Interventions for ED Students Interventions

Interventions for ED Students

Interventions for Students with Emotional Disturbances in Middle School

There are over 470,000 adolescents in the United States who are receiving special education and related services under the category of emotional disturbance, and the number is growing each year. The above figures from the year 2003 represent a 2% increase from the previous year and a 20% increase from 1993 (Nelson 2003). Several million school-age children and adolescents with emotional disturbance have been served since the passage of the Individuals with Disabilities Education Act in 1975 (Nelson 2003). The status and trends in academic intervention research with students with emotional disturbance must be examined to provide teachers, parents and school administrators the opportunity to make sound, objective instructional decisions (Nelson 2003).

The five eligibility characteristics of the federal education disability emotional disturbance includes: the inability to learn, relationship problems, inappropriate behavior, unhappiness or depression, and physical symptoms or fears (Sabornie 2004).

Approximately 65% of the some 475,000 U.S. students identified and provided special education under the category of emotional disturbance, ED, are 12 years of age and older, with the most numerous age group being 15-year-olds (Sabornie 2004). Adolescents with ED generally do poorly in school and thereafter, and more than half of 12- to 17-year-old students with ED receive most of the education apart from peers without disabilities, meaning not in regular public schools, or in regular schools but out of general education classes more than 60% of the day (Sabornie 2004). In comparison, this is true for only one sixth of adolescent students with learning disabilities (Sabornie 2004).

As a whole, graduation rates for students with education disabilities have improved over the last ten years, yet not for teens with emotional disturbance. In fact, students with ED have the highest drop out rate, 51%, of any category of students with disabilities, with only 42% graduating from high school with a standard diploma (Sabornie 2004). Yet, despite such large numbers, researchers know little about adolescent students with emotional disturbance, especially the details of their problems and interventions for them, since most professional attention has focused primarily on elementary students, rather than middle or high school students (Sabornie 2004).

While ED is a single federal category of education disability, students with emotional disturbance may demonstrate various problems, especially related to social, persona, and educational issues (Sabornie 2004). This is not unusual, for Individuals with Disabilities Education Act's definition of ED explicitly encompasses diverse behavior, emotion, and cognition problems, and although this definition has been criticized as being ambiguous and unscientific, the vast majority of the criticisms have been presented and debated on logical rather than empirical ground (Sabornie 2004).

In fact, there are few studies that have measured the definition's key constructs or evaluated how the definition influences identification of students, educational interventions, or other effects of its use (Sabornie 2004). In the September 2004 issue of the Journal of Emotional and Behavioral Disorders, Edward Sabornie explains, "our knowledge is limited as to how ell the definition captures important characteristics of adolescent students with ED because so little research has been conducted on its eligibility characteristics among such students" (Sabornie 2004). According to Sabornie's study, students of middle and high school age with ED exhibit these characteristics to an elevated extent. His research examined variables that appear to correspond to the eligibility characteristics: inability to learn, relationship problems, inappropriate behavior, unhappiness or depression, and physical symptoms or fears (Sabornie 2004).

After reviewing fifteen studies of learning problems and academic status of teens with emotional disturbance, researchers concluded that they had more problems with mathematics and reading than did students without disabilities and that academic success was not commensurate with their chronological ages (Sabornie 2004). In fact, students with ED were more likely to fail courses than either students without disabilities or students with learning disabilities. Studies of 9- to 17-year-old students with emotional disturbance revealed that 58% performed below grade level in reading and 93% below grade level in math (Sabornie 2004).

When researchers examined the regular classroom social status of adolescents with ED, they discovered that teens with emotional disturbance were more likely to be rejected and less likely to be accepted than either students without disabilities or students with learning disabilities (Sabornie 2004). Students with ED were judged by middle school general and special education teachers to exhibit less peer-preferred social behavior than students without disabilities (Sabornie 2004). Studies have found that relationship problems are common in teens with ED in work environments and community living settings. Moreover, researchers found that adolescent males with emotional disturbance had less empathy, less frequent contact with friends, and lower quality of peer relationships that comparable peers without disabilities (Sabornie 2004).

Studies, conducted in the mid-1980's, found that teens with emotional disturbance "exceeded peers without disabilities on conduct disorder, a multivariate factor of teacher-rated behavior problems reflecting aggression, defiance, and destructiveness" (Sabornie 2004). When specific teacher-rated emotional and behavior problems among teens with and without ED were subdivided by gender and level in school, researchers found that for both genders and levels (middle and high school), students with emotional disturbance showed greater inappropriate behavior, such as disruptiveness, fighting, disobedience, and destructiveness, than students without ED, although there were a few exceptions among high school girls (Sabornie 2004). A 1999 study found that middle school students with emotional disturbance were significantly more frequently referred for violence and other discipline problems than peers without disabilities (Sabornie 2004).

According to researchers, adolescent students with emotional disturbance were more depressed than students with no disabilities, and reported more suicidal ideation and suicidal attempts than those without disabilities (Sabornie 2004). Girls with ED reported more suicidal ideation and attempts than did boys with ED, and some 21% of middle school and high school students with ED reported severe depression, with middle school students more depressed than senior high students (Sabornie 2004).

Moreover, both teacher and self-reported data indicated that students with emotional disturbance were more anxious than students without disabilities (Sabornie 2004).

Studies have found that for each of the five characteristics of emotional disturbance defined in the federal guidelines, adolescent students with emotional disturbance show significantly greater problems than students without ED (Sabornie 2004). However, Sabornie notes that additional research is needed, because only a few of the existing comparisons of adolescent students with and without emotional disturbance examined possible variations by age, and it is possible that middle and senior high school students differ in the extent to which they tend to show one or more of the characteristics. Moreover, there have been few studies conducted on how the characteristics of emotional disturbance might vary by student gender, and none that varies according to race and/or ethnicity (Sabornie 2004). Sabornie also notes that there have been no studies conducted that compare students with emotional disturbance and those without ED on all five of the characteristics in the federal definition of ED, and few studies that have addressed more than one characteristic (Sabornie 2004).

