John
Case Study
By: Jessica M. Lascano, NCSP
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Who is John?
John is a 17-year-old boy
John has qualified for special education since 2006, initially with a developmental delay and articulation problem (speech and language impairment)
John was identified with specific learning disability in 2009 and an other health impairment due to ADHD in 2015
John was assessed for an emotional disturbance in 2015, he did not qualify in this area, examiner said social maladjustment was the issue
John is a community school student (due to expulsion from home school)
John has had a well documented history of behavioral, social and emotional problems starting in his elementary school years, these issues intensified when he began high school
John has had over 55 disciplinary infractions since leaving a comprehensive high school campus (in 2017), these include suspensions, he has had an improvement since moving to ABC Schools
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Who is John? (continued)
John has moved schools several times (IEP changes, discipline problems, transportation issues)
John’s mother experienced domestic violence while he was an infant and this continued through his elementary school years
John is diagnosed with depression and uses depression medication
John’s mother has a chronic illness which causes hospitalizations and can lead to death
John has a twin brother who has the same challenges and is in the same class as him
John does best with teachers who are kind, calm, patient, and proactive
John struggles with adults who are irritable, coercive, and reactive
John recently had a manifestation determination based on a fight that resulted in injury to a peer, expulsion was considered but the MD team determined that John may have an emotional disturbance which was not properly assessed for and therefore was not found
ED assessment was the recommendation of the IEP team
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Procedures Used
Record review
Interview with parent, teacher, student
BASC-SDH
Observation in classroom and in testing setting
Academic testing, processing tests
BASC-3 PRS, TRS, SRP with follow-up interview
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IDEIA Sec. 300.8 (c) (4)��
(i) Emotional disturbance means 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.
(ii) Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under paragraph (c)(4)(i) of this section.
Last modified on May 2, 2017
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Parent Rating EDQs
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Teacher Rating EDQs�
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Self-Report EDQs�
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A) An inability to learn which cannot be explained by intellectual, sensory or health factors�
BASC-3 ratings from Teacher place John in the Clinically Significant range for Learning, Attention Problems and Study Skills. Ratings from Teacher and Parent place the area of Leadership in the At-Risk range. John’s BASC-3 self-report ratings fall in the Average range for School Problems, Attitude to Teachers, and Attitude to School. John has many school and learning related troubles, but he does not report (interview, BASC-3 ratings) them to be problematic.
During an interview with John’s teacher, she indicated he becomes easily frustrated with grade level school-work. John needs support and tools such as a calculator, a math calculation table, graphic organizers, speech to text, and word processing software, to get his work done independently. John’s mother reports that John has always had problems with learning, and shares that he initially qualified for special education due to a developmental delay as a toddler. IEP records corroborate parent report and indicate that John has been identified as having a specific learning disability since 2009, and an other health impairment due to ADHD since 2015.
John’s trouble with learning appears to be related to a well-documented learning disability. John’s frustration with tasks can sometimes impede his ability to complete challenging work, but even before he exhibited trouble with tolerance for difficult work, he had significant problems with math, reading and writing. These problems were evident in his early elementary years (second grade). John’s problems with learning are not related to an emotional disturbance. John does not meet this criterion.
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B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers�
John’s BASC-3 self-ratings place interpersonal relations within the Average range, though John’s history of suspension, well-documented trouble with self-soothing, and noted trouble with having a good relationship with peers (report card comments, present levels of historical IEPs, psychoeducational assessments, former and current teacher report) contradict these ratings. John’s teacher and parent each rate the BASC-3 areas of Social Skills and Leadership as At-Risk.
John tends to use maladaptive coping skills to deal with conflict and this impacts the way he interacts in relationships with many adults and peers. At times John’s relationships are very strained. This is typically due to interpersonal conflict, a lack of coping skills which can be accessed by John for problem solving during high stress interactions, and a tendency to perceive certain social exchanges as very intense, even when others perceive them as normal.
