What constitutes an appropriate diagnostic workup for children with emotional or behavioral disorders (EBD) varies in both school and clinic settings. Current definitions of EBD suggest that a symptom checklist should be required, but there is some disagreement about what constitutes a functional impairment and what role out-of-school assessments should play. The purpose of this study was to determine the impact of different diagnostic criteria on EBD identification by systematically varying the respondent for the symptom checklist (parent and/or teacher) and the type of functional impairment (poor academic achievement and/or poor social skills) required for diagnosis. The sample included 3.694 children in second grade, who were part of a longitudinal sample of Head Start graduates. Clinical cutoff points on behavior problem checklists from parents and teachers, on social skills ratings from parents and teachers, and on individual measures of academic achievement were serially applied to the sample to determine the rate of EBD identification with various combinations of instruments. The 13 different diagnostic combinations identified from 1.1% to 27.5% of the sample. Four of these combinations resulted in significant ethnic or gender bias. Findings are discussed with reference to current diagnostic criteria used for EBD in school or clinic settings.
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References
1.
Achenbach, T. M. (1985). Assessment and taxonomy of child and adolescent psycho-pathology. Beverly Hills, CA: Sage.
2.
Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist. New York: Queen City Printers.
3.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavior and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington. DC: Author.
5.
Apter, A., Fallon, T. J., King, R. A., Ratzoni, G., Zohar, A. H., Binder, M., Weizman, A., Leckman, J. F., Pauls, D. L., Kron, S., & Cohen, D.J. (1996). Obsessive-compulsive characteristics: From symptoms to syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 907–912.
6.
Artiles, A. J., & Trent, S. C. (1994). Overpresentation of minority students in special education: A continuing debate. The Journal of Special Education, 27, 383–409.
7.
Artiles, A. J., & Trent, S. C. (1997). Building a knowledge base on culturally diverse students: The need to enrich research with a sociocultural perspective. Learning Disabilities Research & Practice, 12, 79–91.
8.
Bird, H. R., Gould, M. S., Staghezza, B. (1992). Aggregating data from multiple informants in child psychiatry epidemiological research. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 78–85.
9.
Bird, H. R., Yager, T. J., Staghezza, B., Gould, M. S., Canino, G., & Rubio-Stipec, M. (1990). Impairment in the epidemiological measurement of childhood psychopathology in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 796–803.
10.
Boyle, M. H., Offord, D. R., Racine, Y., Szatmari, P., Fleming, J. E., & Sanford, M. (1996). Identifying thresholds for classifying childhood psychiatric disorder: Issues and prospects. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1440–1448.
11.
Brandenburg, N. A., Friedman, R. M., & Silver, S. E. (1990). The epidemiology of childhood psychiatric disorders: Prevalence findings from recent studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 76–83.
12.
Caseau, D. L., Luckasson, R., & Kroth, R. L. (1994). Special education services for girls with serious emotional disturbance: A case of gender bias?Behavioral Disorders, 20, 51–60.
13.
Cohen, J. (1960). A coefficient for agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.
14.
Conners, C. K. (1969). A teacher rating scale for use in drug studies with children. American Journal of Psychiatry, 126, 152–156.
15.
Conners, C. K. (1973). Rating scales for use in drug studies with children. Psycho-pharmacology Bulletin, 9, 24–84.
16.
Dunn, L. M., & Dunn, L. (1981). Peabody picture vocabulary test–Revised. Circle Pines, MN: American Guidance Service.
17.
Epstein, M. H., & Sharma, F. (1998). Behavioral and emotional scale (BER)S: A strength-based approach to assessment. Austin, TX: PRO-ED.
18.
Ferguson, D. M., & Horwood, L. J. (1995). Predictive validity of categorically and dimensionally scored measures of disruptive childhood behaviors. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 477–485.
19.
Forness, S. R. (1990). Resolving the definitional and diagnostic issues of serious emotional disturbance in the schools. In S. Braaten & G. Wrobel (Eds.), Perspectives on the diagnosis and treatment of students with emotional/behavioral disorders (pp. 1–15). Minneapolis: Council for Children with Behavior Disorders.
20.
Forness, S. R. (1992a). Legalism versus professionalism in diagnosing SED in the public schools. School Psychology Review, 21, 29–34.
21.
Forness, S. R. (1992b). Broadening the cultural–organizational perspective in exclusion of youth with social maladjustment. Remedial and Special Education, 13(1), 55–59.
22.
Forness, S. R. (1996). School children with emotional or behavioral disorders: Perspectives on definition, diagnosis, and treatment. In B. Brooks & D. Sabatino (Eds.), Personal perspectives on emotional or behavioral disorders (pp. 84–95). Austin, TX: PRO-ED.
23.
Forness, S. R., & Kavale, K. A. (1997). Defining emotional and behavioral disorders in school and related services. In J. W. Lloyd, E. J. Kameenui, & D. Chard (Eds.), Issues in educating students with disabilities (pp. 45–61). Hillsdale, NJ: Erlbaum.
24.
Forness, S. R., & Knitzer, J. (1992). A new proposed definition and terminology to replace “serious emotional disturbance” in the Individuals with Disabilities Education Act. School Psychology Review, 21, 12–20.
25.
Forness, S. R., Ramey, S. L., Ramey, C. T., Hsu, C., Brezausek, C. M., MacMillan, D. L., Kavale, K. A., & Zima, B. (1998). Head Start children finishing first grade: Preliminary data on school identification of children at risk for special education. Behavioral Disorders23, 111–124.
26.
Gonzales, P. (1991). A comparison of state policy of the federal definition and a proposed definition of serious emotional disturbance. Alexandria, VA: National Association of State Directors of Special Education.
27.
