EDDT/EDDT-PF Effective Assessment of Emotional Disturbance

1. EDDT/EDDT-PF Effective Assessment of Emotional Disturbance

2. Purpose • Assess a different approach to evaluating Social Maladjustment (SM) which treats it as a supplemental, proportional trait (not part of an either-or ED/SM diagnosis) • Accomplish this in the context of a standardized instrument that addresses all areas of the IDEA definition of Emotional Disturbance (ED)

3. Definition of ED (IDEA, 2004) (i) The term means a condition exhibiting one or more of the following characteristics over a long period of time 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 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 (ii) The terms includes schizophrenia. The term does not apply to children who are socially maladjusted unless it is determined that they have an emotional disturbance.

4. Characteristics Typically Associated with ED • Behavior is involuntary or reactive • Disruptive behaviors are emotionally-driven • Student feels remorseful • Student is self-critical • Student experiences feelings of inadequacy • Student tends to be anxious and guilt-laden • Student has few if any friends (Clarizio, 1992b; Constenbader & Buntaine, 1999)

5. DSM-IV Diagnoses That May Be Associated With ED • Affective Disorders (Depression, Dysthymia, Bipolar Disorder, Cyclothymia) • Eating Disorders • Generalized Anxiety Disorders • Obsessive-Compulsive Disorders • Panic Disorders • Phobias • Post Traumatic Stress Disorder • Reactive Attachment Disorder • Schizophrenia • Separation Anxiety Disorder • Somatization Disorder (Tansy, 2007)

6. Characteristics Typically Associated with SM • Knows and understands rules and norms, but intentionally breaks and rejects conventions • Perceives self to be “normal” and able to behave “normally” when needed • Views rule-breaking as normal and acceptable • Misbehavior does not result in anxiety or remorse unless caught (Clarizio, 1992a; Clarizio, 1992b; Kelly, 1990)

7. DSM-IV Diagnoses Typically Associated with SM • Oppositional Defiant Disorder • Defiance • Conduct Disorder • Violate rights of others and societal rules • Anti-Social Personality Disorder • CD characteristics since age 15 • Diagnosed after age 18

8. “Concept Drift” for Psychopathy • DSM and DSM-II: Specific personality variables were central to the diagnosis of “psychopathic personality disturbance” • DSM-III and DSM-IV: Psychopathy was redefined as antisocial personality disorder and was defined behaviorally to increase reliability (Hare, Hart, & Harpur, 1991)

9. Characteristics of Psychopathy • Deficient Affective Experience: Callous, low remorse, weak conscience, low guilt, low empathy, shallow affect, failure to accept responsibility • Arrogant Interpersonal Style: Glibness or superficial charm, self-centeredness, grandiose sense of self-worth, lying, conning, manipulative, deceitful • Impulsive/Irresponsible Behavioral Style: Boredom, excitement seeking, reward-dominant response style, lack of long-term goals, impulsivity, parasitic lifestyle (Cleckley, 1941; Cooke and Michie, 2001; Cooke et al, 2004; Farrington, 2005; Hare, 1990; Salekin et al., 2003, 2005; Yochelson & Samenow, 1976)

10. Summary of the Major Risk Factors Associated With Conduct Disorder • Dispositional risk factors Contextual risk factors • Neurochemical abnormalities Pre-natal exposure to toxins • Autonomic irregularity Early exposure to poor quality child care • Birth complications Parental psychopathology • Difficult child temperament Family conflict • Impulsivity Inadequate parental supervision and discipline • Preference for dangerous and Lack of parental involvement and novel activities and neglect • Reward dominant response style Peer rejection • Low verbal intelligence Association with a deviant peer group • Academic underachievement Impoverished living conditions • Deficits in processing social info Exposure to violence Frick (2004)

11. Developmental Pathways • 1. Childhood Onset – high CU • 2. Childhood Onset – low CU • 3. Adolescent Onset

12. Existing Arguments • “Treating disruptive behaviors of SM students as manifestations of a disability creates difficulties with regard to student accountability, administrative discipline, and burnout among teachers” (Gacono & Hughes, 2004) • ED and SM are distinctive enough that they need and benefit from different types of programs (Theodore et al., 2004) • Incarcerated youth have seven times the incidence of ED of “normals” but are often not identified/served until after incarceration. ED students are equally likely to be violent or non-violent (Johnson et al., 2001)

