Factoid of the Day: 100,000 Seriously Emotionally Disturbed Children in Virginia

by James A. Bacon

The term “serious emotional disturbance” (SED) refers to diagnosable mental health problems that disrupt a child’s ability to function socially, academically and emotionally. Virginia’s Department of Behavioral Health and Developmental Services estimates that between 85,000 and 104,000 Virginia children and adolescents have SED. Between 47,000 and 66,000 suffer extreme impairment.

(Source: “Collection of Evidence-based Practices for Children and Adolescents with Mental Health Treatment Needs,” a report of the Virginia Commission on Youth.)

Is the number of emotionally disturbed children increasing or decreasing? Based purely upon my personal experience, I would say that the number is increasing. We simply didn’t see the same kinds of emotional meltdowns when I was a youth a half century ago that seem so epidemic today — and we didn’t enjoy the “blessings” of Prozac, Zoloft and the rest of the anti-depression formulary that we do today.

But the historical record shows that emotional disorders have always afflicted people, although they may have taken a different form. I suspect that emotional fragility is a genetically influenced trait that arises in a predictable percentage of the population generation after generation, the difference being how each generation manifests the anxiety and how society classifies the behaviors.

I have in my library a book written by Edward Shorter, “From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era.” Shorter notes that there have always been people with emotional disorders. In the Middle Ages, their bizarre behaviors were interpreted as demon possession. By the early Victorian era, new intellectual fashions had brought new diagnoses and new kinds of behavior. Young women spent years on the couch, rendered paralyzed by “spinal irritation.” The 19th century also saw widespread motor hysteria, in which people (primarily young woman) thrashed about with their limbs. As medical paradigms changed, new behaviors arose, such as fainting spells.

After the age of Freud and the discovery of the subconscious, outward manifestations of emotional fragility turned inward. At the time of his writing in 1992, Shorter suggested that Americans had developed a proclivity to amplify and medicalize normal bodily signals of pain and fatigue. Thus, levels of pain that would be easily tolerated in a peasant society became a source of great emotional distress. Another manifestation of stress and anxiety that became socially sanctioned in modern society was chronic fatigue.

Writes Shorter, “If one interprets being sick as seeking care for an illness, the average person in our society today is ‘sick’ more than twice a year, as opposed to less than once a year on average in the 1920s. … Illness is now channeled to the doctor’s office, as people redefine themselves as patients.”

Shorter was writing two decades ago, before the widespread dispensation of pharmaceuticals to address depression. The word “depression” did not make an appearance in his book’s index. But as medical paradigms have evolved, so have patients’ response to the cues of their doctors and society at large. Thus, today’s  seeming epidemic of depression may be just the latest manifestation and classification of age-old emotional fragilities.

It is theoretically possible that we are seeing something entirely new. A plausible case can be made that widespread lead poisoning contributed to the spike, and subsequent decline, of violence seen in America’s inner cities. Perhaps the playing of computer games alters the wiring of young children’s brains in a way that affects their functioning.

But if Shorter is right — if Americans are now more prone to medicalize psychosomatic illness — that may explain a lot about the nation’s soaring health care costs. Emotional illnesses tend to be chronic; they cannot be “cured” with a single procedure, as, say, an appendectomy can cure a burst appendix. Patients wander from doctor to doctor seeking medical treatment for an underlying disorder that has no cure.

What’s the answer? I don’t know. I’m not even sure I know the question.

28 Responses to Factoid of the Day: 100,000 Seriously Emotionally Disturbed Children in Virginia

  1. Nothing has changed with the children. What you are seeing is the extreme over-diagnosis of autism. As a father of a child mis-diagnosed as “on the autistic spectrum” I have seen this in person. The autistic spectrum business is a well funded growth industry. I personally believe that the people engaged in this business are well meaning and have the best interests of the children in mind. However, they (and the parents) are insulated from the economic consequences of their actions. So, you hear a lot of, “This certainly won’t do any harm.”. And it generally doesn’t. Except to the town that loses firemen in the budget cuts while funds are preserved for the treatment of perfectly normal children misdiagnosed as autistic.

