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What is BENTON VISUAL RETENTION TEST (BVRT)?n. a psychological test specifically designed to measure short-term visual memory and visual

perception. Ideally, this draw-and-recall task should be individually administered to children no

younger than age 8. Briefly, aparticipant is shown cards with 2-3 geometric designs each after

which he or she draws them from memory. Developed by U.S. psychologist Arthur LesterBenton in 1946.

BENTON VISUAL RETENTION TEST (BVRT): "The Benton Visual Retention Test (BVRT) is a

draw-and-recall task which challenges the sharpness of your short-term visual memory."

Psychology DictionaryWorld's MostComprehensive Online Psychology Dictionary

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Psychology Articles

Emotional Disturbance and How To Identify It

Eli Bower, a pioneer in

the field of early childhoodeducationof emotionally handicapped children, wrote, I often

thoughtabout [these]studentsthey did not know how to have fun, could not separate

play fromreality, could not attend to concepts outside of self, and were driven by

impulses unchecked byrealitycontrols (Bower, 1990). Like Eli Bower, professionals in

the field ofeducationand childpsychologyhave been intrigued by thispopulationsince

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before the early 20thcentury. By the late 1950s multiple communities were studying

emotionally disturbed children (Bower, 1990). By the 1970s, researchers had

conducted enough work on emotionally disturbed children to establish thespecial

educationcategory ofSeriously Emotionally Disturbedfor P.L. 94-142 (Merrell, 2007).

Today, the needs and numbers of emotionally disturbed youth are growing. In 2004,

there were about 450,000 emotionally disturbedstudentsin the national student

population(Wagner et al., 2005). Further, the U.S. Department of Education (2002)

found that these students had the highest drop out rate of anydisabilitygroup with as

much as 51 percent leaving before earning a high school diploma. Children with

emotional disturbance are said toexperienceless school success than any other

subgroup of students, with or without disabilities (Landrum, Tankersley, & Kaufman,

2003). Although much work is needed to help support these students, professionals

today cannot even agree on adefinitionof emotional disturbance. Stemming from this

rudimentary issue areancillarydebates about how to assess for emotional disturbance

and how to resolve differential diagnoses. In this paper, current definitions of emotional

disturbance will be reviewed, inherent diagnostic difficulties in the eligibility criteria will

be outlined, and bestpracticeinassessment, given these issues, will be summarized.

Currently, there are two main perspectives conceptualizing emotional disturbance,

though both acknowledge that maladaptive and distressing behaviors, emotions, and

thoughts (Cullinan, 2004) are main components. The first, the dimensional classification

system, holds the viewpoint that emotional and behavioral disorders are extreme forms

ofbehavior, emotions or cognitions that exist in all people. Those less able to regulate

themselves are more likely to have emotional disturbance. With the dimensional

perspective, situational aspects and contexts are emphasized more than in thedisease

perspective(Cullinan, 2004). The IDEIAdefinitionof emotional disturbance is a resultof the dimensional classificationperspective. The Diagnostic and Statistical Manual of

Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR) is the product of those

who follow the secondperspective, known as thediseaseclassification perspective.

These people believe emotionally disturbed children have a collection of maladaptive

and distressing behaviors, emotions, or thoughts that are different from normal children.

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This perspective views thedysfunctionas within the person. Manymental health

agencies, government organizations, insurance companies, medical providers, and

other agents consider theDSM-IV-TRthe official classification system (Cullinan, 2004).

Often, services and reimbursements are contingent on the child receiving a DSM

diagnosis. For these reasons, and many more, professional in the education field

should have someknowledgeof the DSM-IV-TRcriteria.

With both classification systems loosely described, it is safe to move on to thesubjectof

definitions. While classification systems beg questions about which kind of emotional or

behavioral disorders exist, definitions only aim to determine if emotional or behavioral

disorders exist. If the definition of emotional disturbance indicates that characteristics

are present, then it can play a role in deploying financial, personnel, and other

resources to children in need of them. The federal government has employed a

regulation, most recently known as the Individual with Disabilities Education

Improvement Act (2004), to guide educators in determining whether emotional

disturbance is present. Children with emotional and behavioral disorders most likely

qualify under the category of emotional disturbance if they demonstrate the following:

Section300.8 (c)(4)(i) Emotional disturbance means 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 educationalperformance:

(A) An inability to learn that cannot be explained by intellectual,sensory, or health

factors.