13. Existing Arguments (continued) • ED is correlated with antisocial behavior so that ED students are often SM (Kehle et al., 2004) • SM students often have internalized problems too, so SM/ED overlap is common (Davis et al., 2002; Seeley e. al., 2002; Marriage et al., 1986) • There is no discernible difference in SM and ED students (Bower, 1982 as in Tansy, 2004) • ED and SM cannot be completely distinguished (Constenbader & Bundaine, 1999)

15. Overview- the SM / ED Problem • Dichotomy – IDEA language, Political Issues • Internalizing/Externalizing Model • Failure to Consider Comorbidity (SM and masked ED present) • Misdiagnosis and Exclusion

16. Alternatives to Dichotomization and Exclusion • Include SM Under the ED Umbrella (Olympia et al., 2004) • Differentiate SM and ED but Provide SM Treatment (Hughes & Bray, 2004) • Use a “Two Factor” Model of SM That Includes Both Behavior and Internal Attitudes, to Overcome Externalization Equivalence and Assure True SM (Gacono & Hughes, 2004, Tansy, 2004; Frick, Barry, & Bodin, 2000; Harpur et al., 1989) • Evaluate ED Based on the Actual IDEA Criteria First, Then Treat SM as a Supplemental and Relative Issue (Euler, 2007)

17. Emotional Disturbance Decision Tree The EDDT is a standardized, norm-referenced scale that assists in the identification of students who may meet IDEA (2004) criteria for Emotional Disturbance (ED). It is normed for ages 5-18. The EDDT is criterion referenced. It is based on the criteria presented in the Individuals with Disabilities Education Act of 2004 It maps on to all the ED criteria. The EDDT was designed to be completed by teachers or other professionals (e.g., school psychologists, clinical psychologists, diagnosticians, counselors, social workers) who have had substantial contact with the student.It is not aparent rating scale, although parents can contribute. The EDDT takes 15-20 minutes to complete and 15 minutes to score.

18. Emotional Disturbance Decision Tree – Parent Form • Provides a standardized approach to gathering parent information about children’s functioning in the areas that make up the federal ED criteria. • Normed for ages 5-18 • 15-20 minutes to complete, 15 minutes to score • When considered with data from the EDDT, promotes a comprehensive assessment of the student across both school and home environments • Promotes integration of parent input in the eligibility process • Spanish Version

19. Measuring Never-Defined Criteria:The Development of the EDDT The original items were based on: • Literature on ED and SM (heavily considered) • Author’s experience with regard to how ED characteristics are manifested by students • Key features of conduct problems and antisocial attitudes observed by the author in both school and correctional settings

20. Next, two pilot studies were conducted: • First study: 2-year period in multiple schools during which the working group and author met regularly for feedback about items and the overall measure. • Second study: Assessed effectiveness of the measure. School psychologists, educational diagnosticians, and other professionals rated the degree to which the EDDT items accurately reflected ED and SM. Results also analyzed in terms of internal consistency and correlations with other published measures.

21. Development of the EDDT (continued) Standardization version: • Further input from practicing school psychologists • Select items were rewritten for clarity • Following data gathering, the scales were further modified with the goal of reducing the number of items to a more reasonable level while maintaining excellent score reliability and validity • Frequency distributions, item-with-total correlations, and consistency coefficients were examined. Items with low specificity and low correlations were eliminated, as well as items were reassigned to scales depending on its best fit.

22. Sections of the EDDT Section Potential Exclusionary Items (IQ, Hearing-vision, Health, Duration Checklist) Emotional Disturbance Characteristics Social Maladjustment (SM) Cluster Level of Severity (SEVERITY) Cluster Educational Impact (IMPACT) Cluster

24. Over a long period of time to a marked degree that adversely affects a child’s educational performance • Over Six Months • Addressed in Section I • Based on DSM criteria that differentiates adjustment problems from a diagnosis

