Emotional Disturbance

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The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.

We refer to mental disorders using different “umbrella” terms such as emotional disturbance, behavioral disorders, or mental illness.  

Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include:

  • anxiety disorders;
  • bipolar disorder (sometimes called manic-depression);
  • conduct disorders;
  • eating disorders;
  • obsessive-compulsive disorder (OCD); and
  • psychotic disorders.

You may be reading this with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.

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Definition

We are using the term “emotional disturbance” in this fact sheet because that is the term used in the nation’s special education law, the Individuals with Disabilities Education Act (IDEA).

IDEA defines emotional disturbance as follows:

…a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance:

(A) An inability to learn that 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 behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems.”

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.

Characteristics

As is evident in IDEA’s definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person’s physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness (NAMI) puts this very well:

Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

  • Hyperactivity (short attention span, impulsiveness);
  • Aggression or self-injurious behavior (acting out, fighting);
  • Withdrawal (not interacting socially with others, excessive fear or anxiety);
  • Immaturity (inappropriate crying, temper tantrums, poor coping skills); and
  • Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors—heredity, brain disorder, diet, stress, and family functioning—have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. 

Frequency

According to the CDC (Centers for Disease Control and Prevention), approximately 8.3 million children (14.5%) aged 4–17 years have parents who’ve talked with a health care provider or school staff about the child’s emotional or behavioral difficulties.  Nearly 2.9 million children have been prescribed medication for these difficulties. 

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2003-2004 school year, more than 484,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance.

Determining a child’s eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let’s take a brief look at some of the most common of these.

Anxiety Disorders

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

As with the term emotional disturbance, “anxiety disorder” is an umbrella term that actually refers to several distinct disabilities that share the core characteristic of irrational fear: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias.

According to the Anxiety Disorders Association of America,  anxiety disorders are the most common psychiatric illnesses affecting children and adults. They are also highly treatable. Unfortunately, only about 1/3 of those affected receive treatment.

Bipolar Disorder

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood.

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment. 

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. This may include some of the following behaviors:

  • aggression to people and animals;
  • destruction of property;
  • deceitfulness, lying, or stealing; or
  • truancy or other serious violations of rules.

Although conduct disorder is one of the most difficult behavior disorders to treat, young people often benefit from a range of services that include:

  • training for parents on how to handle child or adolescent behavior;
  • family therapy;
  • training in problem solving skills for children or adolescents; and
  • community-based services that focus on the young person within the context of family and community influences.

Eating Disorders

Eating disorders are characterized by extremes in eating behavior—either too much or too little—or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to  develop an eating disorder.

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening.

Binge eating is also considered an eating disorder. It’s characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives.

According to the National Eating Disorders Association:

The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional  needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual, and this will vary according to both the severity of the disorder and the patient’s individual problems, needs, and strengths.

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away.  Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. Treatment for most people with OCD should include one or more of the following:

  • therapist trained in behavior therapy;
  • Cognitive Behavior Therapy (CBT);
  • medication (usually an antidepressant).

Psychotic Disorders

“Psychotic disorders” is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder. There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling).

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem.  A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

  • For a child whose behavior impedes learning (including the learning of others), the team developing the child’s Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

  • Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

The Importance of Support

Families often need help in understanding their child’s disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

To locate systems of support in your community or state, visit the organizations we’ve listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

Mental Health America | 1.800.969.6642
http://www.mentalhealthamerica.net/farcry/go/searchMHA

NAMI | National Alliance on Mental Illness | 1.800.950.NAMI
http://www.nami.org/template.cfm?section=Your_Local_Nami

National Mental Health Consumers’ Self-Help Clearinghouse
1.800.553.4539 | http://www.cdsdirectory.org/

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Source: National Dissemination Center for Children with Disabilities (NICHCY)