    Thomas Sowell, the economist, had a son mis-diagnosed as autistic. Or, as people like to say nowadays – on the autistic spectrum. Dr. Sowell took a very analytical approach to looking at the problem from a societal standpoint. He has written widely and brilliantly on the matter.

    Don’t get me wrong – neither Dr Sowell nor I doubt the existence of autism. Profound autism is as unmistakable as it is heartbreaking. Borderline (and treatable) autism also exists. However, extending this serious disease to almost any and every deviation from the average in young children is scandalous.

    For example, as Dr Sowell writes about the so-called spectrum:

    “We would see the dangers immediately if people who wear glasses were included on “the blindness spectrum” or people with harmless moles were included on “the cancer spectrum.”

    Blindness, cancer and autism are all too serious — indeed, catastrophic — to use loose definitions that fudge the difference between accurate and inaccurate diagnoses.”.

    http://townhall.com/columnists/thomassowell/2007/11/14/crusades_versus_caution_part_ii

  2. I have a similar but slightly different view having spend time with a teacher.

    First, remember in the “good old days” what we did with kids that did not “fit” in public schools. There were no services, analytic nor instructional. If you had “issues”, you stayed home or they let you sit in class as long as you were not disruptive.

    Now flash forward where every kid gets an academic ‘score’ as well as a ” is he screwing up the class” score.

    If the kid shows that he/she has “learning” problems then it’s pretty much an admission that he cannot be in a normal class – and still learn – since he needs special help.

    but if that same kid also is not quiet and docile – and disrupts the teaching to the rest of the kids – to the point where the other kids are not staying on grade level either – something has to be done.

    It’s not fair to the teacher and not fair to the rest of the kids for one kid to suck up all the resources – to the detriment of others.

    Now days, if the whole class falls behind – guess who gets the blame? That’s right – the teacher. they become a “bad teacher” and their job is endangered.

    no matter that the replacement will have the same challenge if the disruptive kid stays .. someone has to pay for the failure of the whole class.

    So you can see why a teacher – under the gun to keep their entire class on grade level – is having to stop every 20 minutes to deal with a kid who if not dealt with is going to turn the classroom in chaos.

    If you think I am exaggerating, I encourage you to talk to a real classroom teacher.

    so when a kid in a classroom shows academic issues as well as disruption issue – they do get “referred” to be tested and assessed – and yes.. sometimes it’s done wrong but more often that not – it’s done right – and the rest of the class is able to learn and stay on grade level.

    we seem to have this idealistic view that a ‘good’ teacher can handle all these issues but we forget that when 20-year veterans cannot that a new right-out-of-college teacher has even less ability.

    I attribute this to the tendency of all of us to engage in blame-game politics.

    it’s corrosive and it undermines our institutions and it basically pretends that we don’t have disruptive kids that need something more than just a “good” teacher.

  3. The question is not whether autism exists. It does. The question is why the number of diagnoses of autism is skyrocketing.

    My qualitative belief is that an “autism cottage industry” has developed. It exists at the intersection of BigEd and BigMed. It is built upon the foundation of expanding autism to include maladies that are nothing more than the normal statistical variances of individual children’s development rates. It is financed through higher taxes and higher insurance premiums.

    BigMed participates because it generates referrals, assessments and tests that are funded by insurance companies.

    BigEd participates because it provides a taxpayer-funded outlet for pushing hard to teach children into special education classes.

    Most misdiagnosed children in the special ed classes move toward the mean and are eventually deemed “cured” after tens of thousands of dollars (beyond the standard education costs) have been expended.

  4. I suspect there’s truth in your observations about autism. I bet the same logic applies to ADD and ADHD, and possibly to other “disorders.” From time immemorial, little boys have had trouble sitting still in class. Now that’s a psychological disorder?

    When we were coming along, people would say someone was “immature.” Often, they did grow out of it.

