Saran Tugsjargal knew from a young age that she was treated differently than her classmates. Starting in elementary school, she received IEP services for a specific learning disability and ADHD, as well as forms of speech therapy, physical therapy, counseling, and individualized study. But it wasn’t until she was in high school that she discovered that as a young child she had also been assessed for an emotional disability, then called an emotional disturbance.
“I knew I was different since I was very little, but I just never really knew what was different about me,” she says. “Until I kept getting pulled out of classes. . . . The first time when I saw the word ‘emotional disturbance’ was on my IEP papers.”
Tugsjargal is far from alone. Emotional disabilities (ED) can present families with unique challenges, from navigating IEP assessments, accommodations, goals, and placement to understanding the nuances of ED eligibility itself. Students who receive IEP services under ED also face disproportionate rates of discipline, stigma, and dropping out, but there is plenty that parents and educators can do to help their children and students thrive. Just last year, in fact, Tugsjargal’s efforts alongside policymakers helped pass California’s AB 2173, a bill that changed the language from emotional disturbance to emotional disability.
We spoke with Tugsjargal (who is now a first-year student at Rice University), a disability advocate and former commissioner for the California Department of Education’s Advisory Commission on Special Ed; Sarah Pelangka, PhD, BCBA-D, special education advocate and owner of Know IEPs; Hadassah Lynn Foster, non-attorney education advocate; and John Maag, PhD, the Larry and Sharon Roos professor in special education at the University of Nebraska-Lincoln.
An emotional disability is one of thirteen categories the federal Individuals with Disabilities Education Act (IDEA) has identified under which a child qualifies for an IEP and special education services. However, parents should be aware of an important distinction from some other categories: eligibility for IEPs and services under emotional disability is not contingent on a medical diagnosis or a DSM-5 category diagnosis. At the state level, California defines IEP eligibility for an emotional disability virtually identically to the federal IDEA definition. A student is eligible for an IEP under emotional disability if they exhibit one or more of the following characteristics over a long period of time and to a degree that adversely affects their education:
A note: this doesn’t apply to children identified with the equally-stigmatizing term “socially maladjusted.” Current legislation does not provide clear language or criteria for how to determine a social maladjustment versus from an emotional disability, which we will discuss the implications and potential consequences of later.
Estimating the population of students with emotional disability can be tricky, especially with the enduring, prevalent stigma toward mental health and conditions associated with ED. Data from the National Center for Education Statistics indicate that around 4% of students ages 3-21 who qualified for services under IDEA in the 2022-23 school year were categorized as having an emotional disability. However, these numbers do not clarify whether those students were receiving services primarily for emotional disability or whether it was listed in the IEP as a co-occurring, secondary, or tertiary disability. Many children eligible for IDEA services and IEPs under different categories can and do receive services that address emotional disability, but it may not be reflected in how agencies collect data.
States can choose to expand on this definition or alter the language used, as long as it doesn’t infringe on the parameters set by IDEA. While some states, like Nebraska where Dr. Maag lives and works, may also refer to an emotional disability as an emotional or behavioral disorder, most states still use the term defined in the federal legislation emotional disturbance.
California is one of the only states to enshrine in law more progressive language around ED, having passed AB 2173 in 2024 to strike the term emotional disturbance from the language used in state special education law and replace it with emotional disability. In fact, most of the sources we spoke to take issue with the enduring use of emotional disturbance, calling it stigmatizing and regressive. As we’ve written about before on talking about disability, the language and framing used to define emotional disability itself influences perceptions about students who have them.
“I know that it seems like it’s a small change — disturbance rather than disability. It doesn’t seem like a big change, but actually it is, because the phrase emotional disturbance is highly negative, highly charged,” says Foster. Even before a child has been assessed for an ED, the possibility of an emotional disability can impact how they’re treated by teachers, peers, and other school staff.
“Once we have a student who has been identified as having an emotional disability, they could be put in the category of ‘there’s nothing that you can do’ very easily. [Then] it’s all about controlling the student’s response to whatever is distressing them, and we don’t spend time on addressing the underlying reasons for the distress,” Foster adds.
