DIFFERENTIATION OF EMOTIONAL DISTURBANCE AND SOCIAL

MALADJUSTMENT: INTRODUCTION TO THE SPECIAL ISSUE

TAMMY L. HUGHES
Duquesne University
MELISSAA. BRAY
University of Connecticut
We provide an overview of this special issue of Psychology in the Schools, which focuses on the
current status of the debate about the denition of emotional disturbance (ED) provided in the
Individuals with Disabilities Education Act (1997) and the exclusionary clause regarding social
maladjustment (SM). The debate centers on three areas: special education classication, which
is ultimately a scal matter for law makers; differential diagnosis of clinical or educational
disorders, which is ultimately a question about the worth of diagnostic taxonomies; and use of
the terms emotional disturbance and social maladjustment, which have not been scientically
established. In this introduction we argue that Congress has already decided the issue of special
education eligibility for those with social maladjustment. Rather, the core issue is the evaluation
of the scientic merit of ED and SM differentiation as it relates to treatment planning. This is
addressed in this special issue by a number of authors outlining the steps necessary for schools
to move forward from this debate toward a focus on empirically-based treatment for children
whose emotions and/or behaviors interfere with their learning or the learning of others. 2004
Wiley Periodicals, Inc.
School psychologists, as part of multidisciplinary evaluation teams, are required by the Indi-
viduals with Disabilities Education Act (1997) to consider qualifying children with emotional
problems under emotional disturbance (ED) and to exclude children with social maladjustment
(SM) from special education. However, children with SM who also have an ED diagnosis should
be included in special education. This has been the case since the passage of the Education of All
Handicapped Children Act in 1975. And, according to the current reauthorization bill for the
Individuals with Disabilities Education Act (1997), this will be the case for the next several years.
Therefore, differential special education classication has been and will remain intact for the
practicing school psychologist. It is necessary to determine how school psychologists should
address this classication requirement so that children will not get caught in the middle. Our aim
in this special issue then is to further examine whether ED and SM are distinct classications and
move forward to examine treatment approaches for children in these categories.
Why has this debate been sustained for almost 30 years? First, whether a child should be
given the procedural safeguards and the federal funding entitled to children in special education
has been contentious with regard to social maladjustment. Skiba and Grizzle (1991) have argued
that the social maladjustment clause was a legislative accident of history (p. 581) in 1975.
However, including all children with social maladjustment could increase the cost of special edu-
cation at the federal, state, and local levels signicantly. Increased cost leads legislators to be
reticent to include those with social maladjustment under federal special education protection.
Also, others have argued that the criteria for ED can also dene the exclusionary classica-
tion of SM and is therefore illogical (Nelson, 1992). However, this is, in fact, the point of exclu-
sionary clauses. For example, in the Diagnostic and Statistical Manual of Mental Disorders,
Fourth EditionText Revision (DSM-IV-TR; American Psychiatric Association, 2000), having the
diagnostic symptoms of ADHD will not allow you to carry the diagnosis if you have a pervasive
Correspondence to: Tammy L. Hughes, Duquesne University, 102C Canevin Hall, Pittsburgh, PA 15282. E-mail:
hughest@duq.edu
Psychology in the Schools, Vol. 41(8), 2004 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20038
819
developmental disorder (PDD), schizophrenia or other psychotic disorder, mood disorder, anxiety
disorder, disassociative disorder, or a personality disorder because the same behaviors are better
accounted for by the other disorder. Despite such arguments, the SM exclusionary clause has
withstood two reauthorizations and is about to withstand a thirdsuggesting it is no accident.
School psychologists, on the other hand, would like to help all children learn. Whether this
occurs within or outside of special education is immaterial to some. Rather, what is important is
whether or not the childs difculties are described in a manner that will result in the most appro-
priate treatment. Here there are differences of opinion. Some argue that there is a continuum of
emotional and behavioral disturbances among children and that they cannot be meaningfully dif-
ferentiated for classication or treatment purposes. On the other hand, there are those that argue
there is adequate research on the differential diagnosis and developmental trajectories of children
with internalizing disorders and those with externalizing disorders to legitimately differentiate the
two groups for treatment planning. This discussion is complicated because the terms, emotional
disturbance and social maladjustment have not been scientically established. Despite this con-
cern, it is unlikely that this debate would be resolved with an ofcial introduction of scientically
established terminology in the DSM-IV-TR (APA, 2000).
These two issues, qualication for special education and differential diagnosis, when consid-
ered simultaneously result in a conundrum. Psychologists interested in not differentiating ED and
SM must support the inclusion side of the qualication for special education debate. To take the
other side would result in excluding those with depression, anxiety, and schizophrenia from spe-
cial education protection, which would not be appropriate. Those that support differential diag-
nosis can be comfortable with either inclusion or exclusion of those classied as socially maladjusted,
as long as they are provided appropriate, but different services. When the debate heats up, though,
the differentiate group can be criticized as not wanting to serve children with social maladjustment
by lumping into the argument the qualication issue, namely claiming that exclusion is equivalent
to not treating. However, this is not the case. Those from the differentiate group tend to support
treatments, just different treatments.