John has a difficult time accepting redirection from adults, and at times he may become defensive or angry when he is given a directive from a teacher that most students would comply with without incident. When John is redirected, he may become combative, overly-emotional (crying, hitting, leaving the area, pacing, demonstrating an inability to control emotions) and tends to need a relatively long period of time (30 minutes or more) to recover or cool off. There are occasions when John does not recover and this may send him into an extremely irate state which requires intense (many staff, quiet area, time to cry, and at times crisis management procedures) crisis intervention. John’s teacher reports he sometimes has the same responses to challenges from peers or during peer conflict. John will engage in the behavior when he perceives a peer as challenging him, even when the peer is not doing so.
John’s mother reports that in the home setting John engages in the same behavior that is observed at school. He has a difficult time accepting redirection or simple correction and often over-reacts to instruction or support given by an adult caregiver. John’s mother reports that he has had trouble with regulating his emotions when he is in trouble or when he perceives that a correction or redirection may lead to punishment or undesired consequences.
The BASC-3 Emotional Disturbance Qualification Scales in the area of Unsatisfactory Interpersonal Relationships for both Parent and Teacher fall within the Clinically Significant range. John’s Emotional Disturbance Qualification Scale in the area of Unsatisfactory Interpersonal Relationships (for self-rating) falls within the Acceptable range; however, this contrasts with his history of well-documented challenges with interpersonal relationships with both adults and peers.
John has problems with his interpersonal relationships, especially with peers and teachers, that are intense, and pervasive and which have lasted for a long-period of time. John meets this criterion.
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C) Inappropriate types of behavior or feelings under normal circumstances�
Teacher and John rated the BASC-3 area of Atypicality as Average, while parent rated this area as At-Risk. The area of Anxiety was rated as Clinically Significant by Teacher, At-Risk by Parent and Average by John. The area of Depression was rated as At-Risk by Teacher, Clinically Significant by Parent and Average by John. The area of Withdrawal was rated as Average by Teacher and At-Risk by Parent. The content scale for Developmental Social Disorders was rated as Average by Teacher and At-Risk By Parent. Emotional Self-Control was rated as Clinically Significant by both Teacher and Parent. Negative Emotionality was rated as Clinically Significant by Teacher and At-Risk by parent.
At school John has been noted to perceive correction from adults as a threat. He has a very difficult time accepting direction, and “no”. He will try to argue, bargain, or use physical force to require others to comply with what he wants. When John believes a peer or adult has slighted or threatened him, he escalates his behavior. During these instances he rapidly moves from negative self-talk and questioning to verbal threats, and sometimes physical aggression. If John does not get his way, if he is corrected or redirected by a staff member, or if he is slighted by a peer, he will verbally talk to himself, cry unconsolably, and punch walls or other items. John cannot control his emotions during these times, and even when he appears deescalated, he can move right back into a flight or fight state with certain stimuli present (the person he was angry at, a teacher or other adult he does not have a relationship with, someone trying to force him to talk about the event when he is not ready to etc.). John has a long history, since at least 2015, of exhibiting this behavior.
John has extreme over-reaction to events that are commonplace for most children who are enrolled in an alternative education setting (correction from adults, reminders of the expectations/rules, challenges from peers). John has engaged in these behaviors with several adults, and in different schools as well as within the home setting. The examiner has observed John engage in this behavior. She was present during instances when John was unable to self-soothe. Once such instance, which involved a physical altercation with a peer, ended with John requiring direct support from a therapist and nearly two hours of cool-down time. Additionally, John demonstrated difficulty regulating his emotions during direct assessment. He threw his pencil and the test booklet, verbally protested, and cried on one occasion seemingly due to frustration with the tasks presented. Some days, John refused to participate in any assessment. John’s overreaction, emotional dysregulation, and hypervigilance are pervasive and intense. These feelings and behaviors greatly affect John’s educational performance as he is often removed from the classroom setting during these instances and misses significant portions of the school day while managing and working through emotions.
The BASC-3 Emotional Disturbance Qualification Scales in the area of Inappropriate Behavior/Feelings Interpersonal Relationships for both Parent, and Teacher, fall within the At-Risk range. John’s Emotional Disturbance Qualification Scale in the area of Inappropriate Behavior/Feelings for his self-rating falls within the Acceptable range; however, this contrasts with well-documented history of challenges with regulating emotions, recovering from setbacks and reacting in an expected manner to challenges or stressors that arise as part of everyday school and home life. John meets this criterion.
