ED and Trauma: How the EDDT Can Help

Why should psychologists and other clinicians assess for emotional disturbance (ED) in the school setting? Parents and caregivers of 8.3 million school-aged children (ages 4 to 17 years) have sought help from school staff or mental health professionals about their child's emotional or behavioral difficulties. Approximately 7.5% of children ages 6 to 17 years  used prescribed medication during the past 6 months for emotional or behavioral difficulties. Assessment of ED is necessary in the school setting to help children obtain the emotional and behavioral support services they need to be successful.

Over the past 20 years, the number of students served within special education has steadily increased, while the number of students being served under ED eligibilities has steadily decreased. For example, during the 2000-2001 school year, 6.29 million students received special education services with 7.6% of those students identified as having an ED. Although the population of students receiving special education services grew by almost one million children to 7.13 million over the next 18 years, only 5% were identified as having an ED during the 2018-2019 school year.

How to improve emotional disturbance identification

How can we improve ED identification and help children obtain the services they need to be successful in school? It is the school's responsibility and a school psychologist's professional role to find children who are struggling emotionally and behaviorally, identify them through the evaluation process, and then connect them with appropriate services and interventions so they can begin to heal and make educational, social, emotional, and behavioral progress.

When completing assessments for ED, we need to carefully consider and adhere to specific eligibility criteria while distinguishing the difference between social maladjustment (SM) and ED. Practitioners also need to consider DSM-V-related diagnoses as well as the impact of trauma, adverse childhood experiences (ACES), and the pandemic on the child's functioning. It is also imperative to be cognizant of racial disproportionality in determining eligibility for ED services (see NASP Position Statement: Racial and Ethnic Disproportionality in Education).

ED assessments should include impact of trauma

Assessments of ED need to be comprehensive and include multiple tests and information from a variety of sources. Clinical interviews with the student, caregivers, and teachers, as well as observations of the student in the natural environment are paramount. Trauma, ACES, and the pandemic also need to be considered in the assessment of ED. Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious threat to a child's physical or psychological wellbeing, including child abuse, neglect, divorce, bullying, poverty, and community violence. Adverse experiences can have profound consequences, particularly when they occur early in life, are chronic, and accumulate over time. Trauma is an outcome of exposure to adversity while adversities are the cause of trauma. Trauma affects everyone differently, depending on individual, family, and environmental risk, as well as protective factors.

Repeated or prolonged trauma in addition to the effects of the pandemic can have a litany of adverse outcomes on our children in the areas of cognition, brain development, behavior, emotions, mental health, physical health, and relationships. These factors need to be considered in a comprehensive evaluation for ED.

Assess for ED with the EDDT and map directly to IDEA criteria

Since the start of the pandemic, we have seen a significant increase in kids struggling with both emotional and behavioral difficulties. This increase may lead to an uptick in the number of ED-related assessment referrals that come across our desks and the number of students who require special education services. This leads us into how we assess children for an ED and the benefits of using the Emotional Disturbance Decision Tree (EDDT)

Dr. Bryan Euler, the author of the EDDT, has worked as a school counselor, diagnostician, lead school psychologist, and a clinical psychologist. While working in the Albuquerque public schools, Dr. Euler teamed up with PAR to create the EDDT to provide a standardized approach to the assessment of ED. It was designed to directly address the framework of the federal ED eligibility criteria; for every component of the federal ED criteria, there's a corresponding EDDT scale or cluster. The scales within the assessment are written to address these broad domains thoroughly, then help school psychologists apply the specific criteria to make informed decisions on both eligibility and programming.

The EDDT includes all the relevant aspects of the federal ED criteria. It contains scales and clusters that address each of the specific ED criteria. The structure of the EDDT walks the practitioner through each area of the federal ED criteria.

• Section 1 reviews the important exclusionary items to address an inability to learn that can't be explained by other factors.
• Section 2 Part A examines the 4 important characteristics we look for in ED (building/maintaining relationships, inappropriate behaviors/emotions, depression factors, and physical symptoms and fears).
• Section 2 Part B serves as a screener for characteristics of both ADHD and schizophrenia/psychosis.
• Section 3 assesses the characteristics of social maladjustment.
• Section 4 measures the level of severity, where we examine the magnitude of the symptoms and characteristics the student is exhibiting. 
• Section 5 helps determine the level of educational impact that these issues may be causing in school.

Bryan Euler, PhD, describes the benefits of the EDDT and the importance of multiple informants, including the student's perspective, here.

Include multiple rater and interviews as best practice

There are several best practices to keep in mind with the EDDT: Include the viewpoint of multiple raters (teacher, parent, and/or self) from different settings (school, home, and community). Use the EDDT as part of a comprehensive evaluation to determine ED eligibility. In addition to the EDDT, be sure to include qualitative information such as interviews (from the student, parents, and/or teachers) and observations across school settings to supplement the data received on the EDDT.

Carrie Champ Morera, PsyD and Theo Miron, PsyS will present on the EDDT at the National Association of School Psychologists (NASP) annual convention in February. In their presentation, Assessing Emotional Disturbance in Schools Using the Emotional Disturbance Decision Tree (EDDT), they will explore the features and trends in ED and investigate the structure and use of the EDDT. If you attend NASP, feel free to stop by the PAR booth to learn more about how PAR can meet your assessment needs.