    I’m still wondering about anxiety disorders, depression and obsessive-compulsive disorder. I’ve read about research that suggests that those problems have genetic influences, even if they manifest themselves in very different ways.

  5. re: “trouble sitting in class” – right. what was done about it before? what can be done about it now?

    Some of this is not “new” cases but more “reporting”. But part of this unfortunately is our healthcare system which does what?

    it pays healthcare professionals to “treat” and thus if your policy “covers” the treatment – then it’s likely that the Medical folks will find it worth their time to “treat” it.

    Most of all -here – don’t blame the teachers. They are mostly just trying to get the majority of their class to meet the SOL standards whereas years ago if a kid raised hell and hurt the rest of the class academically, no one really knew.

    Now they know.

    and the teacher will get blamed.

    so the teacher must focus on performing.

    this is what people wanted, right?

    can we “afford” little boys who cannot “learn” without being disruptive?

    you decide.

    • Your argument would work if not for two facts:

      1. We have been dramatically increasing our per-pupil expenditures (in real terms) for K-12 education over the last 50 years.

      2. We have been steadily slipping in our educational competitiveness.

      Once upon a time our schools could afford little boys who could not learn without being disruptive. This was possible while the schools spent less (in real terms) and produced a more competitive product.

      Something is badly broken in our system. It’s as simplistic to blame the SOLs as it is to blame the teachers.

      • we have been increasing our costs – in part – to provide professionals to assess kids to determine the nature and extent of their learning disability which I can assure you is far wider in scope that most people believe with a wide range of responses – all of them involving increased costs.

        we have not been slipping – that’s a myth DJ. we have stayed the same. the other countries are getting better, in part, because they are incorporating critical thinking into their curriculums.

        http://voices.yahoo.com/researchers-claim-us-students-not-falling-behind-rest-11978178.html

        re: once upon a time…. yeah.. until people started accusing teachers of being “bad” if they could not keep an entire class on grade level – with 2 or 3 disruptive “little boys”.

        you cannot have it both ways.

        All I ask you to do is talk to a REAL classroom K-3 teacher and ask them about the “disruptive kid” problem. It’s HUGE. some teachers quit, transfer, retire when they know they are getting class with 3 bad kids… and the replacement is some poor schmuck right out of college who has no clue what they are dropping into.

        • Dude! When I say that we are slipping in our educational competitiveness, it is the same as saying that the other countries are getting better. That’s what competitiveness means.

          • I’ll give you a pass but “usually” slipping means falling back from where you were as opposed to getting left behind by your competitors.

            the narrative is what is driving the blame game against teachers – that they are “failing” to perform – as opposed to “failing to get better”.

            you cannot blame teachers for our entire education system from not getting better. There’s a LOT more to it that what teachers are doing or not. When an entire school or entire school system does poorly on standardized tests – it’s kind of hard to believe that EVERY teacher is that school or school system is “bad”.

            With respect to autism and private schools and disruptive kids – in the old days in public schools, if your kid was disruptive, he was invited to leave which they no longer can do – but private schools can and will unless the state requires them to deal with these issues no different than public schools.

            In fact, one of the exemptions given to Charters and Choice schools is relaxation of the rules the public schools have to follow. Would this be one of them?

            But the reality is this – that lots of kids have learning disabilities. there are a ton of adults now days that say they did not know they were dyslexic until after they finished school but they always had problems in school.

            Also – ask yourself why our global competitors that best us academically don’t have these issues apparently. Why is that?

        • “All I ask you to do is talk to a REAL classroom K-3 teacher and ask them about the “disruptive kid” problem. It’s HUGE.”.

          No doubt. But it isn’t any more of a problem today than in the past. So, why the 78% increase in diagnoses of autism? Why the escalating spending on evaluations?

  6. There is great truth and wisdom in what Don says in this Post.

    Despite the incredible array of advances in hard science, and medicine, and indeed in part because of them, human nature (like always before in the past) can take shards of new findings from research and/or other studies, and use they’re conclusions to march off in the wrong direction with harmful results.