(B) An inability to build or maintain satisfactoryinterpersonalrelationships with peers

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and teachers.

(C) Inappropriate types ofbehavioror feelings under normal circumstances.

(D) A general pervasive mood of unhappiness ordepression.

(E) A tendency to develop physical symptoms or fears associated with personal or

school problems.

(ii) Emotional disturbance includesschizophrenia. The term does not apply to children

who are socially maladjusted, unless it is determined that they have an emotional

disturbance under paragraph (c)(4)(i) of thissection.

As it stands, the definition of emotional disturbance does not translate into any specific

diagnosis in the DSM-IV-TR. It works as a legal term that initiates a multitude of

mandated services to meet the needs of emotionally disturbed children (U.S.

Department of Health and Human Services ,1999). However, a DSM-IV-TRdiagnosis

of an emotional or behavioraldisordercan help determine whether a child qualifies to

receivespecial educationservices for emotional disturbance because it provides a

taxonomyof mental disorders and symptoms that can be used to describe conditions

that persist over a long period of time and adversely affect educationalperformance

(House, 1999). Further, its reputation and wide use by other organizations and fields

can help school psychologists communicate withmental healthprofessionals and other

non-school service providers in common terms, and help access financial resources for

the child and family.

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Diagnostic Difficulties Inherent in Eligibility Criteria

The federal definition has been thoroughly criticized throughout the years (Kauffman,

2001). The definitions vagueness andsubjectivity, as well as peoples personalphilosophies toward the label of emotional disturbance, have made this category very

unpopular (Wagner et al., 2005). The first attack on the definition typically focuses on

the definitions vague and unclear terms. They are not operational orobjective, and

therefore are difficult concepts to measure. Many important features are perplexing,

withphraseslike long period of time, marked degree, adversely affects educational

performance, and socially maladjusted. Additionally, criteria A, which states the child

must exhibit, an inability to learn and/or inappropriate types of feelings or behaviors

under normal circumstances have been found to be vague (Cullinan, 2004). Critics

also do not like the seeming circular logic and/or illogic behind many of the definitions

features. For instance, an example of a contradictory statement appears when one

compares criteria B saying children must show, interpersonalrelationshipproblems,

yet cannot be socially maladjusted. Children who are socially maladjusted often have

problems relating to other people, which make this statement confusing.

Redundantphrasesabout the behaviors or emotions being adverselyaffectivehas also

received disapproval, especially since this phrase is unclear and diffuse and hard to

measure objectively (Cullinan, 2004). Lastly, theconfusionaboutsocial maladjustment

disqualifying a child from the emotional disturbance category, unless the child exhibits

bothsocial maladjustmentand emotional disturbance has been enraging to some critics

(Cullinan, 2004). This glaring issues have made critics question the source of many of

these criteria, saying they seem to have been arbitrarily chosen and lack support from

scientificresearch. At the same time, there are said to be otherbehaviorproblems not

found in the emotional disturbance definition for whichresearchsupport exists (Cullinan,2004). There are also holes in the definition, which leave many educators frustrated

with their idiosyncratic situations. For example, the definition makes no mention of what

to do with children who are exhibiting signs of emotional disturbance, but have not had

their education adversely affected. These childrens outbursts and disruptions may be

harming their classmates educations, and would probably subside with targeted

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behavioral interventions, but are left untreated because they do not meet criteria. Yes,

many diagnostic difficulties stem from the federal definitions lack of acumen in the area

of emotional and behavioral disorders, which force educators to makesubjective

decisions, and place some in legally precarious situations.

Critics have been particularlycriticalof the phrase socially maladjusted. The terms

ambiguityis emphasized by the many diverse interpretations that exist (Center, 1990).

Policymakers, lawyers, and other stakeholders have managed to handcraft their own

term in order to do their jobs. Traditionally, it entails apatternof behavioral problems

that arethoughtto be willful, goal oriented, and possibly reinforced as part of ones

immediate socialreference group. It is typically seen asantisocialin nature, and typified

by the type of behaviors exhibited in the DSM-IV-TRdiagnostic categoriesConduct

Disorder. To add to theconfusion, the current federal definition allows students who are

considered to be socially maladjusted to receive special education services it if is

determined that they are also emotionally disturbed. In commenting on this and related

statements in federal definition discussion of socialmaladjustment, Kauffman (1999)

remarked the final addendum regarding socialmaladjustmentis incomprehensible.

