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What is an emotional or behavioral disorder?

The process of identifying an emotional disorder is a difficult one for many reasons. For instance, it cannot be stated with certainty that something "goes wrong" in the brain, causing a child to act in a particular way. And, contrary to early psychiatric theories, it is impossible to conclude that a mother or father did something "wrong" early in the child's life, causing an emotional or behavioral disorder or mental illness.

Experts continue to disagree on whether emotional disorders have a genetic component or whether they are "caused" externally or internally. Promising research in the field of nuclear medicine has shown that the actual brain function - the way information is received and processed - is different for children with some types of emotional disorders than for children who do not have those problems.

While some professionals and parents may tend to latch onto simple explanations of why a child has an emotional problem, causation is complex, and often the result of multiple factors interacting. It is perhaps more useful for an individual family to concentrate, not on the "cause" of an emotional disorder (except to the extent that cause can be readily agreed on), but on their role in helping their child to learn the adaptive skills and appropriate behaviors he or she lacks. The child judged to be disturbed or troubled is probably not going to do anything that other children do not. It's simply that inappropriate behavior will be seen more often or she or he will misbehave in more extreme ways. Parents are in a good position to judge when their child's behavior has gone beyond the realm of what all children do at one time or another and into a more extreme phase.

Sometimes it is difficult for parents to seek an emotional assessment for their child, even when they perceive it may be needed. The realization that a child's behavior is not appropriate is often painful, and personalized as a failure of the parent. Many parents are afraid their child may be inappropriately labeled; the array of diagnoses, medicines and therapies have not been agreed upon by all specialists in the field. Still other are turned off after obtaining an assessment for their child only to discover that the evaluator believed that emotional disturbances originate in family dynamics, and that "parenting skills" classes were the best way to address the child's problems.

Different professionals view emotional or behavioral disorders in different ways. Their outlook - and their treatment plan - is usually shaped by their training and their philosophy about the origins of emotional disorders.

Though a philosophical orientation or direction may seem like a pretty fancy topic to sit around discussing by parents who are frantically seeking a way to get their child to stop terrorizing or being terrorized by other neighborhood children, it's still recommended that parents discuss this with the professional they contact. Since the treatment program for the youngster will stem from the professional's philosophy, parents should be sure they agree with "where the professional's coming from." Otherwise, their cooperation in the treatment process may be limited and hurt its chances of success. When seeking a treatment program for their child, parents may also want to seek a second opinion if they disagree with the approach suggested by the first mental health professional.

Examples of emotional/behavioral disorders and related conditions

A diagnosis of an emotional or behavioral disorder made by a psychiatrist will be based on one of several classification systems commonly used in the United States. The most well-known diagnostic classification system is the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, Revised), or DSM-III(R). A second system, the International Classification of Diseases Manual (ICD), is used in the US less often. The following are examples of diagnosis from DSM-III(R):

Adjustment Disorders describe behaviors children may exhibit when they are unable, for a time, to appropriately adapt to stressful events or changes in their lives. Children with adjustment disorders may have difficulty in educational or social domains, or they may have aggravated physical symptoms which do not have a medical basis.

Affective Disorders (Mood Disorders) refer to disturbances of affect or mood, which are not due to physical or mental illness. Bi-Polar Disorder (sometimes called manic depression) and Childhood Depression (also known as Major Depressive Episode) are examples of affective disorders. Affective disorders are cyclical in nature, meaning that children have periods of normal feeling and behaviors between episodes of depression or manic-depression; such disorders generally respond to medications.

Anxiety Disorders are a family of disorders (school phobia, post-traumatic stress disorder, avoidant disorder, etc.), where the predominant feature is exaggerated anxiety. Anxiety disorders may be manifest as physical symptoms, such as headaches or stomachaches, as disorders in conduct (work refusal, etc.) or as inappropriate emotional responses, such as giggling or crying.

Disruptive Behavior Disorders encompass some of the more common disorders of childhood, including Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorders. ADHD, defined as a pattern of behavior combining inattention, impulsivity, and hyperactivity, is usually present in a child before the age of seven. Some children with attention deficit hyperactivity disorder have secondary diagnosis, such as learning disabilities, conduct disorders, or depression. Conduct Disorders as a category refers to youth whose behaviors violate social norms. Some children with conduct disorders may refuse to follow rules at home or in school, become truant, delinquent, or even violent. An appropriate, supportive behavioral intervention program is a key component of a treatment program for such youth.

Schizophrenia is a serious emotional disorder characterized by loss of contact with environment and personality changes. Hallucinations and delusions often exist as symptoms of this disorder, which is frequently manifest in young adulthood, although the symptoms may also occur at a younger age.

Pervasive Developmental Disorders (PDD) refer to disorders where the brain has difficulty processing information; characteristics of pervasive developmental disorders may include hallucinations, delusions, or a faulty perception of reality. PDD is a disorder of thought rather than one of mood.

School professionals do not generally use diagnostic classification systems in deciding whether a child has an emotional or behavioral disorder. While they must consider a child's mental health diagnosis when evaluating needs, they also rely on a set of criteria provided by their state Department of Education, based on the requirements contained in PL 94-142. Many children with psychiatric diagnoses have problems that are not severe enough to warrant special education intervention. Or, they may receive special education services in other areas, such as reading or math. Still others have needs that significantly interfere with their ability to learn the necessary academic, social or behavioral skills to be successful in school, and which require special education services in emotional and behavioral areas.

The school's responsibility is to provide services for students with emotional or behavioral disorders when their problems are so severe that they cannot succeed without special education intervention. Many children served by schools may not have an outside mental health diagnosis; rather, their emotional and behavioral needs in school determine their eligibility for special education.

"Seriously emotionally disturbed" is defined under the Individuals with Disabilities Act (IDEA) as a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance:

a. an inability to learn which cannot be explained by intellectual, sensory, or health factors;

b. an inability to build or maintain satisfactory interpersonal relationships with peers and teachers;

c. inappropriate types of behaviors or feelings under normal circumstances;

d. a general pervasive mood of unhappiness or depression; or

e. a tendency to develop physical symptoms or fears associated with personal or school problems.

The school's responsibility is to provide services for children with EBD when their problems are so severe that they cannot succeed in schools without special education. Such children may or may not have an outside mental health diagnosis; rather, their emotional and behavioral needs in school determine their eligibility for special education.

© 1992. PACER Center, Inc., 4826 Chicago Avenue South, Minneapolis, MN 5547-1098; (612) 827-2966

 

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