According to reports Brian M. Rosenthal published in the Houston (TX, US) Chronicle, since the early 2000s when the Texas Education Agency (TEA) essentially limited enrollment in special education to 8.5% of the school population, the category of students with disabilities that saw the largest decline in enrollment was emotional disturbance.
Mr. Rosenthal published a series of articles reporting his investigation of systematic denial of services to students with disabilities in Texas beginning in September 2016. The TEA created a system for rating local education agencies’ special education programs that included a benchmark for how many students should be be enrolled. In an installment published 19 November 2016 and entitled “Mentally ill lose out as special ed declines,” he begins the report with the story of Alston Jeffus, an adolescent who is on his way home after spending months in a state hospital. Here are a few paragraphs from Mr. Rosenthal’s article:
The Texas Education Agency’s decision to set an 8.5 percent target for special education enrollment has led schools to cut services for children with all types of disabilities, but mentally ill students like Alston have been disproportionately affected, the Houston Chronicle has found.
Federal law requires schools to provide counseling, therapy, protection from discipline and other support to children with “emotional disturbances,” including severe anxiety, depression, bipolar disorder and post-traumatic stress disorder. Today, however, Texas schools serve 42 percent fewer of those students, relative to overall enrollment, than when the TEA set the benchmark in 2004.
It is a bigger drop than has occurred in almost any other disability category.
In all, an estimated 500,000 school-age children in Texas have a serious mental illness that interferes with their functioning in family, school or community activities, according to the state Health and Human Services Commission.
Only 30,034 receive special education services.
There is a lot more to this story (subscription may be required). I recommend it to readers. Also, I encourage readers haven’t been following Mr. Rosenthal’s excellent reporting on this matter to catch up; the Chronicle published a guide to the series.
On 1 February 2016, the US National Academy of Sciences published a booklet that summarized the presentations and discussion at a workshop on measuring serious emotional disturbance in children. Some readers of EBD Blog probably will want to secure a (free) copy. The accompanying image, which is a 2013 infographic from the US Centers for Disease Control, appears on page 19 of the report. The following is the recommend citation for the report:
National Academies of Sciences, Engineering, and Medicine. (2016). Measuring Serious Emotional Disturbance in Children: Workshop Summary. K. Marton, Rapporteur. Committee on National Statistics and Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education. Board on Health Sciences Policy, Institute of Medicine. Washington, DC: The National Academies Press.
Using machine-learning techniques, Professor Dennis Wall and colleagues were able to achieve highly accurate classification of children with Autism that only required a small selection of items from the Autism Diagnostic Observation Schedule-Generic (ADOS). The ADOS, a semi-structured and standardized assessment used with children suspected of having Autism, has four 30- to 60-minute parts where children are observed for social interaction, communication, play, and imaginative use of materials; it is very widely used in diagnosis of Autism, Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS), and non-spectrum disorders. As they reported in Translational Psychiatry, Professor Wall’s team was able to determine that 8 of the 29 items in Module 1 of the ADOS were sufficient to classify autism with 100% accuracy.
Continue reading ‘Briefer, accurate diagnosis of Autism is possible’
In an accompanying PDF I have listed studies that are currently seeking children (both female and male) with Emotional of Behavioral Disorders (especially autism spectrum disorders) as participants (some include adults, as well) that are registered with ClinicalTrials.gov, a service of the US National Institutes of Health (NIH). The studies have diverse purposes: They may be observing different events (whether overt behavior or neurochemical activity) or they may be testing different therapies (ranging from behavioral to medical methods). Many are sponsored at least in part by the NIH, but some have funding from universities or even private industries. Because of its affiliation with NIH, ClincialTrials.gov is more likely to represent medically oriented studies and studies that use rigorous scientific methods (i.e., randomized clinical trials or RCTs), but this is not exclusively the case. Readers should examine the studies carefully.
The list is not exhaustive (I used “autism” in the search, so there are many more studies that could be located by using other terms), and I’ve provided only some of the data about each study in the table, but you can learn a fair bit about individual studies. For example, one can learn about study number NCT00198107 that is entitled “Evaluating the Effectiveness of Aripiprazole and D-Cycloserine to Treat Symptoms Associated With Autism.” It focuses on individuals with Autistic Disorders and examines an intervention (in this case, comparing drugs called Aripiprazole D-cycloserine to placebo in a randomized design with double-blind (Subject, Caregiver, Investigator, Outcomes Assessor) | Primary Purpose: procedures. The study began 1-Sep-05 and will end 1-Sep-11 (making it odd that it is still listed as open, no?).
To locate additional information about a particular study, copy the NCT ID number, go to ClinicalTrials.gov, and enter that number into the search box. Download the PDF here (10 pages).
I’m asking readers of EBD Blog to help me identify important research questions about interventions for students with Emotional and Behavioral Disorders. As I noted in a parallel post on LD Blog, these need to be BIG IDEA questions. What do teachers and parents need to know about how to help students with EBD?
Examples (just for provoking discussion): Continue reading ‘What do educators need to know?’
Under the headline “Time to reexamine bipolar diagnosis in children,” Brendan Borrell reports on proposed changes in the American Psychiatric Association
s Diagnostic and Statistical Manual for the identification of bipolar disorder. In addition to presenting the basic information, Mr. Borrell has alternative views by Dr. Gabrielle Carlson and Dr. David Axelson.
Psychiatrists in favor of a new label, temper dysregulation disorder, cite a spike in bipolar diagnoses. But others worry it will add uncertainty to the treatment of an already confusing condition.
I wonder which side the psychiatrists who were concerned about the change from “manic depressive” to “bipolar” are on with this newest change. Will I have to change the category label in EBD Blog?
Link to Mr. Borrell’s story. Use the short link for this entry: http://wp.me/peQI7-iw
|Twelve key children’s services for community services boards
- specialized children’s emergency services;
- crisis stabilization;
- evaluations for Comprehensive Services Act services;
- office-based mental health therapy;
- office-based substance abuse therapy;
- mental health case management;
- intellectual disabilities case management;
- substance abuse case management;
- home-based behavioral treatment and support for families;
- school-based day treatment; and
- local residential services.
Right here in my home commonwealth of Virginia last week, Mira Signe, Vicki Hardy-Murrell, John Morgan, and Margaret Nimmo Crowe explained why it is important that government and private organizations attend to and address issues in children’s mental health. By explaining that Virginia has inadequate services and that one in every five children or youths experience mental health problems at some time during their lives, they made the point that that there is a tremendous need for public focus on these issues. This was the kick-off event for the Campaign for Children’s Mental Health.
The Campaign for Children’s Mental Health is a 3-year sustained effort to make mental health services more available and accessible to Virginia children in need. It will strongly endorse Governor-elect McDonnell’s call for system improvements; urge the General Assembly and state and local government to work collaboratively with the administration to address system deficiencies; and conduct a high-profile three-year advocacy and education drive to build public and political support for improved mental health services for children.
Only about one in 20 of Virginia’s children have access to the key services listed in the accompanying box. So, four out of five children who need these services do not have access to them.
No, Virginia, this is not an acceptable way to treat our children. Let’s do better.