Gould, M. S., Bird, H., & Jaramillo, B. S. (1993). Correspondence between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample. Journal of Abnormal Child Psychology, 21, 287–313.
28.
Green, M. T., Clopton, J. R., & Pope, A. W. (1996). Understanding gender differences in referral of children to mental health services. Journal of Emotional and Behavioral Disorders, 4, 182–190.
29.
Gresham, F. M., & Elliott, S. N. (1990). Social skills rating system. Circle Pines, MN: American Guidance Service.
30.
Head Start Bureau. (1996). Head Start children's entry into public school: An interim report on the National Head Start–Public School Early Childhood Transition Demonstration Project. Washington, DC: Administration on Children, Youth, & Families, U.S. Department of Health and Human Services.
31.
Johnson, R. A., & Wichern, D. W. (1992). Applied multivariate statistical analysis (3rd ed.). Englewood Cliffs, NJ: Prentice Hall.
32.
Kavale, K. A., Forness, S. R., & Duncan, B. (1996). Defining emotional or behavioral disorders: Divergence and convergence. In T. Scruggs & M. Mastropieri (Eds.), Advances in learning and behavioral disabilities (Vol. 10, pp. 1–45). Greenwich, CT: JAI Press.
33.
Keogh, B. K., & Bernheimer, L. P. (1998). Concordance between mothers' and teachers' perceptions of behavior problems of children with developmental delays. Journal of Emotional and Behavioral Disorders, 6, 33–41.
34.
Lambert, N., Windmiller, M., Cole, L. & Figueroa, R. (1974). AAMD adaptive behavior scale, public school version, 1974 revision. Bellevue, WA: Edmark.
35.
McConaughy, S. H. (1993). Evaluating behavioral and emotional disorders with the CBCL, TRF, and YSR cross-informant scales. Journal of Emotional and Behavioral Disorders, 1, 40–52.
36.
McIntyre, T. (1995). McIntyre assessment of culture: An instrument for evaluating the influence of culture on behavior and learning. Columbia, MO: Hawthorne Educational Services.
37.
McIntyre, T. (1996). Guidelines for providing appropriate services to culturally diverse students with emotional and/or behavioral disorders. Behavioral Disorders, 21, 137–144.
38.
Offord, D. R., Boyle, M. H., Racine, Y., Szatmari, P., Fleming, J. E., Sanford, M., & Lipman, E. L. (1996). Integrating assessment data from multiple informants. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1078–1085.
39.
Piacentini, J. D., Cohen, P., & Cohen, J. (1992). Combining discrepant diagnostic information from multiple sources: Are complex algorithms better than simple ones?Journal of Abnormal Child Psychology, 20, 51–63.
40.
Prior, M., Smart, D., Sanson, A., Pedlow, R., & Oberklaid, F. (1992). Transient versus stable behavior problems in a normative sample: Infancy to school age. Journal of Pediatric Psychology, 17, 423–443.
41.
Quay, H. C., & Peterson, D. R. (1983). Interim manual for the Revised Behavior Problem Checklist. Coral Gables, FL: University of Miami.
42.
Reid, R. (1995). Assessment of ADHD with culturally different groups: The use of behavioral rating scales. School Psychology Review, 24, 537–560.
43.
Reid, R., & Maag, J. W. (1994). How many fidgets in a pretty much?: A critique of behavior rating scales for identifying students with ADHD. Journal of School Psychology, 32, 339–354.
44.
Reynolds, W. M. (1987). Reynolds adolescent depression scale. Odessa, FL: Psychological Assessment Resources.
45.
Reynolds, W. M. (1989). Reynolds child depression scale. Odessa, FL: Psychological Assessment Resources.
46.
Rueda, R., & Forness, S. R. (1994). Childhood depression: Ethnic and cultural issues in special education. In R. Peterson & S. Ishii-Jordan (Eds.), Multicultural issues in the education of students with behavioral disorders (pp. 40–62). Cambridge, MA: Brookline.
47.
Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., Lahey, B. B., Bourdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D.A. (1996). The NIMH diagnostic interview schedule for children version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865–877.
48.
Shoukri, M. M., & Edge, V. L. (1995). Statistical methods for the health sciences. New York: CRC Press.
49.
Verhulst, F. C., & Akkerhuis, G. W. (1989). Agreement between parents' and teachers' ratings of behavioral/emotional problems of children aged 4–12. Journal of Child Psychology and Psychiatry, 30, 123–136.
50.
Walker, H. M., & Severson, H. H. (1990). Systematic screening for behavioral disorders. Longmont, CO: Sopris West.
51.
Walker, H. M., Severson, H. H., & Feil, E. (1995). The early screening project. Longmont. CO: Sopris West.
52.
Witmer, D., Doll, B., & Strain, P. (1996). Social and emotional development in early childhood: The identification of competence and disabilities. Journal of Early Intervention, 20, 299–318.
53.
Woodcock, R. W., & Johnson, M. B. (1989). Woodcock-Johnson psychoeducational test battery–revised. Allen, TX: Riverside.
54.
Yell, M. L., & Shriner, J. G. (1997). The IDEA amendments of 1997: Implications for special and general education teachers, administrators, and teacher trainers. Focus on Exceptional Children, 30(1), 1–19.
55.
Zima, B. T., Bussing, R., Forness, S. R., & Benjamin, B. (1997). Sheltered homeless children: Eligibility and unmet need for special education evaluations. American Journal of Public Health, 87, 236–240.
56.
Zima, B. T., Forness, S. R., Bussing, R., & Benjamin, B. (1998). Homeless children in emergency shelters: Need for prereferral intervention and potential eligibility for learning or behavioral disorders. Behavioral Disorders, 23, 98–110.
