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This week’s blog was contributed by Carrie Champ Morera, PsyD, lead project and content director, and Theo Miron, PsyS, regional manager–educational assessments.

Why should psychologists and other clinicians assess for emotional disturbance (ED) in the school setting? Parents and caregivers of 8.3 million school-aged children (ages 4 to 17 years) have sought help from school staff or mental health professionals about their child’s emotional or behavioral difficulties. Approximately 7.5% of children ages 6 to 17 years used prescribed medication during the past 6 months for emotional or behavioral difficulties. Assessment of ED is necessary in the school setting to help children obtain the emotional and behavioral support services they need to be successful.

Over the past 20 years, the number of students served within special education has steadily increased, while the number of students being served under ED eligibilities has steadily decreased. For example, during the 2000–2001 school year, 6.29 million students received special education services with 7.6% of those students identified as having an ED. Although the population of students receiving special education services grew by almost one million children to 7.13 million over the next 18 years, only 5% were identified as having an ED during the 2018–2019 school year.

How can we improve ED identification and help children obtain the services they need to be successful in school? It is the school’s responsibility and a school psychologist’s professional role to find children who are struggling emotionally and behaviorally, identify them through the evaluation process, and then connect them with appropriate services and interventions so they can begin to heal and make educational, social, emotional, and behavioral progress. 

When completing assessments for ED, we need to carefully consider and adhere to specific eligibility criteria while distinguishing the difference between social maladjustment (SM) and ED. Practitioners also need to consider DSM-V-related diagnoses as well as the impact of trauma, adverse childhood experiences (ACES), and the pandemic on the child’s functioning. It is also imperative to be cognizant of racial disproportionality in determining eligibility for ED services (see NASP Position Statement: Racial and Ethnic Disproportionality in Education).

Assessments of ED need to be comprehensive and include multiple tests and information from a variety of sources. Clinical interviews with the student, caregivers, and teachers, as well as observations of the student in the natural environment are paramount. Trauma, ACES, and the pandemic also need to be considered in the assessment of ED. Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious threat to a child’s physical or psychological wellbeing, including child abuse, neglect, divorce, bullying, poverty, and community violence. Adverse experiences can have profound consequences, particularly when they occur early in life, are chronic, and accumulate over time. Trauma is an outcome of exposure to adversity while adversities are the cause of trauma. Trauma affects everyone differently, depending on individual, family, and environmental risk, as well as protective factors.

Repeated or prolonged trauma in addition to the effects of the pandemic can have a litany of adverse outcomes on our children in the areas of cognition, brain development, behavior, emotions, mental health, physical health, and relationships. These factors need to be considered in a comprehensive evaluation for ED.

Since the start of the pandemic, we have seen a significant increase in kids struggling with both emotional and behavioral difficulties. This increase may lead to an uptick in the number of ED-related assessment referrals that come across our desks and the number of students who require special education services. This leads us into how we assess children for an ED and the benefits of using the Emotional Disturbance Decision Tree (EDDT).

Dr. Bryan Euler, the author of the EDDT, has worked as a school counselor, diagnostician, lead school psychologist, and a clinical psychologist. While working in the Albuquerque public schools, Dr. Euler teamed up with PAR to create the EDDT to provide a standardized approach to the assessment of ED. It was designed to directly address the framework of the federal ED eligibility criteria; for every component of the federal ED criteria, there’s a corresponding EDDT scale or cluster. The scales within the assessment are written to address these broad domains thoroughly, then help school psychologists apply the specific criteria to make informed decisions on both eligibility and programming.

The EDDT includes all the relevant aspects of the federal ED criteria. It contains scales and clusters that address each of the specific ED criteria. The structure of the EDDT walks the practitioner through each area of the federal ED criteria.

  • Section 1 reviews the important exclusionary items to address “an inability to learn that can’t be explained by other factors.”
  • Section 2 Part A examines the 4 important characteristics we look for in ED (building/maintaining relationships, inappropriate behaviors/emotions, depression factors, and physical symptoms and fears).
  • Section 2 Part B serves as a screener for characteristics of both ADHD and schizophrenia/psychosis.
  • Section 3 assesses the characteristics of social maladjustment.
  • Section 4 measures the level of severity, where we examine the magnitude of the symptoms and characteristics the student is exhibiting. 
  • Section 5 helps determine the level of educational impact that these issues may be causing in school.

