Although the traditional medical model has been vilified by special educators, new evidence on treatment and comorbidity of psychiatric disorders suggests a more relevant and effective version of this model. This evidence is reviewed briefly with the purpose of suggesting odds that a child with behavioral disorders may indeed have a disorder that is responsive to psychopharmacologic treatment. Merging the medical and behavioral models is suggested as critical to certain special education decisions in functional behavioral analyses and positive behavioral intervention.
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References
1.
AchenbachT. M., & EdelbrockC. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile.Burlington: University of Vermont, Department of Psychiatry.
2.
AchenbachT. M., & EdelbrockC. (2001). Achenbach system of empirically based assessment. Available from: University Medical Education Associates, One South Prospect Street, Room 6436, Burlington, VT 05401–3456.
3.
ArnoldL. E., JensenP. S., HechtmanL., HoagwoodK., GreenhillL., & MTA Cooperative Group. (2000, October). Do MTA treatment effects persist? New follow-up at 2 years. Paper presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, New York, NY.
4.
BernsteinG. A., BorchardtC. M., & PerwienA. R. (1996). Anxiety disorders in children and adolescents: A review of the past ten years.Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1110–1119.
5.
BiedermanJ., & SpencerT. (1999). Depressive disorders in childhood and adolescence: A clinical perspective.Journal of Child and Adolescent Psychopharmacology9, 233–237.
6.
BirmaherB., & BrentD. (1998). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders.Journal of the American Academy of Child and Adolescent Psychiatry, 37(10 Suppl.), 63S–83S.
7.
BlanksteinA. M., Bullock,L M., & CopansS. A. (1998). Special issue: Interventions without drugs: A focus on AD/HD.Reaching Today's Youth, 2(2), 2–3.
8.
BussingR., ZimaB. T., BelinT. R., & FornessS. R. (1998). Children who qualify for LD and SED programs: Do they differ in level of ADHD symptoms and comorbid psychiatric conditions?Journal of Emotional or Behavioral Disorders, 22, 85–97.
9.
CrenshawT. M., KavaleK. A., FornessS. R., & ReeveR. E. (1999). Attention deficit hyperactivity disorder and the efficacy of stimulation medication: A meta-analysis. In ScruggsT., & MastropieriM. (Eds.), Advances in learning and behavioral disabilities (Vol. 13, pp. 135–165). Greenwich, CT: JAI.
10.
Del'HommeM., KasariC., FornessS. R., & BagleyR. (1996). Prereferral intervention and students at risk for emotional or behavioral disorders.Education and Treatment of Children, 19, 272–285.
11.
DulcanM. (1997). Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder.Journal of the American Academy on Child and Adolescent Psychiatry, 36(10 Suppl.), 85S–121S.
12.
FaraoneS. V., TsuangM. T., & TsuangD. W. (1999). Genetics of mental disorders.New York: Guilford.
13.
FornessS. R., CluettS. E., RameyC. T., RameyS. L., ZimaB. T., HsuC., KavaleK. A., & Mac-MillanD. L. (1998). Special education identification of Head Start children with emotional or behavioral disorders in second grade, Journal of Emotional or Behavioral Disorders, 6, 194–204.
14.
FornessS. R., & KavaleK. A. (2001). Reflections on the future of prevention.Preventing School Failure, 45, 75–81.
15.
FornessS. R., & KavaleK. A. (in press). ADHD and a return to the medical model of special education.Education and Treatment of Children.
16.
FornessS. R., KavaleK. A., CrenshawT. M., & SweeneyD. P. (2000). Best practice in treating children with ADHD: Does not using medication in a comprehensive intervention verge on malpractice?Beyond Behavior, 10(2), 4–7.
17.
FornessS. R., KavaleK. A., KingB. H., & KasariC. (1994). Simple versus complex conduct disorders: Identification and phenomenology.Behavioral Disorders, 19, 306–312.
18.