25. ED Characteristics:An inability to learn that cannot be explained by intellectual, sensory, or health factors • Sub-par Academic Performance (NOT just poor standard scores) • Serious Lags/Deficits in Social Learning and Development Also Count • Students With Intellectual, Sensory, or Health Problems Can Conceivably Have an ED Also, but Separate Contribution of an ED is Harder to Prove: Rigorous Evidence Needed

26. ED Characteristics: An inability to build or maintain satisfactory relationships with peers and teachers Inability to Build or Maintain Relationships (REL) Related Literature Piaget, 1969 – Cognitive and affective-social development are inseparable Erikson, 1963 – Well developing child is eager to make things cooperatively…profit from teachers and emulate ideal prototypes (Initiative vs. Guilt stage) Hay et al., 2000- Social difficulty is tied to lower frequency of desirable classroom activity like persistence, leadership

27. Domain Characterized By: unstable, few-no relationships chronic hostility in interaction social avoidance inappropriate interaction chronic peer rejection age inappropriate friend preference poor reciprocity lack of empathy or respect poor “connectivity skills” poor social conversation skill aggressiveness with peers qualitative relationship problems Item Examples • Is hostile towards peers • Is resentful, spiteful, or angry toward others

28. ED Characteristics:Inappropriate types of behavior or feelings under normal circumstances Inappropriate Behaviors or Feelings (IBF) Related Literature – Multiple pathways and indirect but clear relationships Crockett et al. 2006 – There are multiple pathways by which youth reach problem outcomes and express distress ( many types of behaviors reflect ED and interfere with social/school success. Examples -Compulsion interferes with school (Piacentini et al., 2003). Poor self regulation is tied to depression- that leads to school problems. Zeman et al. 2002 – Youth with good coping have less risk for bad outcomes. Youth who can’t inhibit anger more likely to develop emotional symps (& school probs)

29. Domain Characterized By: age inappropriate behavior attention seeking failure to self-regulate teasing-taunting mismatch of behavior/emotion over-aroused behavior dramatic or strange behavior tantrums / shut down defensiveness, defiance suspiciousness poor coping restricted interests distorted views &/or emotions risk taking Item Examples • Behaves in an unusual or strange manner compared to peers • Displays strange, distorted, or inappropriate emotions

30. ED Characteristics: A tendency to develop physical symptoms or fears associated with personal or school problems Physical Symptoms or Fears (FEARS) Related Literature March, 1997 – Socially fearful children fear embarrassment, rejection (such as from talking in class) Black, 1995 – Separation anxiety disorder is a variant of panic disorder (and can prevent basic school attendance and participation)

31. Domain Characterized By: nervousness, anxiety obsessive thoughts absorption with past events fearfulness of peers or adults school avoidance due to fears separation anxiety re. caregivers panic symptoms physical withdrawal from others over-dependency self-isolation due to social discomfort somatic complaints risk avoidance restlessness ritualistic behavior compulsive behavior Item Examples • Has physical complains which result in leaving or avoiding school • Expresses obsessive fear that a catastrophe (e.g., death of a parent) will occur

32. ED Characteristics: A general pervasive mood of unhappiness or depression Pervasive Mood/Depression (PM/DEP) Related Literature Mattison et al., 1990 – Depression is correlated with lower GPA Strauss et al., 1982 – Depression is correlated with lower standardized achievement Puura et al. 1998 – Self reported depression is correlated with poor teacher ratings

33. Domain Characterized By: depressed, sad, hopeless irritability, anger, frustration lack of interest / pleasure low animation unexplained crying feeling rejected deteriorated self-care low self esteem physiological signs lethargy low social interest, enthusiasm preoccupation with death self mutilation suicidality Item Examples • Appears dejected or unhappy • Is emotionally flat or unanimated

34. Possible Psychosis/Schizophrenia Cluster (POSSIBLE PSYCHOSIS) Screener Incoherence Illogic Hypervigilance Distorted Perception Emotion Poor Self Care Hallucination Delusion Fantasy Involved Strange Behavior Item Examples • Has distorted view of situations and people • Displays deteriorated self-care, hygiene, or concern about personal appearance

35. Attention-Deficit Hyperactivity Disorder Cluster (ADHD) Screener Motor Agitation Poor Attention Forgetfulness Fidgety Poking Prodding Others Item Examples • Displays motor agitation or restlessness • Has difficulty paying attention in classroom and/or other settings

