities.⁶ However, some proponents of exclusionary settings argue that these specialized environments might better serve students with emotional/behavioral disorders because they may receive more benefit academically and behaviorally by being in a smaller classroom with fewer students, more paraprofessionals, and a specially trained special education teacher.⁶

Unfortunately, the use of evidence-based programs and practices is not common in programs for students with emotional/behavioral disorders. Two studies found that fewer than half of students with emotional/behavioral disorders received behavioral interventions or mental health services within the school setting. In one study of teachers of students with emotional/behavioral disorders, 29.8 percent reported making “some” modification to the curriculum, and 15.7 percent reported making “substantial” modification. Almost 20 percent of the teachers reported not using any curriculum at all. Students in this study did tend to receive accommodations, although the range of accommodations used was narrow.

Since IDEA was first passed in 1975, special education has evolved considerably. More involvement of parents and educators, greater societal awareness about disability issues, and the passage of IDEA have all contributed to better access to public education for students with disabilities, earlier identification of disabilities, an infrastructure for educating children with disabilities, and greater inclusion in general education classrooms. Despite these advances, there is little evidence regarding the effectiveness of the services that special education students receive.²

How effective these services are is not an easy question to answer, for several reasons.

One challenge is a lack of accurate measures to assess academic achievement, attendance, grade promotion, and engagement in school activities. Benchmarks for educational outcomes are not clearly agreed on and may vary across students with disabilities. There is a paucity of good data on the interventions and types and amounts of services these students receive. It is difficult to disentangle the effects of special education services received and other variables, such as their general education experiences. As a result, relatively little research has been conducted on the efficacy of specific special education programs or practices.²

What little research there is shows continuing problems and very little improvement in academic, social interaction, and long-term outcomes.^{2, 6} Several well-known longitudinal studies of students with emotional/behavioral disorders began in the early 1980s. These studies found that students with emotional/behavioral disorders have the poorest outcomes of any of the disabilities covered through the IDEA law.

Half of all of those with emotional/behavioral disorders drop out of school; of those who remain, only about half graduate.^{2, 5, 6} They also earn the lowest grades and fail more classes than students with any other disability.⁷ Seventy-five percent of students with emotional/behavioral disorders are below grade level in reading, and 97 percent are below grade level in math.⁶

Discipline is a big issue with children with emotional/behavioral disorders because their disability and their behavior are closely related. Behavioral problems are increasing among children with disabilities, and schools continue to struggle with how to manage those problems. A major emphasis of special education law and regulations is whether students with behavioral problems and other disabilities can or should be disciplined.² In one study, the students’ general education academic teachers reported that 36.4 percent of their elementary students, 42.3 percent of their middle school students, and 53.5 percent of their high school students with emotional/behavioral disorders were subject to the same disciplinary policies as their nondisabled peers. Bradley and colleagues (2008⁶) state, however, that in practice it appears that students with emotional/behavioral disorders probably receive more severe disciplinary procedures. Additionally, students with disabilities are most likely to be negatively affected by zero-tolerance discipline policies.²

Unsurprisingly, students with emotional/behavioral disorders are suspended and expelled at almost triple the rates of the general school population.⁶ Before leaving school, 20 percent are arrested at least once, and more than half are arrested within a few years of leaving school. Additionally, of those who have dropped out of school, 70 percent have been arrested.⁵

In addition to involvement with the justice system, many studies of students with disabilities have found poorer outcomes related to adjusting to adult life in the years after high school, compared with their peers without disabilities. These individuals have difficulties with personal relationships, are less likely to receive any postsecondary education, are less likely to live independently, and are more likely to deal with substance misuse, poor social supports, and unemployment after leaving school. Within 3 years of leaving school, only half of those with emotional/behavioral disorders are employed, compared with nearly two thirds of individuals with learning disabilities.^{2, 5, 6} Although IDEA requires transition planning, many students who drop out of school never receive it. For those students who do receive it, it is not clear whether it is helping.²
Children with emotional/behavioral disorders would greatly benefit from linking mental health services along with their special education classroom services. One advantage to this pairing is that those with mental health difficulties tend to have lower academic performance and higher rates of suspensions and expulsions. A second advantage is that teachers and other school staff, particularly in urban and high-crime communities where student-to-staff ratios are high, often do not have the resources or skills to manage children with high needs.

Despite these advantages, fewer than 40 percent of youths with severe emotional disturbances are receiving mental health services in addition to their special education classroom services. That is likely due to several reasons, including school staffs’ attention being drawn toward testing and crisis intervention more so than providing support. Also, those in the school systems believe these services are medical or psychological, and not educational. And school districts and other local agencies disagree about whose responsibility it is to provide and pay for these types of services.⁷

An approach called Response to Intervention (RtI) was introduced with the reauthorization of IDEA in 2004. With this approach, documentation of a discrepancy between cognitive ability (e.g., IQ) and academic achievement is no longer a requirement for eligibility for special education services. Instead, educators can document that the student is not benefiting from being in the general education setting even with additional supports and accommodations put in place.⁵

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