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D) A general pervasive mood of unhappiness or depression�
John can have happy moods, but they are overshadowed by irritability and frustration that occurs daily and impedes his interactions. He also has an inability to move forward when a setback occurs. John’s BASC-3 self-report ratings place him within the Average range for the areas of Depression, Self-Esteem and Sense of Inadequacy. Parent rates the area of Depression as Clinically Significant, while Teacher rates this area as At-Risk. Teacher rates John as Clinically Significant in on the composite Negative Emotionality, while Parent rates this area as At-Risk.
John consistently exhibits moods of unhappiness and depression both in the school and home settings. He is diagnosed with depression, and ADHD and uses a medication to treat major depressive disorder. His mother reports that he is often depressed in the home setting. She feels this depression is related to the way that John snaps at people, and the aftermath of those interactions, as well as the remorse he feels when he reflects on his actions. Teacher reports John as irritable, sometimes negative, and hard to please. His irritability is reported to get in the way of his schoolwork completion, his interactions with others, and sometimes interferes with his attendance.
During classroom and assessment observation the examiner observed John’s tendency toward irritability and fluctuating moods. When he became overwhelmed, he tended to lash out (yell, cry, throw), have a hard time handling his stress, and appeared hopeless. Parent reports that John engages in similar behaviors in the home setting and shares that these behaviors affect the quality of his relationships with family members. The BASC-3 Emotional Disturbance Qualification Scales in the area of Unhappiness or Depression for both Parent, and Teacher, fall within the At-Risk range. John’s Emotional Disturbance Qualification Scale in the area of Unhappiness or Depression for his self-rating falls within the Acceptable range; however, this contrasts with his history of a negative outlook on school and life, fluctuating moods, and chronic irritability which has been noted, observed and reported for several years within the school and home settings. John’s issues with depression, including mood problems, low frustration tolerance, and irritability, are pervasive (seen in the home and in school throughout the school day with different adults) and intense (extraordinary in comparison to peers, and noted to be unusual/extreme). These problems have occurred for a long period of time (documented in IEPs, report cards, and psycho-educational evaluations since 2015). John meets this criterion.
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E) A tendency to develop physical symptoms or fears associated with personal or school problems. �
BASC-3 ratings reveal that Parent and John each rate the area of Somatization within the expected range, while Teacher rates this area as Clinically Significant. John rates the area of Anxiety within the expected range, while Parent rates this area within the At-Risk range, and teacher rates this area within the Clinically Significant range. John rates the areas of Social Stress and Test Anxiety within the Average range.
John is reported by his mother to have anxiety about going out in public, going to school, and her health. John is constantly worried that his mother will fall ill or pass away. He has expressed this on several occasions to both her and his teacher. Some days John comes to school and is worried about his mother’s well-being. On these occasions he will not leave the front office until he can use the phone to contact her. He typically sleeps on the floor in his mother’s room and often checks to ensure she is breathing though the night. He can be tired or grouchy in the mornings, which his mother attributes to poor sleep due to his concern with her.
John is observed to demonstrate hypervigilance regarding events that occur in his environment. John is chronically worried that something bad is going to happen. He also feels that people are out to get him, and that he is always going to be blamed. He has expressed his concern with being targeted and blamed both before and after disciplinary infractions, and in interview with the examiner. John often reports that he does not feel well to his teacher and will ask to call the school nurse or go home. There are no known or observed medical causes for these feelings. John has had panic attacks at school and during these instances he needs to sit with a trusted adult who can help him to self-soothe and calm. Parent reports that these panic attacks also occur in the home setting.
