Emotional Disturbance
NICHCY Disability Fact Sheet #5
June 2010
The mental health of our children is a natural and impor-tant concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnod and untr
eated for years.1
We refer to mental
disorders using different “um-brella” terms such as emotional disturbance, behavioral disor-ders, or mental illness. Beneath the umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. The include (but are not limited to):•anxiety disorders;
•bipolar disorder (sometimes called manic-depression);•conduct disorders;•eating disorders;•obssive-compulsive disorder (OCD); and •
psychotic disorders.
You may be reading this fact sheet with one of the specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either ca, keep reading to find out what differ-ent emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disor-ders.
Definition
We’ve chon to u the term “emotional disturbance”in this fact sheet becau that is
the term ud in the nation’s special education law, the Individuals with Disabilities Education Act (IDEA). IDEA defines emotional disturbance as follows:
“...a condition exhibiting one or more of the follow-ing characteristics over a long period of time and to a marked degree that adverly affects a child’s educational performance:(A) An inability to learn that cannot be explained by intellectual, nsory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relation-ships with peers and teachers.
(C) Inappropriate types of behavior or feelings under normal circum-stances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symp-toms or fears associated with personal or school problems.”
2
is the
National Dismination Center for Children with Disabilities.NICHCY
1825 Connecticut Avenue N.W .
Washington, DC 200091.800.695.0285 (Voice / TTY)202.884.8200 (Voice / TTY)
nichcy@fhi360 nichcy
As defined by IDEA, emo-tional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.3
Characteristics
As is evident in IDEA’s definition, emotional distur-bances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person’s physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness (NAMI) puts this very well:
Mental illness are
medical conditions that
disrupt a person's
thinking, feeling, mood,
ability to relate to others
and daily functioning.
Just as diabetes is a
disorder of the pancreas,
mental illness are
medical conditions that
often result in a dimin-
ished capacity for
coping with the ordi-
nary demands of life.4
Some of the characteristics and behaviors en in children who have an emotional distur-bance include:•Hyperactivity (short atten-tion span, impulsiveness);•Aggression or lf-injurious behavior (acting out,
fighting);
•Withdrawal (not interacting socially with others, exces-
sive fear or anxiety);•Immaturity (inappropriate
crying, temper tantrums,
poor coping skills); and
•Learning difficulties (aca-
demically performing below
grade level).
Children with the most
rious emotional disturbances
may exhibit distorted thinking,
excessive anxiety, bizarre motor
acts, and abnormal mood
swings.
Many children who do not
have emotional disturbance
may display some of the same
behaviors at various times
during their development.
However, when children have
an emotional disturbance, the
behaviors continue over long
periods of time. Their behavior
signals that they are not coping
with their environment or
peers.
Caus
No one knows the actual
cau or caus of emotional
disturbance, although veral
factors—heredity, brain disor-
der, diet, stress, and family
functioning—have been sug-
gested and vigorously re-
arched. A great deal of re-
arch goes on every day, but to
date, rearchers have not found
that any of the factors are the
direct cau of behavioral or
emotional problems.
According to NAMI, mental
illness can affect persons of
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any age, race, religion, or
income. Further:
Mental illness are not
the result of personal
weakness, lack of
character, or poor
upbringing. Mental
illness are treatable.
视觉区
Most people diagnod
with a rious mental
illness can experience
relief from their symp-
toms by actively partici-
pating in an individual
treatment plan.5
F requency
According to the CDC
(Centers for Dia Control
and Prevention), approximately
8.3 million children (14.5%)
aged 4–17 years have parents
who’ve talked with a health care
provider or school staff about
the child’s emotional or behav-
ioral difficulties.6 Nearly 2.9
million children have been
prescribed medication for the
difficulties.7
Help for
School-Aged Children
IDEA requires that special
education and related rvices
be made available free of charge
to every eligible child with a
disability, including
preschoolers (ages 3-21). The
rvices are specially designed
to address the child’s individual
needs associated with the
disability—in this ca, emo-
tional disturbance, as defined
by IDEA (and further specified
by states). In the 2003-2004三水一生
school year, more than 484,000
children and youth with emo-
tional disturbance received
the rvices to address their individual needs related to emotional disturbance.8
Determining a child’s eligibility for special education and related rvices begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.
