Unraveling the Emotional Disturbance and Social Maladjustment Dilemma

Katherine is an 8-year-old who attends public school. Following a traumatic event, she began to insist on wearing a helmet to school and during class. When school personnel requested she remove the helmet, she adamantly refused, expressing fear that the ceiling would fall and they would all be killed. Her grades have dropped considerably, and she is having problems socializing with peers. Her mother reports similar disruptions at home. Katherine’s grades have dropped to Ds and Fs, and her behavior has become disruptive in class. She cries frequently and has most recently expressed a desire to stay home from school.

Jeremy is a fifth grader who currently receives special education services under the category of emotional disturbance (ED) and other health impaired (OHI). One year after his initial ED diagnosis, he was diagnosed with autism spectrum disorder (ASD). His original ED eligibility was based on violent behavior in kindergarten and first grade. Once it became evident that his violent outbursts were related to characteristics associated with his ASD diagnosis and appropriate interventions were put into place, Jeremy was able to function more effectively at school. His grades are above average, and he has not experienced any behavioral outbursts since second grade. His parents are planning to place him in a private school and have requested an evaluation to eliminate the ED diagnosis. They believe the OHI eligibility is the most appropriate eligibility for him; the school administration and teachers agree.

Brian is a 15-year-old who was expelled from his last school. The administration at his home school considers him occasionally volatile and “a constant liar.” His mother confirms the lying and additionally reports daily fights between Brian and her live-in boyfriend. She states that “he hangs with a bad crowd, and his behavior is out of control.” Brian’s teachers describe him as a loner who appears sad throughout the school day. His grades have dropped from Bs to Ds and Fs.

These three cases exemplify the diversity and difficulty inherent with evaluating students who have been referred for a comprehensive assessment due to academic and/or behavioral concerns.

Instead, we began to see a decline. By the 2011-2012 school year, only 373,000 students were classified as having ED.  It appeared the numbers were dwindling. And by 2020–2021, only 5% of individuals receiving IDEA services were classified as having ED. That number decreased slightly to 4% in 2022–2023. Yet, we know that the number of families seeking help for their child’s behavioral and mental health issues has only increased since the COVID-19 pandemic.

Clearly, questions arise. What accounts for the disparity between those asking for help and those receiving services? How do we account for what may be an under-identification of ED? Are students with ED not receiving the services they need because they have not been identified properly? What can we put in place to stop the decline and get those who require help the services they need?

One of the greatest challenges in determining eligibility services involves the social maladjustment/emotional disturbance dichotomy. The term socially maladjusted (SM) has not been defined by IDEA. The federal definition of ED, which was written in 1957 and remains virtually unchanged, leaves the operationalization of the criteria set forth by IDEA to individuals and organizations in the field along with state and local educational agencies, who are responsible for implementing special education services.

To further complicate matters, we have only recently begun to question the longstanding belief that SM students externalize their behaviors, while ED students internalize their behaviors. However, since ED was defined in 1957, neuroscience has shown that “brain differences underlie both internalizing and externalizing behaviors,” says Richard M. Marshall, EdD, PhD, author of the Pediatric Behavior Rating Scale (PBRS). 

“From a neurobiological perspective, therefore, the only difference between the two is the expression of behavior. There is little evidence that students with externalizing behaviors are any more capable of controlling their emotions or behavior than students with internalizing disorders. Yet students with internalizing disorders are provided with interventions, while students with externalizing behaviors are punished.”

In addition to the difficulties defining and determining SM versus ED, the federal criteria definition includes two potential areas of ED eligibility that are very broad and have no clinical definition:

Lastly, we cannot negate the fact that in the past, psychologists lacked psychometrically sound instruments to provide them with the hard data needed to substantiate a well-informed decision in regards to ED eligibility.

Learn more about how the PBRS and the newly refreshed Emotional Disturbance Decision Tree (EDDT) can help you evaluate individuals with SM and ED.