ED or conduct disordered A standardized approach

1. ED or conduct disordered? A standardized approach Presented by: Jennifer Henderson and Kris Martin School Psychologists, Liberty Public Schools

2. Prevalence of Emotional Disturbance -According to the National Center for Educational Statistics 283,000 children age 3-21 years old were receiving special education services for the Emotionally Disturbed in 1976-1977. -That number had risen to 442,000 in 2007-2008 for the same population.

3. Assessment of Emotional Disturbance Since the inception of the first Education for All Handicapped Children Act of 1975, educational professionals have employed various means of assessing emotional disturbance. -Classroom-based behavioral observations and teacher reports -Direct clinical assessments of students involving projective-type instruments Standardized measures

4. Assessment (cont.) -The lack of uniformity and standards across the ED domain exceeds that seen in other exceptionalities and the significance of the problem has grown just as the numbers and percentages of students with ED have grown.

5. Existing Measures of Emotional Disturbance Scale for Assessing Emotional Disturbance (SAED) Behavioral Assessment System for Children � 2nd Edition (BASC-2) Clinical Assessment of Behavior (CAB) Child Behavior Checklist (CBCL) Differential Test of Conduct and Emotional Problems (DTCEP)

6. Some Problems with Existing Measures Are not directly linked with federal criteria for eligibility under the category of ED Do not distinguish between ED symptomology and OHI symptomology (such as that present with ADD/ADHD) Do not appropriately measure limiting or exclusionary criteria Unclear sample and normative data

7. Emotional Disturbance Decision Tree

8. Development of the EDDT Designed as a tool to make structured, sequential decisions about ED eligibility Prevents users from having to make �interpretive leaps� when assessing eligibility that are necessary when using other instruments. Includes 5 sections that match up with federal criteria Product of 3 separate pilot studies spanning more than 2 years

9. Development of the EDDT Developed in a large, multiethnic New Mexico school district by a practicing Clinical School Psychologist Reliability coefficients quite high, ranging from .86 to .95 (median = .87) Validity data strongly supports the ability of the EDDT to differentiate between normal and emotionally disturbed behavior. looking at internal consistency, test-retest, and inter-rater reliability Validity consistent with BASC-2 and looking at internal consistency, test-retest, and inter-rater reliability Validity consistent with BASC-2 and

10. Raters Completed by school staff only Can be completed by an individual or as a school team EDDT was not designed for parent or caregiver use A second measure, such as the BASC-2 or SAED, is needed to determine whether or not behaviors are present across settings

11. Purpose of the Emotional Disturbance Decision Tree (EDDT) -The intent of the EDDT is to aid in the identification of children who are eligible for special education services under the Individuals with Disabilities Education Improvement Act of 2004 with regard to the category of Emotional Disturbance. -The EDDT assists school-based teams to consider all of the factors needed to make decisions about eligibility for special education services.

12. Purpose (cont.) -The EDDT is designed to map onto the federal Special Education criteria for ED eligibility by including what the author terms inclusionary criteria, as well as exclusionary criteria, which may rule out eligibility (if not met). An important distinction between the EDDT and other social/emotional scales is that the EDDT is designed to map onto the federal Special Education criteria for ED eligibility by including what the author terms inclusionary criteria, which support potential ED eligibility, as well as exclusionary criteria, which may rule out eligibility (if not met). An important distinction between the EDDT and other social/emotional scales is that the EDDT is designed to map onto the federal Special Education criteria for ED eligibility by including what the author terms inclusionary criteria, which support potential ED eligibility, as well as exclusionary criteria, which may rule out eligibility (if not met).

13. Inclusionary Criteria -An inability to build or maintain satisfactory interpersonal relationships with peers and teachers -Inappropriate types of behavior or feelings under normal circumstances -Pervasive mood of unhappiness or depression -Physical symptoms or anxiety associated with personal or school problems -Schizophrenia

14. Exclusionary Criteria -Learning problem cannot be caused solely by IQ, sensory, or health deficits -Problem cannot represent social maladjustment alone -Adequate duration required (�present for a long period� = beyond short-term or temporary) -Adequate severity required (�present to a marked degree = meaningful level) -Adequate educational impact required (�adversely affects performance� = meaningful level)

15. Criteria (cont.) By including all of the inclusionary and exclusionary criteria listed in the federal regulations, a decision tree model is formed, whereby evaluators (IEP Team) can work through the criteria in a sequential manner. By including all of the inclusionary and exclusionary criteria listed in the federal regulations, a decision tree model is formed, whereby evaluators (IEP Team) can work through the criteria in a sequential manner with the goal of enhancing federal compliance in regard to ED eligibility. By including all of the inclusionary and exclusionary criteria listed in the federal regulations, a decision tree model is formed, whereby evaluators (IEP Team) can work through the criteria in a sequential manner with the goal of enhancing federal compliance in regard to ED eligibility.

