1 2010 Special Education Hearing Officers and Mediator Training (San Diego) The Nexus Between the DSM & IDEA: Social Maladjustment v. Emotional Disturbance Mary Schwartz, Impartial Hearing Officer, Illinois 2 3 • Determine eligibility for special education and related services • Develop educational program to meet unique needs of individual student • Official nomenclature for professionals • Differential diagnosis based on medical model • Treatment planning • Third party reimbursement 4 • Child must have at least one of disabilities defined in regulations • Disability must adversely affect child’s educational performance • Because of above, child needs special education and related services • AXIS I: Clinical Disorder • AXIS II: Personality Disorders and Mental Retardation • AXIS III: General medical conditions • AXIS IV: Psychosocial and environmental problems • AXIS V: Global Assessment of Functioning (GAF) 5 Those most likely to appear in due process complaints/hearings • Disorders usually first diagnosed in infancy, childhood or • • • • • • • • • • adolescence Mood Disorders Impulse Control Disorders Anxiety Disorders Schizophrenia and Other Psychotic Disorders Personality Disorders Substance Abuse Disorders Somatoform Disorders Eating Disorders Sleep Disorders Adjustment Disorders 6 • Intellectual and Cognitive Impairments • Mental Retardation • Learning Disorders • Motor Function Impairments • Motor Skills Disorder • Tic Disorders • Stereotypic Movement Disorder 7 • Disruptive or Self-Injurious Behavior Disorders • Attention Deficit Disorders • Conduct Disorder • Oppositional Defiant Disorder • Feeding and Eating Disorders of Early Childhood • Elimination Disorders • Separation Anxiety Disorder • Reactive Attachment Disorder of Infancy or Early Childhood • Information Exchange Disorders • Pervasive Developmental Disorders • Communication Disorders • Selective Mutism 8 • Predominant Feature: Disturbance in mood • Mood episodes are building blocks for diagnoses of mood disorders • Divided into: • Major Depressive Disorder • Dysthymic Disorder • Bipolar Disorders • Cyclothymic Disorder 9 • Conduct Disorder • Oppositional Defiant Disorder (ODD) • Intermittent Explosive Disorder (IED) • Pyromania, Trichotillomania 10 • Panic Disorders • Phobias • Post Traumatic Stress Disorder (PTSD) • Generalized Anxiety Disorder • Substance-Induced Anxiety Disorder 11 • Schizophrenia • Psychotic Disorder NOS • Brief Psychotic Disorder • Narcissistic Personality Disorder • Borderline Personality Disorder 12 • Substances include alcohol, illegal drugs, medications • Categories • Substance Dependence • Substance Abuse • Substance Intoxication • Substance Withdrawal 13 • Somatization Disorder • Body Dysmorphic Disorder • Anorexia Nervosa & Bulimia Nervosa • Breathing Related Sleep Disorder • Sleep Walking Disorder • Emotional or behavioral symptoms in response to identifiable stressor (symptoms are not bereavement) 14 • Symptoms per above diagnoses provide information that may be relevant to determination of emotional disorder • Expert testimony may reference and discuss DSM-IV symptomatology 15 • One or more of the characteristics listed • Over long period of time and to marked degree, and • Adversely affects educational performance 16 E.D. CHARACTERISTICS • Inability to learn that cannot be explained by intellectual, sensory, or health factors Inability to build or maintain satisfactory interpersonal relationships with peers and teachers Inappropriate types of behaviors or feelings under normal circumstances General pervasive mood of unhappiness or depression Tendency to develop physical symptoms or fears associated with personal or school problems Includes schizophrenia Does not apply to social maladjustment unless it is determined that chi had emotional disorder per above. 17 “Teenagers, for instance, can be a wild and unruly bunch. Adolescence is, almost by definition, a time of social maladjustment for many people.” Springer v. Fairfax County School, 134 F.3d 659,664 (4th Cir. 1998). Characterized by: • Intentionality • Little remorse • Lack of empathy • Failure to take responsibility for behavior 18 • Parameters of educational performance • Quantity of impact • If adverse impact, must still determine that student needs special education and related services 19 • Does it matter when emotional disorder is raised – at case study evaluation stage or at MDR? • If a parent is pro se, do we approach questioning of experts differently when DSM-IV diagnosis is raised in testimony? • If we hold a degree and/or certification as clinician, can we use that expertise (and opinions formed thereupon) as part of our decision? • If decision is for district, what about commenting in decision on difficulties faced by family due to student’s emotional problems?