There is a lot to know about the special education process, much of which you can learn at NICHCY. We invite you to read the wide range of publications we offer on the topic, especially tho listed in the box below.
A Look at Specific
Emotional Disturbances
As we mentioned, emo-tional disturbance is a com-monly ud umbrella term for a number of different mental disorders. Let’s take a brief look at some of the most common of the.
Anxiety Disorders
We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persis-tent, emingly uncontrollable, and overwhelming. An irratio-nal fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.
As with the term emotional disturbance, “anxiety disorder”is an umbrella term that actu-ally refers to veral distinct disabilities that share the core characteristic of irrational fear: generalized anxiety disorder (GAD), obssive-compulsive disorder (OCD), panic disorder,posttraumatic stress disorder
(PTSD), social anxiety disorder
(also called social phobia), and
specific phobias.9
According to the Anxiety
Disorders Association of
America,anxiety disorders are
the most common psychiatric
illness affecting children and
adults.10 They are also highly
treatable. Unfortunately, only
about 1/3 of tho affected
receive treatment.11
Bipolar Disorder
Also known as manic-
depressive illness, bipolar
disorder is a rious medical
condition that caus dramatic
mood swings from overly
“high” and/or irritable to sad
and hopeless, and then back
again, often with periods of
normal mood in between.
Severe changes in energy and
behavior go along with the
changes in mood.12
For most people with
bipolar disorder, the mood
swings and related symptoms
can be stabilized over time
using an approach that com-
bines medication and psychoso-
cial treatment.13
Conduct Disorder
Conduct disorder refers to a
group of behavioral and emo-
tional problems in youngsters.
Children and adolescents with
this disorder have great diffi-
culty following rules and
behaving in a socially accept-
able way.14 This may include
some of the following behav-
iors:
•aggression to people and
animals;
•destruction of property;
•deceitfulness, lying, or
stealing; or
•truancy or other rious
violations of rules.15
Read More about the
Special Education Process at NICHCY
•10 Basic Steps in Special Education
nichcy/schoolage/steps/
•Questions Often Asked by Parents about Special Education Services nichcy/publications/lg1
•Evaluating Children for Disability
nichcy/schoolage/evaluation/
•Developing Your Child’s IEP
nichcy/publications/pa12
Although conduct disorder is one of the most difficult behavior disorders to treat, young people often benefit from a range of rvices that include:
•training for parents on how to handle child or adoles-
cent behavior;
•family therapy;
•training in problem solving skills for children or adoles-
cents; and
•community-bad rvices that focus on the young
person within the context of
family and community
influences.16
Eating Disorders
Eating disorders are charac-terized by extremes in eating behavior—either too much or too little—or feelings of extreme distress or concern about body weight or shape.Females are much more likely than males to develop an eating disorder.17 Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by lf-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then lf-induced vomiting or purging. Both of the disorders are potentially life-threatening.18 Binge eating is also consid-ered an eating disorder. It’s characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward
by vomiting or using laxatives.19
According to the National
Eating Disorders Association:
The most effective and
long-lasting treatment for
an eating disorder is some
form of psychotherapy or
counling, coupled with
careful attention to
medical and nutritional
needs. Some medications
have been shown to be
helpful. Ideally, whatever
treatment is offered
should be tailored to the
individual, and this will
vary according to both the
verity of the disorder
and the patient’s indi-
vidual problems, needs,
and strengths.20
Obssive-Compulsive Disorder
Often referred to as OCD,
obssive-compulsive disorder
is actually considered an anxiety
disorder (which was discusd
earlier in this fact sheet). OCD
is characterized by recurrent,
unwanted thoughts (obs-
sions) and/or repetitive behav-
iors (compulsions). Repetitive
behaviors (handwashing,
counting, checking, or cleaning)
are often performed with the
hope of preventing obssive
thoughts or making them go
away. Performing the so-
called “rituals,” however,
provides only temporary relief,
and not performing them
markedly increas anxiety.21
A large body of scientific
evidence suggests that OCD
results from a chemical imbal-
ance in the brain.22 Treatment
for most people with OCD采茶
黎明现象
should include one or more of
the following:
• a therapist trained in
behavior therapy;
•Cognitive Behavior Therapy
(CBT)
•medication (usually an
antidepressant).23
Psychotic Disorders
“Psychotic disorders” is
another umbrella term ud to
refer to vere mental disorderscad安装
that cau abnormal thinking
and perceptions. Two of the
main symptoms are delusions
and hallucinations. Delusions
are fal beliefs, such as think-
罗田天堂寨ing that someone is plotting
骑兵社区against you. Hallucinations are
fal perceptions, such as
hearing, eing, or feeling
something that is not there.