The BASC-3 Emotional Disturbance Qualification Scales in the area of Physical Symptoms or Fears for Teacher fall within the Clinically Significant range and within the Acceptable range for Parent. John’s Emotional Disturbance Qualification Scale in the area of Physical Symptoms or Fears for his self-rating falls within the Acceptable range; however, this contrasts with his consistent self-reports of feeling ill with no medical cause, documented history of hypervigilance, worry about perceived threats or problems, and panic attacks which have been observed and reported by school staff and mother. John’s problems with anxiety and somatization have occurred for several years and have been documented since 2015. These problems are pervasive (happen several times a day in several situations) and are intense as they are extraordinary in comparison to most same-age peers. John’s problems with anxiety and somatization impede his educational performance as he is consistently scanning his environment for problems and trouble. John often overreacts to perceived threats which are reported to be non-threatening by staff and parent. John is unable to cope with stress he feels from home life and school stressors. This stress appears to manifest as attempts to control, change, or correct what others say or do. John meets this criterion.
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Emotional Disturbance Includes Schizophrenia
John’s teacher rated the BASC-3 areas of Atypicality, Withdrawal, and Developmental Social Disorders (composite) as Average, while Parent rated these areas as At-Risk. Teacher and Parent both rate the areas of Attention Problems and Executive Functioning as Clinically Significant. Teacher rates the area of Functional Communication as Average, while parent rates this area as At-Risk. John’s BASC-3 self-ratings fall within the Average range for the following areas: Atypicality, Attention Problems, Interpersonal Relations and Locus of Control. These areas can be associated with schizophrenia.
John reports feeling that others are out to get him, especially when he is telling his side of the story during school disciplinary infractions. John has shared to his teachers, the school principal and parent that he is always blamed for things he did not do. John’s mother reports that John has shared he sometimes hears someone call him even if no one is around. Mother shared with the examiner that there is a familial history of schizophrenia.
The BASC-3 Emotional Disturbance Qualification Scale in the area of Schizophrenia and Related Disorders of Thought fall in the At-Risk range for Teacher, and the Clinically Significant range for Parent. John’s Emotional Disturbance Qualification Scale in the area of Schizophrenia and Related Disorders of Thought falls within the Acceptable range. Although parent reports that John has shared he sometimes hears someone calling him when no one is around, and John has tendency to believe that others are out to get him, he does not demonstrate other signs and symptoms of schizophrenia such as delusional thinking, visual or olfactory hallucinations, disordered or fragmented speech, or a lack of interest or motivation in things he was once interested or skilled in.
John has not been diagnosed with schizophrenia, and although he has some indicators of possible budding development, he does not currently meet this criterion as the issues which are most pervasive and impactful to his education are better captured in the criterion regarding unusual behaviors and physical symptoms/fears. John should be closely monitored in this area. John does not meet this criterion.
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Social Maladjustment
The term (Emotional Disturbance) does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under paragraph (c)(4)(i) of this section
BASC-3 Emotional Disturbance Qualification Scales from Teacher and Parent do not indicate the presence of social maladjustment.
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Takeaways
No one test (lots of procedures and data analyzed)
Analyzed evidence from BASC-3 ratings, BASC EDQs, BASC-SDH and synthesized with observation, interview and record review to draw data-based conclusions
Supported BASC-3 ratings and BASC-EDQs with examples
Considered marked degree (pervasive and intense)
Considered a long period of time
Described impact on educational performance
SM will never negate ED
Trauma does not negate ED
Trauma can look like ADHD
Only share information that is needed to support eligibility
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Book Reccomendation/Resources for You
Identifying and Assessing Students with Emotional Disturbance- Terry Tibbetts Ph.D. J.D.
Colorado Department of Education Social Maladjustment Topic Brief: https://drive.google.com/file/d/1BqwkOA7bAZ9yhup0N5F5yQs_raSvE4ND/view?usp=sharing
Practical School Psychology Instagram (Jessica’s Page with explanations/ideas/resources): https://www.instagram.com/practicalschoolpsychology/
Practical School Psychology Website to Host Links: https://sites.google.com/view/practicalschoolpsychology/home?authuser=1
Riverside County Special Education Local Plan Area (SELPA) Assessment, Identification and Educational Planning for Students with Emotional Disturbance: https://drive.google.com/file/d/1WhJdlSZsDfpntWR1LeoiyG2OTMZ0SyvN/view?usp=sharing
WAYNE RESA Social Maladjustment A Guide to Differential Diagnosis and Educational Options: https://drive.google.com/file/d/1jLHQyxdfasV-ZkwPHbkb9-NfF4MVFYo3/view?usp=sharing
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