EBD Blog

The report of a board meeting of a South Dakota local education agency shows that the LEA plans to create a middle school program for students with Emotional and Behavioral Disorders.

Parents, students, teachers, administrators, school board members — nearly everyone involved with the Yankton School District claims its [sic] one of the best public-education systems in South Dakota. And after approval from the Yankton School Board during Monday night’s meeting, the district is preparing to boost this reputation during the 2005-06 school year by establishing a program for emotionally disturbed students at the middle-school level.

Sadly, it sounds like there are students who really need help. Joyce Wentworth, director of student services for the school district, is quoted as saying, “Those who started at Beadle [elementary school] are now in high school and are literally falling apart. I don’t think many of them will graduate.”

I hope that the program focuses on evidence-based practices.

Schools in Ionia (Michigan, US) are using a test to assess emotional states (e.g., anger, depression, and anxiety) that might indicate risk for dangerous behavior such as fighting or abusing substances, according to a story in the Sentinal-Standard. In his story, Steve DeGrush reports that the Massachusetts Adolescent Youth Screening Instrument (MAYSI), “Can act as an early intervention tool, the results of which could connect parents and their child to counseling or other treatment services if the MAYSI indicates a possible ‘trigger’ symptom.”

The intention is admirable, but I found myself feeling a little skeptical about the instrument. The story described it as a list of 52 questions to be answered either “yes” or “no” and gave as examples “Have you ever felt like life wasn’t worth living?” and “Have you ever gotten in trouble while you were drunk or high?” It gave no data about the reliability or validity of the instrument.

Now, I know that for some readers, asking about reliability and validity starts to induce relaxation, a slowed heart rate, and sonorous breathing. However, whenever there’s a test that purports to provide direction, those ought to be the first questions one asks. If an instrument does not have reliability and validity, then there’s no way to say whether it does what people say it does.

So, I went on a quick search. I found:

• According to an article in the Nebraska Criminal Justice Review, Douglas County Juvenile Assessment Center appears to be using the MAYSI;
• A word processor document shows that Southern Oaks Girls School includes it in a battery of instruments that facility uses.

Next, I turned to the PsycINFO and ERIC databases. I got zero hits. Then I checked Buros Institute of Mental Measurements and got a nada, too.
I’m not a psychologist, so I guess I don’t really have the background to question this. Nevertheless, if this test is being used to serve kids and their parents, I sure hope that it is a trustworthy instrument.

The 12 April 2005 issue of the New York Times carried a good story about selective mutism. Harriet Brown, who reported the story, avoided many of the traps that might befall people who tackle this topic. Her report is balanaced, sensible, sensitive, and accurate. She didn’t fall prey to the psychobabble that too often is associated with this disorder, resisted the temptation to extol only psychopharmacological or behavioral treatments, and (though she used cases for interest) avoided depending only on heart-tugging individual stories. She also gave me the chance to put in a plug for a fine book on this topic

Ollendick, T. H , & March, J. S. (Eds.). (2004). Phobic and anxiety disorders in children and adolescents: A clinician’s guide to effective psychosocial and pharmacological interventions. London: Oxford University Press.

Brown’s story includes a cautionary for those of us concerned with the preparation of special education teachers. She reported that the mother of one of the children she features got some misinformation from a special educator.

[She] asked her sister, a special education teacher, what she thought…. Her sister mentioned something called selective mutism, but quickly said that couldn’t apply to Emily. “She told me, ‘Those children are emotionally disturbed and have been abused,’ ” Mrs. Stanley recalled.”

Brown surely doesn’t read these pages, but she made one of the points we’ve pushed here. It’s O.K. to say “emotionally disturbed.” Let’s get these kids services. In line with my concern about making sure that professionals and parents don’t ignore problems, Brown wrote “Pediatricians often tell parents not to worry, their children will outgrow the problem. That reassurance is well-meaning but misguided.”.

I’m answering my own question, I suppose.

According to a story (free subscription required) from the Jerusalem Post about a facility, pscyhiatrist Michael Bunzel argues that stigma, based in religious teachings, is a deterrent to provision of treatment for emotional and behavioral disorders.

Stigma about emotional problems and concern over finding spouses were not unique to the haredi community, the American-born haredi psychiatrist said. He brought examples of research from southern India and China to prove it.

Professionals agree that psychiatric illnesses are in essence brain diseases – disorders that result from an imbalance in brain chemicals (neurotransmitters such as dopamine). But deep-seated cultural prejudices and fears caused discrimination against the emotionally disturbed, Bunzel said, adding: “It is not limited just to the haredi community, but to all sectors in Israel.”

Patients who are thus stigmatized feel shame, suffer from denial and are reluctant to get treatment, causing a vicious cycle.

Stigma due to emotional disturbance is such a powerful force that when new mothers from several Israeli cities were recently asked to take a simple 10-question screening test for postpartum depression, half of those from Bnei Brak refused to participate; in secular locations, only a negligible minority declined to answer the questions, Bunzel said. As such, many observant Jews who need treatment fall between the cracks because of shame.

Bunzel suggests that the matter of stigma be addressed in professional conferences. I agree, and I suggest that it also become a topic for clerics from any religion. Leaders speaking in temples, mosques, churches, and other sites should advocate for the treatment of individuals—especially children and youths—with emotional or behavioral disorders.

The stigma shouldn’t fall on the kids. It should adhere to those of us who fail to advocate for serving them.

Sometimes I just have to wonder about why schools refuse to serve students who apparently need help. Mayhaps it’s just that I don’t have all the data on some of the cases that I see, that there really isn’t any need for services. That must be it in this case.
Here’s the story as told by the Coles County Leader (Tuscola, IL, USA):

An Odyssey of the Mind finalist in seventh grade, in the 99th percentile on his eighth grade standardized test and placed in Honors english in ninth and tenth grade, Will Sailors’ was a bright young man who for some reason couldn’t keep his grades on par with his intellect.
Although treated with medication and counseling for an emotional disturbance, he finished at CMS with a grade average below a D and as a CHS freshman failed 5 of six classes and barely got a D in PE. As a sophomore, Will’s grades were lower than ever and he racked up seven police citations by October.

Will’s parents requested an eligibility hearing in the fall of 2003, didn’t get one within the requisite number of days, and eventually enrolled Will in a private placement where he flourished, according to the article. The out-of-district placement is, of course, expensive.

Will’s IEP was finally completed on January 13 of this year. The district officially determined that Will is disabled and needs to be placed in a residential facility at state expense. But after ten weeks, it has yet to happen even though Illinois law requires that the IEP be implemented “as soon as possible.” Meanwhile, the Sailors continue paying the monthly costs for their son and hope that the due process hearing will soon lighten their load.

Maybe the newspaper just makes it seem like a simple case. Maybe a due process hearing will reveal another side to it.