Bryan Euler, PhD, describes the benefits of the EDDT and the importance of multiple informants, including the student’s perspective, here.

There are several best practices to keep in mind with the EDDT: Include the viewpoint of multiple raters (teacher, parent, and/or self) from different settings (school, home, and community). Use the EDDT as part of a comprehensive evaluation to determine ED eligibility. In addition to the EDDT, be sure to include qualitative information such as interviews (from the student, parents, and/or teachers) and observations across school settings to supplement the data received on the EDDT.

Carrie Champ Morera, PsyD and Theo Miron, PsyS will present on the EDDT at the National Association of School Psychologists (NASP) annual convention in February. In their presentation, Assessing Emotional Disturbance in Schools Using the Emotional Disturbance Decision Tree (EDDT), they will explore the features and trends in ED and investigate the structure and use of the EDDT. If you attend NASP, feel free to stop by the PAR booth to learn more about how PAR can meet your assessment needs.

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This week’s blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master’s degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids. 

Upon returning to school in fall 2021, my 8-year-old daughter started showing signs of separation anxiety almost immediately. She would not go into the classroom on her own and developed a compulsive habit of checking the weather before school each day to see if it was going to rain. Over the course of a couple of weeks, we spent hours on the playground before (and during) school, attempting to cajole her into feeling safe. We eventually enlisted the help of the fantastic school psychologist who helped our daughter get over her fears and go in on her own within another two to three weeks. 

Though her separation anxiety seemed to come out of nowhere, hindsight would say otherwise. The biggest clue was that she started a new, much bigger school this year. She was also having trouble making friends, which was different for her. The final piece of the puzzle was learning that a classmate had shared information about a flood warning with my daughter, and she became scared that there might be a flood while she was at school—hence the checking of the weather every morning.  

Related post: Jeremy Sharp on trauma-informed assessment 

My daughter is not alone. Depending on what you read, estimates on prevalence of anxiety disorders in kids ages 3–17 range from about 2% to more than 30%, with a recent meta-analysis settling on about 7%. That’s two kids in your average classroom who are experiencing clinical anxiety, with even more who have subthreshold anxiety.  

There are many reasons that kids might feel anxious at school, but let’s break it down into three areas for the sake of simplicity. Those areas are: 

  • Separation from caregivers 

  • Social interaction 

  • Academic demands 

Separation anxiety is the most common form of anxiety in kids under 12. The core theme of separation anxiety is “excessive distress” when separated from or thinking about separating from a primary attachment figure or caregiver. At school, this looks like unwillingness to get out of the car, clinging to a parent’s leg, not leaving the caregiver to go into the classroom, and other similar situations. As in my daughter’s case, it can also show up as a fear of an event that would cause separation from the primary attachment figure. Separation anxiety often ramps up after breaks, like when returning to school after the holidays or summer vacation. Even a typical Monday can increase anxiety, as kids have gotten used to being with caregivers over the weekend. 

Social interaction is another area of potential distress in kids. The clinical diagnosis of social anxiety disorder is estimated to occur in about 9% of adolescents (ages 13–18 years). Social anxiety is characterized by the fear of being judged by others paired with avoidance of certain situations that cause anxiety. An example is eating lunch alone due to a fear of saying something “dumb” while sitting with peers. 

Lastly, academic demands can lead to anxiety in kids. Research suggests that around 20% of students experience test anxiety overall, though it differs depending on several demographic factors. For instance, female-identifying students and ethnic minority students are more likely to experience test anxiety. Regarding personality factors, there is a consistent negative relationship between self-esteem/self-concept and test anxiety. Students with disabilities (i.e., ADHD) are more likely to experience test anxiety than students without an identified disability. Additionally, test anxiety’s negative impact on performance is highest in middle school and decreases in high school. It’s important to note that text anxiety is not the only form of performance anxiety in school, however. Some students feel a variation of social anxiety or fear of being called on in class as well. 