Sabornie's study examined adolescents on all five of the characteristics within the same study, and of the five variables, he found that students with emotional disturbance exhibited more maladaptive functioning than students without ED. These results indicate that adolescent students with emotional disturbance show high levels of various emotional and behavior problems of the types defined by IDEA's definition of ED, and support existing literature that suggests that students with emotional disturbance exhibit the five characteristics to an elevated extent (Sabornie 2004).

Sabornie's research also found that students with ED showed more problems than those without ED on the Socially Maladjusted and Overall Competence variables. The Socially Maladjusted findings are compatible with studies suggesting that adolescent students with emotional disturbance are very likely to exhibit antisocial behaviors outside of school, and that detained juvenile delinquents exhibit especially high proportions of various mental disorders (Sabornie 2004). Sabornie's finding of low Overall Competence scores among ED adolescents is compatible with other literature suggesting that "adolescent students with emotional disturbance exhibit few personal strengths and social resources that might mitigate some debilitating consequences of their maladaptive behaviors and emotions" (Sabornie 2004).

Eugene H. Wong explains in the September 22, 2004 issue of Adolescence that ED students present a significant challenge for school psychologists, and that intervention should assist students to develop a plan for improvements that results in a return to the classroom (Wong 2004). One such method is reality therapy.

For some years now, behavioral strategies, such as 'time out,' have been used for students with disabilities as well as those without, in both the home and school environment. The 'time out' strategy has been described as "time away from positive reinforcement" (Wong 2004). While parents are often advised to use this technique at home, teachers are also encouraged to use in their classrooms in the form of office referrals which are designed to change the child's behavior before he or she can return to the classroom (Wong 2004). Typically, office referrals result in a visit to the school principal or assistant principal, yet for students with ED, methods such as these are usually not effective in reducing problem behavior, thus a more therapeutic intervention, such as realty therapy, is needed for students with emotional disturbance (Wong 2004).

Realty therapy, which was developed by psychiatrist William Glasser during the 1960's, requires those working with a student with emotional disturbance to develop a positive, friendly relationship, especially with those particular students who do not want such a relationship (Wong 2004). Realty therapy differs from other psychological models because it urges everyone who works with the student to enter into a counseling relationship with them, not simply the psychologist (Wong 2004).

Research on the use of reality therapy for students with emotional disturbance has demonstrated a positive effect on student behavior. According to Glasser, "Counseling is just one human being helping another with a problem. This is not hard to do, if the person with the problem wants to be counseled" (Wong 2004). However, students with emotional disturbance may be defensive and resistant to counseling, thus the school psychologist's job is to motivate them to participate in counseling and to persuade them to want to learn and to change their behavior (Wong 2004). At its most fundamental level, reality therapy consists of four questions:

1) What do you want?

2) What are you doing?

3) Is what you are doing getting you what you want?

4) Do you want to figure out a better way? (Wong 2004).

For reality therapy to work effectively, it is important that the students do not perceive themselves as being questioned by a policeman, but rather by a facilitator. The psychologist must attempt to refocus the students toward their goals, and help them understand that the problem behavior is keeping them from reaching those goals (Wong 2004). The students and psychologist then review the students' goals, stressing the alignment, or lack thereof, between goals and behaviors, and once agreement is reached that what the students are doing is not working, then other more appropriate ways for them to achieve their goals is openly discussed (Wong 2004).

While Wong's study provided positive indicators for the use of reality therapy for middle school students with emotional disturbances, he cautions that regulatory demands that are placed on school psychologists make it extremely difficult for them to find the time to provide interventions to reduce emotional behaviors in their school environments (Wong 2004).

The study published by George Sugai in the September 22, 2000 issue of the Journal of Positive Behavior Interventions examined the effect of a functional assessment-based self-management strategy on the problem classroom behavior of a seventh-grade student identified as having emotional and/or behavioral disorders (Sugai 2000). The student was taught a self-management strategy that consisted of self-recoding work completion and appropriate hand raising, self-instruction on 'keeping his cool,' and self-recruitment of adult attention (Sugai 2000). The results of the study suggests that the self-management strategy was "associated with increases in work completion and percentage of intervals of on-task behavior, as well as decreases in percentage of intervals of talk-outs" (Sugai 2000).

Rather than addressing the specific skill deficits of individual students, many educators use packaged programs that focus on teaching a wide array of skills that all students should possess (Sugai 2000). Such interventions are rarely successful "because they emphasize implementing an overriding reinforcement schedule that either worked at altering other behaviors of the same individual or worked with other students with similar inappropriate approaches to behaviors" (Sugai 2000).

As Sugai explains, "self-management involves teaching an individual two behaviors: the target behavior, if the individual has not already acquired it, and the specific self-management behavior being used" (Sugai 2000). Self-management interventions generally combine more than one of four general types of self-management categories: self-monitoring, self-assessment, self-instruction, and self-reinforcement (Sugai 2000). Self-monitoring teaches students to discriminate and to make a permanent record of occurrence/nonoccurrence of antecedent conditions or target behaviors; self-assessment trains students to compare their performance to a set trained criterion; self-instruction requires students to prompt themselves to perform a certain behavior; self-reinforcement involves an individual providing or arranging for delivery of a reinforcer to him-or-herself for achieving a designated level of performance (Sugai 2000).