Tugsjargal knows firsthand how the language of legislation trickles down into how students with disabilities navigate preconceived notions of their capabilities both in and out of the classroom. It was her lived experience that inspired her to pursue advocacy for students like herself.
“Every time I see that word, that phrase, that term, I don’t know why but it makes me feel really emotional. It’s very gut-wrenching because it’s very sad to think about the way that people perceive you or make you feel that you were that crazy kid growing up,” she says. “Because when someone says it, people think, “Oh, she’s always going to be that way.”
Foster adds that emotional disability should be used “as little as possible” as a primary IEP qualification because it can unintentionally prevent parents and the IEP team from identifying co-occurring disabilities that require additional services. Her two exceptions, which we will explore in more depth later in the article, are if a child’s needs require a residential placement change, or if a person has been diagnosed with a mental health condition that is directly impacting their learning, such as schizophrenia.
Eligibility for special education under this category encompasses a broad range of diagnosable conditions as described in the DSM-5 but can also overlap with a range of behaviors and characteristics that do not directly pertain to a diagnosis. Sources agree that identifying the criteria for emotional disability in a child can come with significant challenges, particularly the stigma associated with the conditions and behaviors that qualify a child for IEP and/or 504 services.
The following conditions may manifest into behaviors that meet the IDEA criteria for emotional disability eligibility: autism, anxiety, ADHD, bipolar disorder, depression, obsessive-compulsive disorder, PTSD, schizophrenia, Tourette’s syndrome, oppositional defiant disorder, conduct disorders, and eating disorders such as anorexia.
Receiving a diagnosis for one of these conditions alone, however, does not automatically mean a child qualifies for special education under the emotional disability category (though they may qualify under a different category, such as autism, or as an other health impairment [OHI]); eligibility explicitly depends on how these conditions can manifest in children in ways that warrant the need for IEP services. The following behaviors displayed consistently by a student may lead educators and parents to suspect and subsequently pursue assessment for special education/IEP under emotional disability:
If an IEP assessment indicates that the student is not eligible for an IEP under the emotional disability category, the children will not receive an IEP for ED and its relevant services. They could still be eligible for an IEP under a different category, however — especially if there is a co-occurring condition.
An emotional disability, as defined by IDEA, is not a universal medical condition with a clear diagnosis. It is an IEP category and is determined by a multipronged assessment by the student’s school. A child can meet the criteria for an ED without any of the DSM-5 conditions mentioned above if an assessment determines they meet IDEA’s criteria. Conversely, a child may have a diagnosis of depression or ADHD or ODD but not qualify for an IEP under ED because their condition does not meet the ED criteria.
As Dr. Maag explains, “We don’t really call it a disorder,” and it does not strictly pertain to a student’s mental health. Rather, “When you’re looking at children in school that would be identified [under] emotional disability, or whatever terms are used in different states, you’re really looking at behavioral or emotional issues that interfere with the child’s academic learning. So if someone would say to me, ‘Well, could a kid that’s been diagnosed with depression receive services under emotional disturbance?’ my answer would be, ‘Only if it impacts academics.’ That’s where the distinction lies between a clinical diagnosis with the Diagnostic and Statistical Manual of Mental Disorders (DSM) versus the type of services that kids would get in school.”
Other federal definitions/diagnoses to note
Note that beyond the special education definition and criteria, there are other organizations that define and offer supports for emotional disabilities.
The IDEA criteria for ED does not apply to these other organizations or agencies. For example, the Center for Mental Health Services (CMHS) branch of the Substance Abuse and Mental Health Services Administration (SAMHSA) uses the language of a “serious emotional disturbance (SED),” which they define as “someone under the age of 18 having (within the past year) a diagnosable mental, behavioral, or emotional disorder [of sufficient duration to meet diagnostic criteria specified within the DSM-5] that resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities.”