  7. what’s happening is the schools in other countries are getting better than us rather than us falling behind.

    that’s the truth.

    we are stuck in a perpetual blame game rather than focusing on what we need to do to get better.

    here’s another reference worth knowing the details:

    http://usatoday30.usatoday.com/news/education/story/2012-02-16/us-schools-global-ranking/53110494/1

    what our kids lack – for the most part – is critical thinking. Our kids know the basic academics, but they cannot “use” them to actually solve problems.

    We have schools that ARE doing this right. Massachusetts actually scores 7th in the world – not bad but many other states are failing to adopt the things that Europe and Japan have – among which are National Curriculums so that no matter where a child goes with his mobile parents -he’s getting the same curriculum whereas in the US if a kid moves – even to a different school in the same state – he may not.

    Over and over – I point out – are we interested in getting better or are we most interested in a witch hunt to affix blame? I also point out that every single country that beats us – is a country with PUBLIC schools.

  8. what would be revealing to me is comparing the rates for learning disabilities and autism between the US and the countries that are better than us academically.

    I’ve heard that we have higher rates of autism and learning disabilities.

    that would be troubling if true.

  9. and of course, I’d also point out that Bacon’s “idea” of non-public schools is laughable when it comes to these kinds of kids – they’d be booted out as soon as they disrupted the class … if the state does not require charters and choice schools to provide the same services that public schools provide.

    • Not really. The money provided by insurance companies and the extra amount spent by counties for special autism spectrum classes could easily be “pointed at” private, specialty schools.

      Thinking in terms of autism (rather than just disruptive students) – there is a great deal of money flowing. The question of who is best placed to take that flow of money and get good results could be a real debate.

  10. re: autism and disruptive students

    let’s put this in a realistic context.

    if you have a class of kids that are roughly the same age, same physical and mental capabilities and at about the same place on grade level – and you have a requirement to get them all to the next grade level – and they will be tested to see if they did make a years worth of progress…

    and you throw into this process – kids that require individual attention.

    we’re not blaming the kid nor his condition or anything else – only illustrating that classrooms by their nature are one teacher trying to deal with a subject that all kids will engage in and if one child needs to go to the bathroom, throws a fit, or has other issues that requires the teacher to stop teaching to the group and tend to that kid… the rest of the class stops until it is taken care of.

    Teachers do this every day – for the normal routine interruptions that are expected – but when it gets to the point where it’s the same kid with the same issues, day after day after day… it gets to be something that if not dealt with – is going to affect the rest of the classroom.

    Now think in terms of 2 or 3 kids having these issues… and the teacher on th hook to get the rest of the class educated.

    it’s got a name: “classroom management” and if a new teacher cannot learn that skill, no matter how good they are at the rest, they are toast because the entire class will show that it did not progress as expected.

    the conventional wisdom that teachers have always had to deal with this is not only a non-answer, it evades the issue entirely and basically says “well, that’s the teachers problem”.

    and it ignores what we used to do which was to “socially” promote kids or to send them to detention or just get rid of them if they could not behave.

    so we have this mindset now that we blame teachers and teacher unions for not being able to teach a class of 20 with 2 of them screaming meemies.

    and we believe that Charter or choice schools will fix this problem so we’d end up diverting public-school funding to these “better” non or quasi-public schools who apparently have some magic potion for dealing with this issue.

    to which – all I can say is a quote from Forest Gump – “Stupid is as stupid does”.

    • You’ve lost yourself on this one LarryG. Go back and read Bacon’s column. It has nothing to do with charter schools.

      My point is that the increased number of autism diagnoses in recent years is an unfortunate reaction to funding. I do not believe there has been any increase in the percentage of American children suffering from autism. There has been an expansion of the definition of autism. That expanded definition now includes conditions so mild that they can easily be applied to children who are perfectly healthy.

      Why is this happening?

