How must practice change to address these issues? First, we advocate a more thorough approach to assessment, with attention to a greater depth and range of behavioral disorders at all stages of the assessment process. From screening, the initial point at which most students should be identified as potentially having problems that require specialized services, educators must attend as much to internalizing as to externalizing behavior disorders. Even when students come to our attention due to their behavioral excesses, we must not overlook the potential that comorbid conditions are present.
Second, an increased focus on interventions that teach new skills and behaviors must replace an overreliance on behavior reductive strategies. These interventions obviously must be derived from careful assessments that provide information about not only a student's obvious (i.e., externalizing) behavior problems, but also about potential comorbid disorders that may be less obvious (e.g., depression, anxiety, social withdrawal).
Finally, and ultimately, we advocate for a concentrated reexamination of the definition of serious emotional disturbance that continues to drive educational practice. We believe that an open, inclusive definition, such as the definition proposed by the National Mental Health and Special Education Coalition ( Forness & Knitzer, 1990), may provide practitioners with more guidance than the current restrictive, exclusive definition. Indeed, the worrisome trend in our field toward excluding from services those students who are socially maladjusted warrants our closer attention to the likelihood that these students also display comorbid conditions. For example, the student who can be said to be socially maladjusted may be quite likely to have at least one other, generally less obvious, comorbid emotional and behavioral disorder. For these students, greater attention to the broad range of possible comorbid conditions on the part of professionals may be the only means by which they receive the services they need.
In summary, we believe that the very concept of comorbidity, which has received limited attention in the educational literature, may ultimately play a significant part in such basic decisions for students with emotional and behavioral disorders as determinations of eligibility and intervention prescription. At the least, comorbidity should become a common consideration for any professional involved in assessing students with potential emotional and behavioral disorders.
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