FornessS. R., KavaleK. A., & LopezM. (1993). Conduct disorders in school: Special education eligibility and co-morbidity.Journal of Emotional or Behavioral Disorders, 1, 101–108.
19.
FornessS. R., KavaleK. A., SweeneyD. P., & CrenshawT. M. (1999). The future of research and practice in behavioral disorders: Psychopharmacology and its school treatment implications.Behavioral Disorders, 24, 305–318.
20.
FornessS. R., KavaleK. A., & WalkerH. M. (1999). Identifying children at risk for antisocial behavior: The case for comorbidity. In GallimoreR. G., BernheimerC., MacMillanD. L., & SpeeceD. (Eds.), Developmental perspectives on children with high incidence disabilities (pp. 135–155). Mahwah, NJ: Erlbaum.
21.
FornessS., & SinclairE. (1990). Learning disabilities in clinical depression. In SwansonH. L., & KeoghB. (Eds.), Learning disabilities: Theoretical and research issues (pp. 315–332). Hillsdale, NJ: Erlbaum.
22.
FornessS. R., YoupaD., HannaG. L., CantwellD. P., & SwansonJ. M. (1992). Classroom instructional characteristics in attention deficit hyperactivity disorder: Comparison of pure and mixed subgroups.Behavioral Disorders, 17, 115–125.
23.
GadowK. D. (1997). An overview of three decades of research in pediatric psychopharmacoepidemiology.Journal of Child and Adolescent Psychopharmacology, 7, 219–236.
GadowK. D., & SprafkinJ. (1999). The Symptom Inventories: An annotated bibliography.Stony Brook: State University of New York, Department of Psychiatry.
26.
GarlandA. F., HoughR. L., McCabeK. M., YehM., WoodP. A., & AaronsG. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care.Journal of the American Academy of Child and Adolescent Psychiatry, 40, 409–418.
27.
GellerB., & LubyJ. (1997). Child and adolescent bipolar disorder: A review of the past 10 years.Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1168–1176.
28.
GreenhillL. L., AbikoffH. B., ArnoldL. E., CantwellD. P., ConnersC. K., ElliottG., HechtmanL., HinshawS. P., HozaB., lensenP. S., MarchJ. S., NewcornJ. H., PellhamW. E., SevereJ. B., SwansonJ. M., VitielloB., & WellsK. C. (1996). Medication treatment strategies in the MTA: Relevance to clinicians and researchers.Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1304–1313.
29.
GreshamF. M., MacMillanD. L., BocianK., WardS. L., & FornessS. R. (1998). Comorbidity of hyperactivity-impulsivity-inattention + conduct problems: Risk factors in social, affective, and academic domains.Journal of Abnormal Child Psychology, 26, 393–406.
30.
HeckamanK., ConroyM., FoxJ., & ChaitA. (2000). Functional assessment-based intervention research on students with or at risk for emotional and behavioral disorders in school settings.Behavioral Disorders, 25, 196–210.
31.
HendrenR. L., De BackerI., & PandinaG. L. (2000). Review of neuroimaging studies of child and adolescent psychiatric disorders from the past 10 years.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 815–828.
32.
HewettF. M., & FornessS. R. (1984). Education of exceptional learners (3rd ed.). Newton, MA: Allyn and Bacon.
33.
HughesC. W., GrahamJ. E., CrismonM. L., WagnerK. D., BirmaherB., GellerB., PliszkaS. R., RyanN. D., StroberM., TribediM. H., TopracM. G., SedilloA., LianaM. E., LopezM., RushA. J., & The Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. (1999). The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder.Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1442–1454.
34.
JensenP. S. (2000, April). Comparing the effectiveness of treatments for children with ADHD. Paper presented at the annual meeting of the Council for Exceptional Children, Vancouver, BC.
35.