      Mostly because the treatment of autism is, in many places, very well funded. For truly autistic children, this is great. For children on the borderline, this is great. For healthy children, this is a travesty.

      In medicine, the expanded definition of autism has created a “cottage industry” for testing, evaluation, treatment, etc. It behooves this “cottage industry” to “err on the side of caution” and find children on the autistic spectrum even when the so-called issues are no more than normal differences in childhood development. Once a child is found to be on the autistic spectrum that child becomes a source of revenue to the “cottage industry”. The healthier the child, the better. Healthy children who are simply on a slightly different track from the average will get to the average. At that point, tens of thousands of dollars later, they can be deemed “cured”.

      In education, it allows administrators and teachers to push children who are hard to teach into programs funded for the treatment of children with autism. This is more than disruptive kids. This includes children who are bored, children who have poor handwriting, children who speak late, children who are great in math but have delayed language skills.

      LarryG – you cannot escape the fact that the number of diagnoses of children “on the autistic spectrum” has increased 78% in 10 years.

      You also cannot escape the fact that the American K-12 educational system is failing to keep our children competitive with children from other countries despite the fact that we are spending more money per pupil (in real terms) that we have ever spent in the past.

      You often accuse the Republican Party of being the party of no (ideas). I often agree with you. However, when it comes to America’s failing educational system, it is the Democrats and especially the liberal Democrats who are the party of no (ideas).

  11. on the Charter schools.. yes I brought that up to remind those who say charters can do better than public that disruptive kids are currently a challenge that public schools have to deal with and private schools can just say “no”.

    Charters and choice schools are somewhere in the middle but my bet it that they will shed the “trouble” kids if they can.

    re: the increase in autism. I AGREE with MOST of what you say except to ask if this increase is seen in other country’s schools also.

    re: American education system – I AGREE with you here but I DISAGREE when you say there are no ideas from the left.

    the ideas from the right are to essentially undermine and kill public schools – to abandon them in favor of non-public schools.

    the “other” non-right-wing ideas are to emulate public schools that are doing well and that would be Massachusetts and the other country’s public schools that beat us and one of the big differences is a national curriculum and in that curriculum – teaching critical thinking – problem solving – by using the individual disciplines of reading, writing, science and math such that you’re not remembering by rote – you are USING those disciplines to actually solve problems.

    Part of our problem is not the schools nor the teachers but the parents who do not want their kids to get bad grades so they shy away from the tougher courses that do get into critical thinking….

    Our kids do WELL in 4th grade comparisons with other countries but by the time our kids get to 8th grade, we fall behind.

    why do you think that is? do all the k-3 grades have “good” teachers and all the 8th grades have “bad” teachers “protected” by unions?

    but I agree, I veered sharply from the autism narrative…in part because what is driving autism is, in part, kids who are so disruptive that they cause the teachers to refer them for “evaluation” and that, in turn, often leads to a doctor visit for a “medical’ diagnosis.

    that’s why I asked if our country compares to other countries on the autism issue.

  12. My reaction when reading James’ posting was that we don’t understand the impacts of our substantial change in the environmental conditions of children’s upbringing. By that I don’t mean pollution (albeit we’ve not a clue what our chemical environment has wrought) but the vast social changes affecting children: the change in life’s tempo, brain impacts from very young children watching television/computers, increasing divorce from nature and open space, stressed home life, over protective parenting, increasing single parenting/divorces and so forth. This is not the world I, at 73, grew up in. Along with other impacts folks have mentioned, why would it not have psychic effects on children in our cities and suburbs in particular?

    • Excellent Points. Many of which apply in spades to adults as well.

    • I agree. we do not. And it COULD some difference in the environment and I’d feel somewhat reassured if this was determined to be an increasing problem in more than just the US.

      it’s a puzzle but is it truly unique to US kids only?

      here’s a start:

      http://sfari.org/news-and-opinion/news/2011/researchers-track-down-autism-rates-across-the-globe

      I cannot see the chart … can others?

    • No chance those factors increased the diagnoses of autism by 78% in 10 years.