For now, professionals conducting school-related assessments of children and

adolescents with behavioral, social, and emotional problems should be aware that there

are no psychometrically valid and defensibleassessmentprocedures that can be used

to make the emotional disturbance versus Social Maladjustment distinction (Merrell,

2007).

Alternative Definitions

Dissatisfied with the federal definition, the Council for Children with Behavioral

Disorders and other professional andadvocacygroups have cooperated to try to

change it. Operating as the National Mental Health and Special Education Coalition,

they proposed and alternative definition and petitioned Congress so far unsuccessfully

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to substitute it for the existing one (Forness & Knitzer, 1992). The Coalition proposed

definition is as follows:

(i) The term emotional or behavioraldisordermeans adisabilitycharacterized by

behavioral or emotional responses in school so different from appropriate age,

culture, or ethnic norms that they adversely affect educational performance.

Educational performance includesacademic, social, vocational, and personal

skills. Such a disability (A) is more than a temporarily, expectedresponseto

stressful events in theenvironment; (B) is consistently exhibited in two different

settings, at least one of which is school-related; and (C) is unresponsive to direct

interventionin general education or the childs condition is such that general

education interventions would be insufficient.

(ii) Emotional and behavioral disorders can coexist with other disabilities

(iii) This category may include children or youth withschizophrenic disorders,

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affectivedisorders,anxietydisorders, or other sustained disorders ofconductor

adjustmentwhen they adversely affect educational performance in accordance

with section (i). (Forness & Knitzer, 1992)

This definition seems many of the same mistakes as its predecessor. For one, the

Coalition proposal contains ambiguous terminology. Second, insufficientattentionwas

given to creatingobjectiveand measureable terms. As with the IDEIA definition,

significant parts of the Coalition proposal should be carefully operationalized and

measured in order to judge itspsychometricmerits (Forness & Knitzer, 1992)

Assessing for Emotional Disturbance

A promising and innovativeapproachto assessment and classification of social-

emotional problems of children and adolescents is multiple gating. By using a

sequential series of systematic and increasingly time-consumingscreeningprocedures,multiple-gating methods allow for narrowing a large population down to asmall groupof

candidates who are likely to exhibit behavioral and emotional problems to the point of

needing further assessment andintervention(Merrell, 2007). In formulating an

assessment plan for an individual child, the schoolpsychologistconsiders four

perspectives on emotional and behavioral disorders. One perspective views child

pathologyas the basis for the disorder, and seeks to identify emotional and behavioral

problems that are symptoms or characteristics ofpsychopathology. A second

perspective focuses on behavioral-environmental interactions as the basis for the

disorder. Instead of identifying symptoms or characteristics ofpsychopathologyin the

child, this perspective emphasizes reciprocal interactions between the childsbehavior

and theenvironment(Ysseldyke, Christenson, & Thurlow, 1987). A third perspective

seeks to identify thefunctionalrelationshipbetween environmental events andproblem

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behavior. It assumes that behavior occurs within acontextofantecedentand

consequentevents and that most behavior is afunctionof the reinforcing aspect

ofconsequentevents. The fourth perspective emphasizes the effectiveness of

interventions for emotional or behavioral disorders, directly linking assessment of

problems to intervention planning. This viewpoint defines emotional or behavioral

disorders by the extent to which the childs behavior proves to be resistant to

interventions (McConaughy & Ritter, 2002)

It is significant to remember that doing an assessment on this population does notnecessitate discovering theetiologyof the problem. Rather, it should focus more on

revealing the obstacles that obstruct the childsoptimal functioning. Due to the nature

of emotional and behavioral difficulties these children have in school, school

psychologists are oftenfamiliarwith these cases long before these children are referred

for a special education assessment. All known relevant history with the child and his

school-related difficulties should be considered in the special education assessment.

Additionally, it is important to collect data about the child from various people and

settings, as childrens behavior and emotions often change from one setting to another,

and with one person versus another (McConaughy & Ritter, 2002).