JensenP. S., HinshawS. P., KraemerH. C., LenoraN., NewcornJ. H., AbikoffH. B., MarchJ. S., ArnoldL. E., CantwellD. P., ConnerC. K., ElliottG. R., GreenhillL. L., HechtmanL., HoazB., PelhamW. E., SevereJ. B., SwansonJ. M., WellsK. C., WigalT., & VitielloB. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups.Journal of the American Academy of Child and Adolescent Psychiatry, 40, 147–158.
36.
JensenP. S., KettleL., RoperM. T., SloanM. T., DulcanM. K., HovenC., BirdH. R., Bauer-meisterJ. J., & PayneJ.D. (1999). Are stimulants overprescribed? Treatment of ADHD in four U.S. communities.Journal of the American Academy of Child and Adolescent Psychiatry, 38, 797–804.
37.
KauffmanJ. M. (2001). Characteristics of emotional and behavioral disorders of children and youth (7th ed.). Upper Saddle River, NJ: Merrill/Prentice Hall.
38.
KauffmanJ. M., & HallahanD. P. (1974). The medical model and the science of special education.Exceptional Children, 41, 97–102.
39.
KavaleK. A., & FornessS. R. (1998). Covariance of learning disability and behavior disorders: An examination of the classification and placement issues. In ScruggsT., & MastropieriM. (Eds.), Advances in learning and behavioral disabilities (Vol. 12, pp. 1–42). Greenwich, CT: JAI.
40.
KavaleK. A., FornessS. R., & DuncanB. B. (1996). Defining emotional or behavioral disorders: Divergence and convergence. In ScruggsT, & MastropieriM. (Eds.), Advances in learning and behavioral disabilities (Vol. 10, Part A, pp. 1–45). Greenwich, CT: JAI.
41.
KavaleK. A., FornessS. R., & WalkerH. M. (1999). Interventions for ODD and CD in the schools. In QuayH., & HoganA. (Eds.), Handbook of disruptive behavior disorders, (pp. 441–454). New York: Plenum.
42.
KolbC. (2000, March 6). Drugged-out toddlers.Newsweek, p. 53.
43.
KollinsS. H., BarkleyR. A., & DuPaulG. J. (2001). Use and management of medications for children diagnosed with attention deficit hyperactivity disorder (ADHD).Focus on Exceptional Children, 33(5), 1–24.
44.
LoeberR., BurkeJ. D., LaheyB. B., WintersA., & ZeraM. (2000). Oppositional defiant and conduct disorders: A review of the past 10 years.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1468–1484.
45.
LopezM., FornessS. R., BocianK., MacMillanD. L., & GreshamF. M. (1996). Children with attention deficit hyperactivity disorder and emotional or behavioral disorders in primary grades: Inappropriate placement in the learning disability category.Education and Treatment of Children, 19, 286–299.
46.
MashE. J., & BarkleyR. A. (Eds.).(1996). Child psychopathology.New York: Guilford.
47.
MashE. J., & BarkleyR. A. (Eds.). (1998). Treatment of childhood disorders (2nd ed.). New York: Guilford.
48.
MattisonR. E., & FornessS. R. (1995). The role of psychiatric and other mental health services in special education placement decisions for children with emotional or behavioral disorders. In KauffmanJ. M., LloydJ. W., AstutoT. A., & HallahanD. P. (Eds.), Issues in educational placement of children with emotional or behavioral disorders (pp. 197–211). Hillsdale, NJ: Erlbaum.
49.
McClellanJ., & WerryJ. (2000). Summary of the practice parameters for the assessment and treatment of children and adolescents with schizophrenia.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1580–1582.
50.
MTA Cooperative Group. (1999a). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.Archives of General Psychiatry, 56, 1073–1086.
51.
MTA Cooperative Group. (1999b). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder.Archives of General Psychiatry, 56, 1088–1096.
52.
PelhamW. E. (1999). The NIMH Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder: Just say yes to drugs alone?Canadian Journal of Psychiatry, 44, 981–990.
53.
PliszkaS. R., Greenhill,L L., CrimsonM. L., SedilloA., CarlsonC., ConnersC. K., McCrackenJ. T., SwansonJ. M., HughesC. W., LianaM. E., LopezM., & TopracM. G. (2000a). The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part I.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 908–919.