The Social Security Administration’s definition of eligibility for the children’s Supplemental Security Income (SSI) program is the presence of a mental condition that can be medically proven and that results in marked and severe functional limitations of substantial duration. The out-of-pocket costs for services for a child with an emotional disability outside of school can vary widely depending on the child’s needs and proximity to the necessary services. In order for families to receive resources through the SSI program for children, the child must have a medically determinable physical or mental impairment (or combination of impairments) that:
The eligibility of the impairment must be evaluated by a medical professional, which can include a school psychologist or a school professional who performs the role of school psychologist. A child’s IEP may also be considered as part of their case for SSI, but it does not guarantee SSI benefits. For more information about childhood disability and Social Security, parents should consult the Social Security Administration (SSA) website for school professionals and the most recent benefits book.
Children identified under the CMHS and/or SSI criteria may also be eligible for services under IDEA or under Section 504 of the Rehabilitation Act of 1973; however, eligibility is not automatic. A child must meet the requirements of ED under IDEA. Therefore, identification of a child as emotionally disturbed under the CMHS or SSA definition does not necessarily lead to identification under IDEA.
When an ED is co-occurring with another eligible disability, such as an intellectual disability, ADHD, or autism, both Foster and Dr. Pelangka strongly encourage parents to advocate with their IEP teams to label the ED as secondary. Classifying ED as primary on an IEP can have both legal and practical contingencies; in California state law, for example, categorizing a child’s ED as their primary eligibility prevents the child’s IEP from including autism and a specific learning disability as co-occurring conditions, even if they child’s diagnosis and/or assessment demonstrate eligibility. In other cases, centering the ED can obscure the full scope of where a child’s needs are coming from. “There are multiple prongs to how you qualify for ED, and you only have to meet one. One of them is — I’m not going to quote it word for word, but you can’t really develop meaningful relationships with peers or adults,” says Dr. Pelangka. “Many people with autism would meet that prong, and then they would very likely qualify as having emotional disability, but that’s not an accurate representation.” That inaccurate representation could then defer or slow down the assessment process for a co-occurring condition for which the child needs services.
Both Dr. Pelangka and Foster encourage parents to exercise skepticism of both assessment and assignment of emotional disability as the IEP’s primary eligibility category. In California, students can receive IEP services for more than one disability, such as both autism and an emotional disability, but behaviors that are associated with an emotional disability, such as throwing chairs, yelling at peers or teachers, and refusing to complete tasks, can also be attributed to other IDEA categories. Addressing them as purely ED-related needs, sources say, may deprive the student of services and resources that would concurrently address their ED needs.
“I see only one, possibly two, reasons to ever agree to emotional disability as primary (or even secondary) classification,” says Foster. “Number one, if the student really needs placement, at public expense, in a therapeutic residential setting. The other reason is when really and truly you have a student who’s actually diagnosed with an actual mental health disability.”
Dr. Pelangka also recommends that parents have their children assessed for other disabilities if they or their child’s school suspects there may be an emotional disability. The broad criteria for emotional disability means that its symptoms can overlap with other disability categories and potentially obscure the full scope of the child’s needs.
School can be both a challenging and a rewarding environment for students with emotional disabilities. Being around their peers helps children with ED learn emotional cues, improve their communication, and form bonds with other children and adults. But students can also face bullying by their peers who don’t understand their needs, and even negative treatment by educators. Dr. Maag explains that there are some disabilities, such as dyslexia or Down syndrome, that connote a “label of forgiveness,” where the person with the disability is seen as faultless. Students with ED, by contrast, are often seen as responsible for how their disability manifests.
Biases from kids and adults
For Tugsjargal, she often felt “behind” and alienated from her peers due to the services she received that took her out of her gen-ed classes or even how she expressed herself. She sensed what Foster, Dr. Maag, and Dr. Pelangka all say is a pervasive stigma against students with emotional disabilities. Because they didn’t understand, other students used words like “crazy,” “chaotic,” and “violent” when talking to her. Blame or presumed guilt often came her way from teachers, even if she had nothing to do with the situation.