Standardized Rating Scales

Standardized rating scales provide quantitative information for obtaining parent,

teacher, and self-reports of childrens problems and competencies. Schoolpsychologists are encouraged to select standardized rating scales because their

systematic, easy to share, economical and efficient. Rating scales come in broad-band

forms and narrow-band forms, measuring a wide range ofpotentialproblems or very

specific areas of deficits, respectively. Examples of broad-band measures that are

helpful in Emotional Disturbance assessment include the Achenbach System of

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Empirically Based Assessment (ASEBA, Achenbach & Rescorla, 2001) or the Behavior

Assessment Scale for Children Second Edition (BASC-II; Reynolds and Kamphaus,

2004). Narrow measures can be used inconjunctionwith broad-band measures to

assess specific problems more extensively. Standardized self-reporting scales have

also been developed to obtain childrens own views of their problems and

competencies, and can be very especially useful when assessing for internalizing

disorders. In amultidimensionalassessment, evaluators should compare scores on

self-reportscales to similar scores obtained from parent and teacher rating scales

(McConaughy & Ritter, 2002).

Interviews

As with rating scales, interviews should be conducted with parents, teachers, and the

child. Most structured diagnostic interviews have parallel forms for parents and

children, and some have been adapted for teacher interviews. Interviewformats can

vary from highly structured to semi-structured andunstructuredapproaches. Examples

that can be used for assessment of this population include the National Institute of

Mental HealthDiagnostic InterviewSchedule for Children-Fourth Edition (DISC-IV;

Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000) or theDiagnostic Interviewfor

Children and Adolescents-Fourth Edition (DICA-IV, Reich, Welner, Herjanic, & MHS

Staff, 1999). Unstructuredinterviews are especially appropriate because they can be

tailored to each child, but also help the schoolpsychologistnot forget to ask about

important information (McConaughy & Ritter, 2002).

Direct Observations

Direct observations are an important data source for assessing emotional disturbance.

Several observations should be conducted and should occur in relevant settings

wherever problems are occurring. The labile nature of emotional and behavioral

disorders must always be keep at the forefront when doing these observations, and so

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theobservershould know to obtain more than oneobservationover different days and

times. Peer comparisons provides a helpful framework from which the judge the child

under assessment. Noting the antecedents and consequences are important factors to

observe. The DirectObservationForm or the Student Observation Systemare good

tools to use tostructureobservations (McConaughy & Ritter, 2002).

PersonalityAssessments

Personalityassessments provide additional information on aspects of social-emotional

functioning. Commonly used instrument are the Minnesota MultiphasicPersonality

Inventoryfor Children-Adolescents (MMPI-A; Butcher et al., 1992) andPersonalityInventoryfor Children (PIC; Wirt, Lachar, Klinedinst, Seat, & Brown, 1990). However,

discretion should be used when doing these assessments because of thesubjective

nature in theirinterpretation. Since different examiners often disagree in their

interpretations of personality measures, andreliabilityandvalidityare limited on these

measures, such procedures should not be sued as a primary source for assessment of

emotional disturbance (McConaughy & Ritter, 2008).

Social Skillsand SocialReasoning

Assessingsocial skillsis very important for assessing for emotional disturbance.

Observations of childrens behavior with peers and adults in natural settings, like the

general education classroom, or recess, can provide information about social skills and

relationships that is invaluable when reporting on apotentialemotional disturbance

case. Observing behaviors during social skills instruction or role-playing situationsprovides a more direct method for measuring specific social areas like socialproblem

solvingand socialreasoning(McConaughy & Ritter, 2008).

AcademicAssessment

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For emotional disturbance classification, there must be evidence that the childs is

sufferingacademically because of his behaviors and emotions. Standardized tests,

curriculum-based assessment, grade reports, and work samples can all provide

evidence regarding currentacademic achievement. Evaluationof broader education

performance can focus on academic behaviors, likeproductivityormotivation. Such

evaluations are needed inconjunctionwith the social and emotional assessments, and

cognitive testing, to judge whether educational performance is indeed being impacted

(McConaughy & Ritter, 2008).

Disorders with Emotional Disturbance Overlays

Mood disorders have been well described in individuals with mentalretardation.