Congress has ruled on the inclusion debate. That is, individuals characterized as socially
maladjusted will be excluded from special education. Where school psychologists should provide
clarication is on the latter issue of establishing the scientic merit of differentiating children with
emotional and/or behavioral problemsor notfor the purpose of treatment planning.
Organization of the Special Issue
We begin this issue with Frick (2004) describing the developmental pathways associated with
different types of antisocial behaviors, aggression, and conduct disorders in children. He suggests
that these developmental pathways justify differential treatment. Merrell and Walker (2004) con-
tend that federal denitions are problematic and may inhibit the progress of behavior disorders
subspecialties in special education. They provide an undifferentiated model of emotional and
behavioral assessment in which universal screening and behavioral support are provided along
with increasingly focused assessment and intervention for high-risk children.
Gacono and Hughes (2004) provide a necessary operationalized denition of social malad-
justment based on the extensive literature on child psychopathy. They argue that denitions based
on behaviors alone will prove unsuccessful for the purpose of differentiation. In contrast, Olympia
and his colleagues (2004) examine assessment instruments and conclude denitions and assess-
ment differentiation are not practical. By comparing the usefulness of four rating scales to mea-
sure ED and SM symptoms, they conclude that ratings are not useful for discriminating ED and
SM groups.
820 Hughes and Bray
Miller and colleagues (2004) describe an approach to functional behavioral assessment that
differentially informs intervention planning for children with emotional disturbances and those
with social maladjustment. They discuss how the contribution of individual, social, and environ-
mental risk factors can be considered simultaneously by school teams and can be used for inter-
vention planning. Kehle and colleagues (2004) propose an alternative nonenvironmental explanation
for the increase in incidence of ED and SM based on the genetic phenomenon heterosis. Heterosis,
or hybrid vigor, is the plausible explanation that secular changes in several cognitive, physical,
and psychological characteristics may have the same nonenvironmental etiology. Theodore and
colleagues (2004) provide a rationale for differentiating ED and SM. They explain the role of
clinical judgment as related to selecting tailored intervention strategies.
Elinoff and colleagues (2004) detail the association between bullying and the development of
distinct severe conduct problems in children. They provide specic recommendations about system-
level interventions to address low-level aggression. Heatheld and colleagues (2004) advocate for
intervention strategies that do not require labels. They outline a prevention and intervention model
for all levels of emotional and behavioral difculties exhibited by children. They conclude that
development and academic performance should be where energies and resources are spent.
In summary, the role of the school psychologist in serving children with emotional and/or
behavioral difculties becomes complex when special education classication and the usefulness
of differential diagnosis are muddled together. The authors in this special issue generally agree it
is time to move beyond the ED and SM classication debate, and advocate for serving the needs
of children.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Wash-
ington, DC: Author.
Elinoff, M.J., Chafouleas, S.M., & Sassu, K.A. (2004). Bullying: Considerations for dening and intervening in school
settings. Psychology in the Schools, 41, 887897.
Frick, P.J. (2004). Developmental pathways to conduct disorder: Implications for serving youth who show severe aggres-
sive and antisocial behavior. Psychology in the Schools, 41, 823834.
Gacono, C.B., & Hughes, T.L. (2004). Differentiating emotional disturbance from social maladjustment: Assessing psy-
chopathy in aggressive youth. Psychology in the Schools, 41, 849860.
Heatheld, L.T., & Clark, E. (2004). Shifting from categories to services: Comprehensive school-based mental health for
children with emotional disturbance and social maladjustment. Psychology in the Schools, 41, 911920.
Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq. (1997).
Kehle, T.J., Bray, M.A., Theodore, L.A., Zhou, Z., & McCoach, D.B. (2004). Emotional disturbance/social maladjustment:
Why is the incidence increasing? Psychology in Schools, 41, 861865.
Lynam, D.R. (1996). Early identication of chronic offenders: Who is the edgling psychopath? Psychological Bulletin,
120, 209234.
Merrell, K.W., & Walker, H.M. (2004). Deconstructing a denition: Social maladjustment versus emotional disturbance
and moving the EBD eld forward. Psychology in the Schools, 41, 899910.
Miller, J.A., Williams, S.J., & McCoy, E.L.B. (2004). Using multimodal functional behavioral assessment to inform treat-
ment selection for children with either emotional disturbance or social maladjustment. Psychology in the Schools, 41,
867877.
Nelson, C.M. (1992). Searching for meaning in the behavior of antisocial pupils, public school educators, and lawmakers.
School Psychology Review, 1, 3539.
Olympia, D., Farley, M., Christiansen, E., Pettersson, H., Jenson, W., & Clark, E. (2004). Social maladjustment and
students with behavioral and emotional disorders: Revisiting basic assumptions and assessment issues. Psychology in
the Schools, 41, 835847.
Skiba, R., & Grizzle, K. (1991). The social maladjustment exclusion: Issues of denition and assessment. School Psychol-
ogy Review, 20, 580594.
Theodore, L.A., Akin-Little, A., & Little, S.G. (2004). Evaluating the differential treatment of emotional disturbance and
social maladjustment. Psychology in the Schools, 41, 879886.
Introduction to Differentiation of Emotional Disturbance and Social Maladjustment 821