“Every time I screamed or shouted or if I was yelling, it always seemed like I was the problem,” she says. “Then, when my teacher talked to me, they’d ask, ‘Did you actually do that?’ No, I didn’t do that.”
This was further complicated by her family’s lack of knowledge about emotional disabilities. Tugsjargal’s parents were Mongolian immigrants with limited English fluency and were not able to advocate for her during her early years of IEP meetings. Instead, it was her child psychologist who attended meetings and spoke to Tugsjargal’s changing needs as she aged into middle and high school, including helping her with milestones beyond mental health. Having a trusted adult on campus can make a huge difference in how a student perceives their own needs and how to change how their ED is treated by both the adults and fellow students at school.
“There are these assumptions about what the student is going to be like, and it’s not always true. It automatically might make teachers treat kids, subconsciously, in a certain type of way without recognizing it, and that can then induce the behaviors that we’re seeing,” says Dr. Pelangka. “It leads to change of placement or more restrictive settings because realistically, it’s the adults that are really creating that problem, not so much that the student is having those difficulties. There’s just not enough understanding due to the subconscious or conscious assumptions being made.”
The label itself also leads to exclusion. Often, sources say, schools do not want a student labeled with “emotional disturbance” due to a myriad of factors, such as potential costs incurred for services and perceptions of how they might disrupt class. Less than half of students with ED spend at least 80% of the school year in a regular classroom, compared to 64% of students with disabilities overall, and students with ED are four times as likely to be in a separate school.
“School districts, in my opinion, have this fine tightrope they have to balance. They [don’t] want to kick too many kids out, because then that looks like they’re failing. But they don’t want kids in there that are repeat offenders with severe, challenging behaviors as well,” says Dr. Maag. ”Education programs around the country for general education — very, very few programs require their students to take a class in behavior management,” which differs from the standards of classroom management like developing rules, organizing a seating chart, and setting assignment deadlines. “So you have all these teachers with kids with emotional disabilities that don’t have the skills to deal with them on a daily basis. . . . If you don’t have the skills to find those cues or prompts, that’s when you get on this merry-go-round of exclusionary practices.”
Discipline and behavior
By and large, students with emotional disabilities face higher and more severe rates of discipline than their peers. Having these discussions with a student’s IEP team and documenting discipline in IEP meetings can preemptively protect students from more intense forms of discipline, as well as inform educators on how to engage with a child with ED. Even though the Americans with Disabilities Act (ADA) has anti-discriminatory protections for students in public schools, one of the most common forms of discipline for students with emotional disabilities is seclusion. In severe cases, schools may use restraint.
A report from the Department of Education indicates that despite making up less than 20% of the nation’s student population, students served under IDEA can make up around 80% of documented cases of seclusion and restraint in a given school year. Seclusion can mean a variety of things, from separation from their peers on a timeout to different class placements to extended periods of time alone in a designated room.
“In-school, suspension, reset rooms — pick whatever vernacular you want to use — those really are the main ways that kids’ behaviors are dealt with,” says Dr. Maag. A student receiving a timeout or being pulled out of class doesn’t sound severe at face value, but language the school uses can obscure what kind of discipline a child is receiving. “When you look at seclusion and exclusionary practices, it’s not so much whether the school has a timeout room, a seclusion room. The questions for parents to ask are, ‘How is it used? How often is it used? How is it monitored? What offenses get a child in there? How long is a child in there? What processing goes on when the child comes out?’”
But a child with an IEP cannot be disciplined on the basis of their disability, and that includes ED. An IEP protects a student with an emotional disability from excessive seclusion and gives them more agency when the school may escalate disciplinary action, such as suggesting suspension. If a student’s behavior at school continues to escalate to the point of multiple suspensions, an IEP is also critical to giving a student a manifestation determination review (MDR) before expulsion is considered. An MDR hearing is required by law after the student has served 10 days (consecutive or not) of exclusion due to violations of school codes. The hearing, which includes the parent, the IEP team, and the LEA, determines whether the student acted out of a manifestation of their disability and whether the school and IEP team failed to effectively implement the child’s IEP.