Researchers estimate that 5 to 15 percent of individuals with mentalretardationhave

mood disorders (Meyer & Batshaw, 2002). Syndromes of disturbed mood may be

hidden in people with mental retardation. Sleep orappetiteproblems often go

unnoticed, and fluctuations in such symptoms as noncompliance,social withdrawal,

aggressiveness,irritability, self-injury, or crying are often assumed to be components of

a persons personality rather than a psychiatric disorder. Fragile Xsyndromeis the

most frequently diagnosed inherited cause of mental retardation and has many

characteristics that may look like an emotional and/or behavioral disorder. What

frustrations a child might feel as having delayedsocialization, communication, and daily

living skills may manifest itself in aggressive outbursts, hyperactivity, inattention, or

levels ofanxietyordepressionthat appear to be emotional or behavioral disorders

(Meyer & Batshaw, 2002). The best way to differentiate between emotional disturbance

and fragile Xsyndrome, is to examine medical records or the childsmedical historyto

see if there are references made to this disorder. Cognitive testing will also identify if a

level of mental retardation is present, therefore disqualifying the child as having

emotional disturbance. Adaptive measures, interviews of parents and teachers, rating

scales, and behavioral observations of the child will also provide salient information for

making eligibility decisions.

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Children with specificlearningdisabilities often show impairments in emotional or

behavioral functioning because of their external experiences of school failure, and are

sometimes mistaken as children with emotional disturbance. Although the federal

definition for alearningdisability currently excludes learning problems that are primarily

the result of emotional disturbance, children and adolescents identified as having

learning disabilities demonstrate a high incidence of concurrent emotional and

behavioral problems (McConaughy, Mattison, & Peterson, 1994). These children can

exhibit a range of emotional and behavioral disturbances, includingconductdisorders,

withdrawal, poorself-esteem, and depression (Shapiro, Church, & Lewis, 2002). These

children often exhibit chronicfrustrationand anxiety as they attempt to meet the

demands of skills-based tasks such a phonologicaldecoding, comprehension, spelling,

and math (Shapiro, Church, & Lewis, 2002). School failure, combined with social skills

impairments, possible peerrejection, and poor-self image often results in what appears

to be emotional disturbance (Shapiro, Church, & Lewis, 2002). Although looking at a

discrepancy between cognitive potential andacademic achievementseems like a

simple way to identify whether a child qualifies for emotional disturbance or specific

learning disabled, this is anoversimplificationof bestpracticeassessment procedures

(Shapiro, Church, & Lewis, 2002). In addition to psycho-educational testing, a complete

medical, behavioral, educational, and social history should be considered when making

a classification to determine which of the two eligibilities best fits theprofileof the child

and which would offer the best services for remediation.

A third disorder that often gets confused for emotional disturbance isattentiondeficit

hyperactivity disorder. Emotional and behavioral problems can overlap or co-occur with

inattention or hyperactive problems (Barkley, 2006) that mimic emotional disturbance.

Children with this disorderdisplayhyperactive or impulsive behaviors, and can showsuch disruptive behaviors that some might say they are actually demonstrating

characteristics ofoppositional defiant disorderorconduct disorder(Stein, Efron, Schiff,

Glanzman, 2002), while others might say the child is demonstrating mood disorders.

Estimates of mood disorders in children with ADHD vary considerably. Some studies

say the comorbidity rate is as low as 14 percent, while others say it is as high as 80

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percent (Stein, Efron, Schiff, Glanzman, 2002). Peerrejectiondue to their odd

behaviors, difficulty in school, andregularpunitive interactions with adult figures often

does lead to extreme levels of anxiety and/or depression in these children (Stein, Efron,

Schiff, Glanzman, 2002). As previously stated, carefulexaminationof the childspattern

of behavior and history, may help with theevaluation. One must always consider what

is the bestinterestof the child, and what eligibility would facilitate the services he or she

needs from school and community resources more easily.

To qualify for special education services under IDEIA 2004, it is not enough that a child

exhibit a specific disability, such as emotional disturbance. An actual need for special

education must also be evident. This means that previous intervention efforts have

failed with little to no decrease in a childs target behaviors. When doing an assessment

on a child suspected todisplayemotional or behavioral disorders, it is important for an

assessor to not become overwhelmed with the myriad of unsettled issues regarding the

definition of emotional disturbance and its assessment, but use professionaljudgment

and a multimethod, data-basedapproachto decision-making. Proper assessment may

take more time due to the extensive qualitative information necessary to make a

decision, but it is only with multiple sources of data that one will find it viable to make a

decision as to the presence orabsenceof emotional disturbance.

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