The effect of a psychiatric diagnosis on school psychologists' special education eligibility decisions regarding emotional disturbance.

In this analogue investigation, 215 practicing Pennsylvania school psychologists reviewed hypothetical referral forms and related data (vignettes). Vignettes represented children who met eligibility criteria for special education as well as children who did not. Participants were most likely to recommend, as eligible due to emotional disturbance, children who met eligibility criteria and carried a psychiatric diagnosis; they were least likely to recommend children who neither met criteria nor carried a diagnosis. Participants were just as likely to consider children eligible by virtue of emotional disturbance when they carried a diagnosis but did not meet eligibility criteria, as when they met criteria but had no diagnosis. These results suggest that school psychologists may allow the presence of a psychiatric diagnosis in referral information to inappropriately influence their recommendations regarding eligibility under the special education category of emotional disturbance.

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Few categories of eligibility for special education have generated as much debate as that of emotional disturbance (ED). The definition of ED lacks specificity in qualifying criteria and contains an equally vague and controversial exclusion clause for students who are "socially maladjusted." These characteristics result in imprecision in special educational diagnostic classification that can lead to misclassification and unjust disciplinary exclusions for students (Clarizio, 1992).

Little is known about the in vivo diagnostic judgment practices of school psychologists in the area of ED classification. The present study focused on psychiatric diagnoses as a type of unique information likely to be considered during the decision-making process for eligibility specifically under the ED category. Factors that mediate the eligibility determination process for students are likely to be different for students suspected to have ED (Huebner, 1991) due to the need to focus assessment on the more abstract constructs of social and emotional functioning. This contrasts with the more clearly defined areas of IQ and achievement scores (Huebner, 1991; LeLaurin, 1990; Wodrich, Stobo, & Trca, 1998) that are typically considered in decisions regarding learning disabilities (LD) and mental retardation (MR).

It stands to reason that a heavy reliance on measures of behavioral and emotional functioning is required to make decisions regarding a student's eligibility under the ED category (LeLaurin, 1990), and this is indeed advocated as "best practice" (Sattler, 1994). Based on this reasoning, identification of ED likely differs from that for categories of LD and MR. Thus the body of research in special education decision making, which has focused primarily on students with suspected eligibility for the categories of LD and MR, may not generalize to decision making for students suspected of ED.

For students who are suspected to be emotionally disturbed and are referred for evaluation within the schools, one component of referral data that is sometimes available is information regarding a psychiatric diagnosis per the Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV; American Psychiatric Association, 1994). DSM-IV diagnoses are usually not rendered by school personnel; they usually come from mental health specialists, psychologists, or psychiatrists in settings external to the school (Tharinger, 1995). It may be that psychiatric diagnoses are viewed as a source of potential concurrent validity for diagnosticians seeking to determine whether a student is emotionally disturbed or that a psychiatric diagnosis may make it easier for the psychologist to apply a school-based diagnosis of emotional disturbance. School psychologists may be susceptible to equating psychiatric diagnoses with demonstrated eligibility under the eligibility category of emotional disturbance.

Research on general clinical judgment (Garb, 1998), as well as on special education eligibility decisions in general (de-Mesquita, 1992; Ysseldyke & Algozzine, 1982), has suggested that school psychologists' recommendations may be influenced by psychiatric diagnoses, just as they have been shown to be influenced by other types of referral information such as age and gender. It is reasonable to expect that, all things being equal, a DSM-IV diagnosis in referral information about a particular child is likely to increase the chance that the child will be declared eligible for special education as a child with ED. Further, an increased likelihood of eligibility was hypothesized to occur due to a diagnosis even in the absence of referral information meeting the two-prong condition for eligibility as ED. In other words, it was expected that a diagnosis would increase the child's chance of being labeled ED, whether or not the child actually met all eligibility criteria.

The main independent variable used in the vignettes to focus this diagnostic decision-making exploration is DSM-IV diagnosis. This variable, the presence (or absence) of a psychiatric diagnosis, was not tested in prior studies presumably because it has little effect on the identification of LD or MR students; former studies were concerned with the decision making with regard only to mental retardation or learning disabilities. The second independent variable, eligibility status as per the Pennsylvania (and federal) ED eligibility definition, is necessary to determine the potentially varying effect of psychiatric diagnoses in cases where referred students do or do not otherwise meet eligibility for special education.

Determination of a student's degree of need for (special) educational services is an integral part of the decision-making process for eligibility under ED. Herein lies the second of two "prongs" that must be met for eligibility. The child's presenting problem must meet the …