Education of Emotionally Disturbed

Since enactment of the Education of All Handicapped Children Act of 1975, under 1 percent of school children have been identified for special education and related services as having serious emotional disturbance (SED); since 1997, the term emotional disturbance (ED) has been applied under the Individuals with Disabilities Education Act (IDEA). Although the percentage has remained stable for decades, professional estimates suggest the true prevalence is probably three to six times greater. An early twenty-first century report by the U.S. Surgeon General noted that only about one in five children and youth with ED receive mental health services or special education. Reasons for underidentification include economic factors, concern about a stigmatizing label, confusion among professionals, and a vague definition.

Federal legislation incorporates almost verbatim a definition proposed by Eli M. Bower in 1960, which includes five characteristics, one or more of which a student displays to a marked degree and over a long period of time: (1) an inability to learn, which 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; and (5) a tendency to develop physical symptoms or fears associated with personal or school problems. Federal language specifies that ED must adversely affect educational performance but does not specifically include social learning or behavior as "educational performance." The definition has been criticized as vague and highly subjective (e.g., what is "a marked extent," or a "long period of time"?), and an additional federal clause makes the definition self-contradictory. The addition is an exclusionary statement that the category "does not include children who are socially maladjusted, unless it is also determined that they are seriously emotionally disturbed" (45 C.F.R. 121a.5[b][8][1978]). Nevertheless, the federal definition remains unchanged.

In the 1990s an alternative definition and the term emotional or behavioral disorder (EBD) were proposed by the National Mental Health and Special Education Coalition. The coalition consisted of more than thirty professional organizations serving children's mental health needs. The proposed definition and terminology are thought to be less stigmatizing, to emphasize disorders of emotions and behavior, and they include disabling disorders excluded in the federal definition. Notwithstanding widespread support from coalition members, federal language has not changed. Administrators of special education oppose the alternative definition and terminology, fearing significant increases in the number of students qualifying for special education and related services.

The problems of students with ED are severe and chronic. Only those with the most severe disorders receive services, and appropriate educational services have remained a persistent challenge. Students with ED tend to be served in more restrictive settings (e.g., separate classrooms or schools instead of regular classrooms or schools) than their peers with other disabilities, and student outcomes (school completion, later employment, successful community adjustment) are poorer for students with ED. Research suggests that for children not receiving effective services before the age of eight years, ED should be viewed as a chronic, lifelong condition requiring continuing support services.

In the late twentieth century and into the twenty-first century, controversies surrounded the full inclusion of students with disabilities in regular schools and classrooms. ED students were generally ignored, although serious questions arose about the advisability and feasibility of including all students with ED in general education. Even as other students with disabilities were increasingly included in regular classrooms, those with ED were more likely to be educated in separate classes.

In 1990 Jane Knitzer, Zina Steinberg, and Brahm Fleisch highlighted the overemphasis in many programs on controlling acting-out behavior at the expense of a focus on instruction in academic skills and social behavior. Subsequently, others emphasized design and delivery of effective academic and social instruction.

Controversy continues about placement and programming. Growing evidence that early intervention and prevention are effective has not resulted in widespread prevention. A particular obstacle to truly effective services is the extreme difficulty in coordinating services from multiple agencies and fostering collaboration among schools and numerous community, family, and adult service providers. Awareness of the cultural differences in behavior is increasing. The complexity of the relationship between behavior and culture is underscored by simultaneous calls for increased attention to the mental health needs of students of minority ethnicity and complaints that students of color with ED are over-represented in special education.