This information confirms what we already intuitively know: as “front line” workers in pediatric mental health, school staff plays a very important role in kids’ social and emotional wellbeing. Indeed, the research is clear that kids learn better when they also have skills to manage their emotions. But it’s not always easy to know which students need help! Anxiety is an internalizing disorder, meaning that kids tend to feel it in their minds or bodies without necessarily expressing it overtly to others. What we do know is that kids from lower income homes and ethnic minority kids are at greater risk of “flying under the radar” and not receiving the support that other kids get. We also know that school is a great place to implement interventions given that so many barriers to accessing treatment are removed when kids are already there. 

So, what school-based interventions actually work? A recent meta-analysis of prevention programs showed that cognitive-behavioral strategies make up the vast majority of interventions in the academic environment. The effect sizes across all forms of intervention were small but statistically significant, indicating that prevention programs are certainly helpful in addressing anxiety. The study looked deeper into whether the type of program (universal vs. targeted) made a difference and found that it did not. Similarly, it didn’t matter whether school staff (i.e., teachers, school counselors) or an external mental health professional delivered the intervention. The research suggests, however, that intervention be delivered as early as possible, in a preventative context, given the relatively early age of onset of anxiety.  

To summarize, a substantial minority of kids will experience some form of anxiety at school before finishing high school, but there are ways to help. School counselors and teachers are in a great place to do so. Being mindful of anxiety as an internalizing disorder and paying attention to kids who tend to fly under the radar are excellent places to start. Knowing the different types of anxiety and the places they show up are valuable as well. On a broader scale, prevention programs are helpful and effective, especially when delivered earlier rather than later.  

Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify. 

 

Related: School resources to help you address trauma, anxiety, and more. 

 

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In observance of the holiday season, the PAR offices will close at 4 p.m. ET on Wednesday, December 22. We will reopen at 8 a.m. on Tuesday, December 28.

PAR offices will close in celebration of the new year at 4 p.m. on Thursday, December 30, and reopen at 8 a.m. on Monday, January 3.

As the year comes to a close, we at PAR look back and are incredibly thankful for the trust you put in us to provide you with the tools you need to help those you serve. We look forward to continuing to serve you in 2022.

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The results of PAR’s seventh annual Pay it Forward program are in!  

Each year, we ask our customers to choose a charity from a short list of deserving organizations. This culminates in PAR donating $5,000 on behalf of our customers to the charity that receives the most votes.  

This year’s selected charity is: Family Promise!

Family Promise is the leading national nonprofit organization addressing the issue of family homelessness. Their mission is to help homeless and low-income families achieve sustainable independence through a community-based response.  

To our customers who participated, thank you for helping us Pay it Forward. 

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In 1992, the United Nations General Assembly proclaimed an annual observance of International Day of Persons With Disabilities. Since that time, this day has been dedicated to promoting the rights and well-being of individuals with disabilities, increasing awareness of people with disabilities, and furthering the rights of those with disabilities in every political, social, economic, and cultural sphere. 

The theme for this year, “Fighting for rights in the post-COVID era,” recognizes that people who live with disabilities are among the most affected populations from this pandemic—with an increase in poor outcomes, reduced access to health care, lack of mental health resources, and inadequate emergency services for those with special needs. The pandemic brought to light the need to make meaningful investments in communities and services that reduce the barriers that individuals with disabilities face. 

Learn more about International Day of Persons With Disabilities as well as initiatives from the World Health Organization

 

 

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The National Academy of Neuropsychology (NAN) will hold its 41st annual conference virtually on December 9 and 10. The conference features live presentations as well on on-demand sessions, with a total of 25.5 CE credits available.  

PAR is once again a proud sponsor of this event. Additionally, PAR will offer four poster presentations, including two featuring authors Steven G. Feifer, DEd, and Cecil R. Reynolds, PhD. PAR’s four poster presentations will include a deeper dive into the NAB, the FAR, and Identi-Fi.   

If you are attending NAN, visit our virtual booth to receive a promo code for 15% off all PAR products plus free shipping. Create a library of assessment instruments—for every domain, across all age spans—PAR has it all. All the tests. All the tools. All from a company you trust. View PAR’s neuropsych assessments, and build your battery today.  

