Emotional Disturbance Updated!

Links updated, November 2021
This information in Spanish

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years. (1)

We refer to mental disorders using different “umbrella” terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

• anxiety disorders;
• bipolar disorder (sometimes called manic-depression);
• conduct disorders;
• eating disorders;
• obsessive-compulsive disorder (OCD); and
• psychotic disorders.

You may be reading this fact sheet with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.

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Definition

We’ve chosen to use the term “emotional disturbance” in this fact sheet because that is the term used in the nation’s special education law, the Individuals with Disabilities Education Act (IDEA).

IDEA defines emotional disturbance as follows:

“…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 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 interpersonal 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.” (2)

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. (3)

Characteristics

As is evident in IDEA’s definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person’s physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness of Southern Arizona puts this very well:

Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. (4)

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

• Hyperactivity (short attention span, impulsiveness);
• Aggression or self-injurious behavior (acting out, fighting);
• Withdrawal (not interacting socially with others, excessive fear or anxiety);
• Immaturity (inappropriate crying, temper tantrums, poor coping skills); and
• Learning difficulties (academically performing below grade level).

 Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors—heredity, brain disorder, diet, stress, and family functioning—have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. (5)

Frequency

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder. (6)  Half of all psychiatric illness occurs before the age of 14, and 75% by the age of 24. The most common psychiatric disorders in childhood are anxiety disorders, AD/HD and disruptive behavior, depression and bipolar disorders, and eating disorders. (7)

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2016 school year, more than 349,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. (8)

Determining a child’s eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.

There is a lot to know about the special education process, much of which you can learn here on the CPIR site. We invite you to read the wide range of publications we offer on the topic, especially:

10 Basic Steps in Special Education

Questions Often Asked by Parents about Special Education Services

Evaluating Children for Disability

Developing Your Child’s IEP

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let’s take a brief look at some of the most common of these.

Anxiety Disorders

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

 The term “anxiety disorder” is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias. (9)

According to the Anxiety Disorders Association of America,  anxiety disorders are the most common psychiatric illnesses affecting children and adults. (10)  They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment. (11)

Bipolar Disorder

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. (12)

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment. (13)

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. (14)  This may include some of the following behaviors:

• aggression to people and animals;
• destruction of property;
• deceitfulness, lying, or stealing; or
• truancy or other serious violations of rules. (15)

 Treatment will depend on the child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

• helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what’s known as cognitive-behavioral therapy);
• family therapy;
• peer group therapy (to help better social and interpersonal skills); and
• medications (although these are not typically used to treat conduct disorder). (16)

Eating Disorders

Eating disorders are characterized by extremes in eating behavior—either too much or too little—or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to  develop an eating disorder. (17)

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening. (18)

 Binge eating is also considered an eating disorder. It’s characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives. (19)

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder… Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. (20)

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away.  Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety. (21)

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. (22) Treatment for most people with OCD should include one or more of the following:

• therapist trained in behavior therapy;
• Cognitive Behavior Therapy (CBT);
• medication (usually an antidepressant). (23)

Psychotic Disorders

“Psychotic disorders” is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder. (24) There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling). (25)

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem.  A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

For a child whose behavior impedes learning (including the learning of others), the team developing the child’s Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Recognizing and Addressing the Impact of COVID-19 | As young people return to in-person schooling in the 2021-2022 school year, they may bring with them the impact of the pandemic’s trauma. This makes it essential that schools consider the possibility that many students will need to be re-evaluated to determine if they need additional services, especially behavioral support and mental health services, than they needed prior to COVID-19. Two resources of great relevance to reopening schools and returning students are the following:

• The U.S. Department of Education’s Supporting Child and Student Social, Emotional, Behavioral and Mental Health, a guidance within its Return to School Roadmap series; and
• Mental Health America’s Back to School toolkit, Facing Fears, Supporting Students–which is available in English and Spanish and contains multiple fact sheets (e.g., How trauma impacts school performance; Supporting students facing trauma) and worksheets (e.g., Preparing to share).

Other Considerations

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It’s important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

The Importance of Support

Families often need help in understanding their child’s disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

 To locate systems of support in your community or state, visit the organizations we’ve listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

Mental Health America | 1.800.969.6642
https://arc.mhanational.org/find-an-affiliate

NAMI | National Alliance on Mental Illness | 1.800.950.NAMI
https://www.nami.org/findsupport

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Resources of More Information

AACAP | American Academy of Child and Adolescent Psychiatry | AACAP offers Facts for Families, a series in English, Spanish, and several other languages that includes many briefs on specific mental disorders, including the ones mentioned in this publication.