36. Social Maladjustment Cluster (SM) Related Literature – Frick and Hare (2001) • Callous/unemotional • Lack of guilt • Egocentricity • Lack of empathy • Impulsivity • Use of others for personal gain Three Factor Model Conduct Sociopathic Attitudes School Aversion Item Examples • Appears comfortable with rules and structure – does not act out when these are either present or absent • Appears to require an excessive amount of structure or rules to feel comfortable and secure • Appears to dislike or have low tolerance for structure or rules, and resists by acting-out

37. Has reasonable self-esteem & respect for others • May perceive self as abnormal, damaged, or inferior compared to peers • Perceives self and inappropriate behavior as normal, or even superior to compliant peers • Meets own needs appropriately and adequately • Tries to meet own needs through dependency, attention-seeking, or bizarre behavior • Meets own needs by skillfully and selfishly manipulating others

38. Level of Severity Cluster (SEVERITY) Areas assessed: Frequency and setting Outside treatment Need for restraint Marked problems Need for a safety plan Response to intervention Suspension Example: Disruption, aggression, or loss of emotional control at school • Has occurred rarely, if at all • Has occurred on 1-2 occasions • Has occurred on 3 or more occasions

39. Educational Impact Cluster (IMPACT) Areas Assessed: Work completion Suspension Compliance with direction Counseling Quality of work BIP developed? Behavior related absences Interventions effective? Working without redirection Example: • No behavior related absences • Some behavior related absences but not enough to warrant formal reporting • Behavior related absences are excessive, and/or have warranted formal reporting

40. EDDT-PF • No Educational Impact Scale • Addition of Resiliency Scale (RES) • Personal strength, adult connections, social skills, other individual resources • Addition of Motivation Cluster (MOT) • Tangible/Consumable Motivators (TC) • Independence/Escape Motivators (IE) • Positive Attention Motivators (PA)

41. Metric of Scores • Scales are based on T score (M = 50; SD = 10) • Clusters based on %ile ranges

42. Coefficient Alpha Reliability by Normative Group

43. Coefficient Alpha Reliabilityfor the Normative Sample

44. EDDT: Group differences between the Normative and ED sample

45. EDDT-PF: Group differences between the Normative and ED sample

46. Percentage of Normative and ED Sample Scoring Within Clinically Relevant T-Score Ranges Standardization = GOLD ED Group = WHITE

47. Case Study: EdisonBackground • 13-year-old male, 7th grade • Previous exposure to domestic violence by father • Edison, his mother, and an 8-year-old sister have been residents of a local homeless shelter for 8 months • Previous state of residence IEP indicated OHI-ADHD, recently back on stimulant meds and typical ADHD behavior improved • Behavior: • One half of work done • Fights, Cruel • Marijuana use? • Disregards parent rules • Stares off • Hangs with “bad” kids • Short unstable relationships • Poor social skills • Bragging about gang affiliation • Threw rocks at a dog

48. Case Study: EdisonAssessment Results • Refused to go to community-based therapy • FBA and BIP for increasing work output and reducing aggression were not successful • Conners Rating Scale scores (ADHD) were extremely pronounced, despite the fact he is on medication • High externalizing scores on the BASC-2 for Hyperactivity, Conduct Problems, and Aggression • High Millon Adolescent Clinical Inventory scores for Unruliness, Oppositionality, Delinquent Predisposition, and Substance Abuse Proneness

49. Edison Case Study: Pre EDDT Profile Summary Evidence for Social Maladjustment: • High Conduct and Aggression Scores • Weak in internal right - wrong • Impulsive, Delinquent • Picks fights, enjoys • Animal cruelty • Serious disregard of authority • Aggressive • Some of the behaviors such as staring off could be ADHD Unclear, Weak Picture as to Emotional Disturbance

50. EDDT/EDDT-PF Results EDDT: • REL, IBF, Severity, Impact = High Clinical • PM/DEP, ADHD, SM = Moderate Clinical Additional considerations: • SM items suggest irresponsibility, resistance to authority, aggressiveness, and school aversion. Manipulative and “user” of others items were not endorsed. • Spacey behavior – PTSD? • Rock throwing – modeling?