      The very serious malady of autism has been expanded to include virtually anything.

      One of the five maladies on the autism spectrum is PDD-NOS – Pervasive developmental disorder not otherwise specified.

      PDD-NOS has the following “symptoms”:

      Communication difficulties (e.g., using and understanding language)
      Difficulty with social behavior
      Difficulty with changes in routines or environments
      Uneven skill development (strengths in some areas and delays in others)
      Unusual play with toys and other objects
      Repetitive body movements or behavior patterns
      Unusual likes and dislikes

      Uneven skill development? Are you kidding me? Diagnosed in three, four or five year old children?

      Unusual likes and dislikes? Are you kidding me?

      This has nothing to do with anything other than BigEd mating with BigMed.

  13. I think it is safe to say that virtually every human has some kind of a “flaw” whether it be cosmetic or more serious and the science has gotten to the point where it can identify virtually every one.

    there is now a panoply of “learning” disorders that have always existed but not officially “recognized”.

    In many schools now days, if a child is having trouble – which is determined by their performance on not one but a series of assessments, they are sent to be evaluated to see if they have a specific learning disability.

    this is smart and it has helped many a kid because once it is known that they do have an issue then help can be directed – and is.

    this is one of the reasons why costs have gone up.

    some learning disabilities are related to emotional issues and these are often also determined from testing of kids who are having trouble staying on grade level.

    Instead of this being recognized as improved ways to help more kids deal with previously unrecognized disabilities that inhibit their learning – the focus in our blame-game world now goes towards finding out “who” is “causing” this problem.

    It’s almost as if the more we find out – the more we don’t like what we find out – a kind of modern-day Luddite perspective on a world that has grown more complicated than we care for it to be.

    Remember, if a child IS having academic performance problems – it does take the parents to agree to do something.

    If the child, for any number of reasons including LD or ED is ALSO disrupting the class – then it’s basically irresponsible to have that entire class start to fall behind academically because we think the person causing the upheaval is “just a rambunctious kid”.

    One time, two times, yes. day after day over weeks, no.

    As a society we now interpret these things in sound-bites – laced with ignorance, to be honest. And because we don’t like what we hear or now know – we want someone strung up for causing such “problems”.

    that’s not how we go forward. It’s not how we used to go forward in times past.

    but’s it’s now typical – with virtually all our institutions – something is wrong and it’s got to be somebody’s fault.

  14. there is something else folks should be aware of and that is that we as individuals have different learning styles:

    http://www.learningrx.com/types-of-learning-styles-faq.htm

    ” Although most people use a combination of the three learning styles, they usually have a clear preference for one. Knowing and understanding the types of learning styles is important for students of any age. It is advantageous for students to understand their type of learning style early on ”

    so the rhetorical question I might ask is this: do you think the preferred learning style of the teacher is the one she uses to instruct the kids?

    what’s your guess?

    bonus question: do you think it’s important to know what you and your own kids learning styles are and perhaps know how different learning styles would be taught differently by the same teacher and/or curriculum?

    these are things that the countries that beat us are working on while we go around in circles trying to affix blame for why we are falling further behind.

    again – do you want to go forward – fix what is broke, invest in things that will improve us or do you want to find someone to string up because the world aint right?

  15. here’s an example of what is going on in schools these days:

    ” Ex-school workers accused of assaulting autistic boy in Culpeper”

    ” Two former Culpeper County school employees have been charged with assaulting a 5-year-old boy who has autism. ”

    now I’m not taking sides on this – only pointing out that the two people involved got drawn into something that likely neither of them have a track record of engaging in overall with all kids.

    second, put yourself in the teachers shoes – who has to get the lesson of the day to the rest of the class when a kids goes off?

    the chances are that these two were doing what they were expected to to – but never put to paper, but I’d await further facts.

    I just know that this kind of thing is not a rare thing any more. More and more “kids” are showing up at public schools – totally out of control and are imposing serious impacts on people just trying to teach the rest of the kids if they can.

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