Schizophrenia is one type of
psychotic disorder.24 There are
others as well.
Treatment for psychotic
disorders will differ from person
to person, depending on the
specific disorder involved. Most
are treated with a combination
of medications and psycho-
therapy (a type of counling).
25
More about
School
As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional distur-bance may be eligible for special education and related rvices in public school. The
rvices can be of tremendous help to students who have an emotional disturbance.
Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increa lf-awareness, lf-control, and lf-esteem. A large body of rearch exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are mini-mized and positive, appropriate behaviors are fostered. (See the resource ction at the end of this fact sheet for more informa-tion on PBS.) It is also impor-tant to know that, within the school tting:
•For a child who behavior impedes learning (including
the learning of others), the
team developing the child’s
Individualized Education
Program (IEP) needs to
consider, if appropriate,
strategies to address that
behavior, including positive
behavioral interventions,
strategies, and supports.•Students eligible for special
education rvices under the
category of emotional
disturbance may have IEPs
that include psychological
or counling rvices.
The are important related
rvices available under
IDEA and are to be pro-
vided by a qualified social
worker, psychologist,
guidance counlor, or
other qualified personnel.
Other Considerations
Children and adolescents
with an emotional disturbance
should receive rvices bad on
their individual needs, and
everyone involved in their
education or care needs to be
well-informed about the care
that they are receiving. It’s
important to coordinate rvices
between home, school, and
community, keeping the com-
munication channels open
between all parties involved.
T he Importance of Support
Families often need help in
understanding their child’s
disability and how to address
the needs that ari from the
disability. Help is available from
psychiatrists, psychologists, and
other mental health profession-
als that work in the public or
private ctor. There is also a
network of mental health
support operating in every state
as well as locally.
To locate systems of support
in your community or state,
visit the organizations we’ve
listed in the box on the next
page. They can connect you
with local resources, including
support groups that provide
connection and understanding,
information, referral, and
advocacy for tho living with
emotional disturbance.
References
1 National Institute of Mental
Health (NIMH). (2010). Child
and adolescent mental health.
Available online at:
www.v/health/topics/
child-and-adolescent-mental-
health/index.shtml
2Code of Federal Regulations, Title
34, §300.8(c)(4)(i)
3Code of Federal Regulations, Title
34, §300.8(c)(4)(ii)
4 National Alliance on Mental
Illness. (2010). What is mental
illness: Mental illness facts.
Available online at:
5 Ibid.
F or Science T
or Science Teachers and T
eachers and T
eachers and Their Students in Grades 6-8:
heir Students in Grades 6-8:
T he Science of Mental Illness
This inquiry-bad curriculum from the National Institutes of
Health is designed to help students in grades 6-8 gain a better
understanding of the biological basis of mental illness and
what mental illness are—and what they are not.
science.v/supplements/nih5/mental/default.htm