Fact sheets in English:
https://www.aacap.org/AACAP/Families_Youth/Facts-for-Families/AACAP/Families_and_Youth/Facts_for_Families/Layout/FFF_Guide-01.aspx

Fact sheets in Spanish:
https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Spanish.aspx

AACAP also operates different Resource Centers, which offer consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, Facts for Families, and much more. Visit the Resource Center home page if you are concerned with one of the following:

• Anxiety Disorders
• Autism
• Bipolar Disorder
• Conduct Disorder
• Depression
• Oppositional Defiant Disorder

American Psychological Association | The APA is also a fountain of information and support on specific emotional disturbances.
https://www.apa.org/index

NIMH | National Institute of Mental Health | NIMH is clearly a source of authoritative information on specific mental disorders.  Phone: 1.866.615.6464. TTY: 1.866.415.8051

• English  
  
• Spanish

NAMI | National Alliance on Mental Illness | NAMI is an excellent source of information and connection on mental illness, including the individual disorders mentioned in this fact sheet. NAMI’s website and toll-free helpline are available in English and Spanish.

• Toll-free Helpline | 1.800.950.6264
• Website in English | https://www.nami.org/Home
• Website in Spanish | https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx/La-salud-mental-en-la-comunidad-latina

SAMHSA is the Substance Abuse & Mental Health Services Administration.  It offers many resources to consumers, including:.

• Toll-free help line in English and Spanish:  1-800-662-HELP (4357)
• Website | https://www.samhsa.gov/
• Treatment locator | https://www.samhsa.gov/find-treatment

Detailed information on specific emotional disturbances, or related issues such as positive behavior supports, is also available from these sources:

Anxiety Disorders Association of America | https://adaa.org/

Center on Positive Behavioral Interventions and Supports | The PBIS Center provides research-based  information on how to provide behavioral supports to children who need them. | https://www.pbis.org

Conduct Disorders | A soft place to land for battle-weary parents
https://www.conductdisorders.com/community/

Encyclopedia of Mental Disorders  | http://www.minddisorders.com/index.html

National Eating Disorders Association
1.800.931.2237  |  www.nationaleatingdisorders.org

Something Fishy | (eating disorders)
https://www.something-fishy.org

References

 1 | National Institute of Mental Health (NIMH). (2010). Child and adolescent mental health. Bethesda, MD: Author. Available online at: http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

 2 | Code of Federal Regulations, Title 34, §300.8(c)(4)(i)

 3 | Code of Federal Regulations, Title 34, §300.8(c)(4)(ii)

 4 | National Alliance on Mental Illness/Southern Arizona. (n.d.). What is mental illness: Mental illness facts. Available online at: http://www.namisa.org/what-is-mental-illness–types-of-mental-disorders.html

 5 | Ibid.

 6 | Child Mind Institute. (2015). Children’s mental health report. New York: Author. Online at: https://childmind.org/downloads/2015%20Childrens%20Mental%20Health%20Report.pdf

 7 | Ibid.

 8 | U.S. Department of Education, National Center for Education Statistics. (2018). Digest of Education Statistics, 2016 (NCES 2017-094). Washington, DC: Author. Online at: https://nces.ed.gov/fastfacts/display.asp?id=64

 9 | NIMH. (2016, March). Anxiety disorders. Bethesda, MD: Author. Available online at: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

 10 | Anxiety Disorders Association of America. (2017, August). Facts and stats. Silver Spring, MD: Author. Available online at: https://adaa.org/about-adaa/press-room/facts-statistics

 11 | Ibid.

 12 | NIMH. (2016, April). Bipolar disorder. Bethesda, MD: Author. Available online at: https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

 13 | Ibid.

 14 | American Academy of Adolescent and Child Psychiatry. (2013, August). Conduct disorder: Facts for families. Washington, DC: Author. Available online at:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Conduct_Disorder_33.aspx

 15 | Ibid.

 16 | Johns Hopkins Medicine Health Library. (n.d.). Conduct disorder in children. Baltimore, MD: Author. Online at:
https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/conduct_disorder_90,P02560

 17 | NIMH. (2014). Eating disorders: About more than food. Bethesda, MD: Author. Available online at: https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml

 18 | National Eating Disorders Association. (n.d.). By eating disorder. New York: Author. Available online at: https://www.nationaleatingdisorders.org/learn/by-eating-disorder

 19 | National Institute of Diabetes and Digestive and Kidney Diseases. (2016, June). Binge eating disorder. Available online at: https://www.niddk.nih.gov/health-information/weight-management/binge-eating-disorder

 20 | National Eating Disorders Association. (n.d.). Treatment. Available online at: https://www.nationaleatingdisorders.org/learn/general-information/treatment

 21 | NIMH. (2016, January). Obsessive-compulsive disorder. Bethesda, MD: Author. Available online at: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

 22 | International OCD Foundation. (n.d.). What causes OCD? Boston, MA: Author. Online at: https://iocdf.org/about-ocd/what-causes-ocd/

 23 | International OCD Foundation. (n.d.). How is OCD treated? Available online at: https://kids.iocdf.org/what-is-ocd/how-is-ocd-treated/

 24 | Medline Plus. (n.d.). Psychotic disorders. Available online at: https://medlineplus.gov/psychoticdisorders.html

 25 | MedicineNet.com. (n.d.). Psychotic disorders. Available online at: https://www.medicinenet.com/psychotic_disorders/article.htm