There is still time to register for NAN. You won’t want to miss this year's lineup of presentations. 

 

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All year long, but especially during this time of year, we at PAR are thankful for our loyal customers. We are grateful for the trust you put in us to provide you with the tools you need to help those you serve. 

In observance of Thanksgiving, the PAR offices will be closed from 4 p.m. ET on Wednesday, November 24 until 8 a.m. on Monday, November 29.  

May your Thanksgiving be filled with happiness, joy, warmth, and togetherness.  

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ChecKIT on PARiConnect offers you a centralized location for brief, commonly used mental health checklists. Now we’ve added the Geriatric Depression Scale–Short Form (GDS-SF) to our ChecKIT offerings! This 15-item checklist efficiently screens for depression in older adults. 

The ChecKIT family of products are simple checklists that can be administered, scored, and tracked via PARiConnect. They can be mixed-and-matched within the ChecKIT family, so clinicians can easily build the bundle that is right for each client. Administration and scoring are provided together in one purchase. 

 

What’s on ChecKIT? 

NEW! The Geriatric Depression Scale–Short Form (GDS-SF) is a 15-item checklist designed to screen for depression in older adults. 

NEW! The Michigan Alcoholism Screening Test (MAST) is a 24-item questionnaire developed to screen for alcohol dependence and alcohol-related behaviors.  

The Language Acculturation Meter (LAM) provides a framework for testing culturally and linguistically diverse individuals to help choose appropriate assessment instruments. 

The Patient Health Questionnaire-9 (PHQ-9) is a 9-item depression screener designed for use with adults in a primary care setting that has garnered overwhelming popularity in research and clinical practice. 

The Generalized Anxiety Disorder-7 (GAD-7) is a 7-item screener for anxiety. Based on the diagnostic criteria for generalized anxiety disorder in the DSM-IV ™, the GAD-7 is ideal for use in research and clinical practice. 

 

Flexible purchase model 

Purchase multiple units of checklists up front, and decide which checklists you want to use when you are ready to administer them. 

 

Score reports and technical papers 

After administration, you’ll receive a score report that offers interpretive text that can be easily incorporated into your professional reports. You can also export data for a ready-to-analyze dataset to facilitate research. Furthermore, each ChecKIT product offers a complimentary technical paper that explains the development behind the measure. 

 

Easily track progress 

ChecKIT allows you to save repeated administrations in one location and regularly track client symptoms across therapy sessions. 

 

Check out ChecKIT and the new GDS-SF today! 

 

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Today is Veterans Day in the U.S., and we want to take a moment to pay tribute, honor, and thank those who have served in our military. 

PAR would like to sincerely thank every individual who made the choice to serve our country and defend our freedom. You chose to leave familiar surroundings, family, and friends in service to your country. Your sacrifice has made a true difference in the life of every American and is a debt we can never truly repay. We value and appreciate your selflessness. It is the foundation that our country is built on. 

We’d also like to give a special thanks to the members of our PAR staff who have served in our military: 

  • Adam Barrett-Clarke 

  • Teri Lyon 

  • Mike Nolan 

  • Jarris Suggs 

Thank you for your service and thank you to all veterans on this special day! 

 

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PAR is excited to announce the release In-Person e-Stimulus Books for the Neuropsychological Assessment Battery® (NAB®) modules!  

The NAB Attention Module, NAB Executive Functions Module, NAB Memory Module, NAB Spatial Module, NAB Language Module, and NAB Screening Module In-Person e-Stimulus Books are convenient and more hygienic alternatives to paper stimulus books and cards. They are designed to be used via tablet during face-to-face administration. Be sure to download our new white paper prior to administering for guidance on how to use e-Stimulus Books. 

Did you purchase a NAB kit or paper stimulus book prior to November 3, 2021? We’re pleased to offer the In-Person e-Stimulus Book (for in-person administration via tablet) to you at no charge for a limited time! Just call 1.800.331.8378 or email us at CS@parinc.com with your request.   

PAR offers many more In-Person e-Stimulus Books to provide you with the flexibility and confidence you need when administering tests. Check out our e-Stimulus Books web page to learn more.