54.
PliszkaS. R., GreenhillL. L., CrimsonM. L., SedilloA., CarlsonC., ConnersC. K., McCrackenJ. T., SwansonJ. M., HughesC. W., LianaM. E., LopezM., & TopracM. G. (2000b). The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part II: Tactics.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 920–927.
55.
ReddenS. C., FornessS. R., RameyS. L., RameyC. T., ZimaB. T., BrezausekC. M., & KavaleK. (1999). Head Start children at third grade: Preliminary special education identification and placement of children with emotional, learning, or related disabilities.Journal of Child and Family Studies, 8, 285–303.
56.
RiddleM. A., LabellarteM. J., & WalkupJ.T. (1998). Pediatric psychopharmacology: Problems and prospects.Journal of Child and Adolescent Psychopharmacology, 56, 1088–1096.
57.
StateM. W., LombrosoP. J., PaulsD. L., & LeckmanJ.F. (2000). The genetics of childhood psychiatric disorders: A decade of progress.Journal of the American Academy of Child and Adolescent Psychiatry, 39, 946–962.
58.
SteinerH. (1997). Practice parameters for the assessment and treatment of children and adolescents with conduct disorder.Journal of the American Academy of Child and Adolescent Psychiatry, 36(l0 Suppl.), 122S–139S.
59.
StormontM. (2000). Early child risk factors for externalizing and internalizing behaviors: A five-year follow-forward assessment.Journal of Early Intervention, 23, 180–190.
60.
SugaiG., & HornerR. H. (1999/2000). Special issue: Including the functional behavioral assessment technology in schools.Exceptionality, 8, 145–229.
61.
SwansonJ. M., KraemerH. C., HinshawS. P., ArnoldL. E., ConnersC. K., AbikoffH. B., ClevengerW., DaviesM., ElliotG. R., GreenhillL. L., HechtmanL., HozaB., JensenP. S., MarchJ. S., NewcornJ. H., OwnsE. B., PelhamW., SchillerE., SevereJ. B., SimpsonS., VitielloB., WellsK., WigalT., & WuM.(2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment.Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168–179.
62.
TeplinL. A. (2000, September). Juvenile justice and identification of mental health needs. Paper presented at the U.S. Surgeon General's Conference on Children's Mental Health, Washington, DC.
63.
U.S. Surgeon General's Office. (2001). Surgeon General's Conference on Child Mental Health (executive summary).Bethesda, MD: National Institutes of Health.
64.
VitielloB. (1997). Treatment algorithms in child psychopharmacology research.Journal of Child and Adolescent Psychopharmacology, 7, 3–8.
65.
VitielloB. (1998). Pediatric psychopharmacology and the interaction between drugs and the developing brain.Canadian Journal of Psychiatry, 43, 582–584.
66.
VitielloB., Bhatara,V S., & JensenP. S. (1999). Special section: Current knowledge and unmet needs in pediatric psychopharmacology.Journal of the American Academy of Child and Adolescent Psychiatry, 38, 501–565.
67.
WalkerH. M., ColvinG., & RamseyE. (1995). Antisocial behavior in school: Strategies and best practices.Longmont, CO: Sopris West.
68.
WilensT. E. (1999). Straight talk about psychiatric medications for kids.New York: Guilford.
69.
WinsbergB. G., & ComingsD. E. (1999). Association of the dopamine transporter gene (DAT1) with poor methylphenidate response.Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1474–1477.
70.
ZitoJ. M., SaferD. J., dosReisS., GardnerJ. F., BolesM., & LynchF. (2000). Trends in the prescribing of psychotropic medications to preschoolers, Journal of the American Medical Association, 283, 1025–1030.
71.
ZitoJ. M., SaferD. J., dosReisS., & RiddleM. A. (1998). Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland, Journal of the American Academy of Child and Adolescent Psychiatry, 37, 179–184.