16. Criteria (cont.) It is also important to note that a medical diagnosis that is considered �emotional� in nature (depression, mood disorder, etc.) is not required for eligibility under the label of ED; AND An existing medical diagnosis also does not qualify a student as ED in and of itself unless educational impact can be established

17. Distinguishing ED from CD/BD What ED is��� Inability to Build or Maintain Relationships Pervasive Mood of Depression Unusual Physical Symptoms/Fears Inappropriate Behaviors/Feelings High impact and severe effect on educational performance. What ED is NOT�� A single or short term episode of problem behavior(s) Mild behavior concerns or �annoyances� A disorder of social maladjustment An inability to learn that can be explained by intellectual, sensory, or health factors

18. EDDT Clusters -Social Maladjustment -Level of Severity -Educational Impact -Attention Deficit-Hyperactivity Disorder -Possible Psychosis/Schizophrenia

19. Social Maladjustment Cluster Various aspects of socially maladjusted behavior are: -Aggressive or rule-breaking behavior -Calloused, manipulative, and narcissistic attitudes -School-aversive attitudes and behavior Other characteristics include: - Low tolerance for structure - Impaired sense of right and wrong - Aversion toward school - Deliberate failure in order to gain peer acceptance High clinical scores suggest a combination of aggressive acting out, rule-breaking behavior, along with a lack of regard for others, dishonesty, and rejection of authority. High clinical scores suggest a combination of aggressive acting out, rule-breaking behavior, along with a lack of regard for others, dishonesty, and rejection of authority.

20. Social Maladjustment Cluster (cont.) A Moderate Clinical score suggests fewer of these behaviors or traits. Mild At-Risk suggests that the student is much closer to normal in their acceptance of rules and authority and in their likelihood of empathizing with others. A Normal score suggests no meaningful problems in the area of social maladjustment

21. Attention-Deficit Hyperactivity Disorder (ADHD) Cluster Purpose is to aid in the differentiation of ED behaviors from ADHD behaviors -Challenging because these two areas often overlap behaviorally. This cluster incorporates a combination of hyperactivity/impulsive items and items that measure the capacity to focus, concentrate, organize, self-regulate, listen, and remember.

22. Attention Deficit (cont.) High Clinical or Moderate Clinical scores may likely have ADHD, which could be contributing to their school adjustment problems. Mild At-Risk and Normal scores suggest a lesser likelihood of ADHD. Further evaluation using additional teacher and parent ADHD rating scales along with sustained attention measures and observations should be conducted.Further evaluation using additional teacher and parent ADHD rating scales along with sustained attention measures and observations should be conducted.

23. Possible Psychosis/Schizophrenia Cluster This cluster is included because the federal definition for ED stipulates that students with schizophrenia fall under the ED umbrella. -Purpose is to help examiners determine if additional testing might be warranted in this area -High or Moderate Clinical scores suggest the possibility of a severe psychological disturbance and more intense psychological evaluation is required. Problems in this domain always require broad-based thorough assessment.Problems in this domain always require broad-based thorough assessment.

24. Level of Severity Items address -Frequency and setting of problems -Need for restraint -Need for a safety plan -Suspension -Outside treatment -Marked problems -Response to Intervention

25. Level of Severity (cont.) An elevated score on this cluster suggests potential eligibility for services and the need for intervention A High or Moderate Severity score suggests behaviors that are a serious obstacle to both school and personal adjustment A Mild Severity score is more likely to reflect problems that need only mild support A score that is Not Severe suggests that adjustment problems do not appear to be impacting observed behavior at school

26. Educational Impact This cluster addresses work completion, compliance with teacher direction, quality of work, behavior-related absences, the capacity for working without redirection, behavior-related suspensions, counseling, behavior intervention plans, and whether these interventions have been effective.

27. Educational Impact (cont.) A High Impact or Moderate Impact score � behaviors are a serious obstacle to school progress. -Adds to the picture of potential eligibility for services and the need for intervention. A Mild Impact score reflects problems that require only mild support A No Impact score suggests that adjustment problems do not appear to have an impact on observed behavior at school, even if they are present.

28. Contrasting Characteristics Emotional Disturbance vs. Social Maladjustment

29. Emotionally Disturbed Characteristics -Poor sense of reality -Incapable of maintaining interactive behavior with people -Lack of capacity for pleasure, rarely experiencing truly satisfying feelings Avoidance of people or severely withdrawn behavior Delusional thinking

30. Emotionally Disturbed Characteristics (cont.) Hallucinations Marked illogical thinking Behavior that is grossly disorganized or bizarre Excessive or patently inappropriate guilt Recurrent thoughts of death or suicide

31. Socially Maladjusted Characteristics Shows marked dislike for school Rebels against school routine and restrictions Inadequate conscience development Lack of guilt Inability to profit from mistakes Deviant social relationships

32. Socially Maladjusted Characteristics (cont.) Rejection of authority and discipline Quick ability to rationalize and project the blame for socially disapproved behavior Violates the rights of others Steals Substance Abuse Seeks immediate gratification

33. CASE STUDY Student: Roman Halls Age: 14 Behaviors: cutting class, disrespect towards teachers, fighting over the past 9 months Assessment Results: IQ: Full Scale � Average (106) EDDT: High Clinical in REL and IBF Mild Severity, Mild Impact Moderate in SM BASC-2: Overall BSI: Clinically Significant for problems noted in the areas of Aggression, Hyperactivity, and Attention

34. A Closer Look at ED Criteria