The results of such a hearing determine the school’s course of action, which can mean changes in a student’s IEP, additional assessments, or, in extreme cases, changes in the student’s school placement. A manifestation of behavior may require additional IEP services, such as a functional behavioral assessment (FBA) (if not already conducted) and the implementation or revision of a behavior intervention plan (BIP). Parents can also consider whether a change in placement would benefit their child, but a change in placement is not required unless the student’s behavior involves weapons, drugs, or serious bodily injury, which are not protected by their disability. If the hearing determines that the student’s behavior was not either an IEP failure or an ED manifestation, they can still face disciplinary action.
Learning difficulties
Whether a child has ED listed as a primary or a co-occurring condition on their IEP, many children with ED face learning difficulties at school. The difficulties can result from the specifics of their disability, but they can often be exacerbated by a lack of recognition, assessment, and services. Research from the Journal of Special Education identified more than 20 years ago that children with ED suffered worse learning and graduation outcomes in part due to a lack of early intervention and the administering of demonstrably needed supports. The biggest academic challenges students with ED face, per the article, are “attention to task, academic engagement, and academic responding.”
As we discussed earlier, behaviors that may qualify a child for ED come from a lack of ability to focus in the classroom, a lack of attention to follow-through on assignments, mental health needs like anxiety or depression that may prevent them from asking for help or expressing their needs, and behaviors in the classroom that may lead the teacher to pull the student out of class rather than work through what is causing the behavior. The more overt behaviors associated with ED, Dr. Pelangka says, such as school refusal or emotional outbursts, can also mask the student’s internal needs.
“An emotional disability can come in many forms. It does have to be to a certain level in order to qualify [for an IEP],” she says, “but it doesn’t automatically mean that this is going to be a student who’s going to, I’m going to use the example, come into your room and start throwing desks. It’s not synonymous.”
There is no single way to address learning difficulties for students with ED, but sources agree that the best outcomes come from a highly individualized and multifaceted IEP that addresses the student’s needs both at school and at home. The same article in the Journal of Special Education identified that educational support strategies that emphasize “structure, sequencing, and pacing of instruction, as well as the provision of frequent corrective feedback and opportunities for practice of newly acquired skills” can have lasting positive outcomes for students with ED when coordinated with mental health, behavioral, and interpersonal services.
Students who qualify for Emotional Disability (ED) under an IEP may receive a range of supports, including mental health services. To qualify, a child’s emotional or mental health needs must be affecting their ability to access learning, regulate socially or emotionally, or participate in school. Some students may instead qualify for a 504 plan if conditions like anxiety, depression, or OCD are impacting their learning. In either case, the school will need to conduct an evaluation.
The first step is to contact the school — this might be your child’s teacher, counselor, or IEP team — and share your concerns. You can request, in writing, that the school conduct an assessment to determine what supports your child may need. The evaluation is usually completed by a school psychologist or other qualified professional and is required even if your child already has a medical diagnosis.
Once the evaluation is complete, the IEP team will meet with you (and your child, if appropriate) to review the results and discuss possible supports, such as counseling, accommodations, or other services. Staying in communication with your child’s teacher, school counselor, and other members of the school team can help ensure your child receives the support they need. Learn more about this process, and the IEP services and supports for ED, in our article Top IEP Services Supports for Emotional Disability (ED).
Both California’s state legislation and IDEA make the distinction between emotional disability, which qualifies students to access IEP services, and social maladjustment, which does not. Social maladjustment does not have a clear definition in the DSM-5 or a federal definition under IDEA, so states and local municipalities can define their criteria, and it may vary school district to district. An article in the University of the District of Columbia Law Review defines social maladjustment as “disruptive behavior disorders and their related symptoms including conduct problems, disruptive and/or oppositional behavior, and substance abuse,” which bear similarities to IDEA’s language for emotional disability.
Dr. Maag finds the distinction arbitrary and even potentially harmful; labeling a child who may be displaying disruptive behaviors or complex needs with social maladjustment rather than assessing for ED means schools do not need to adhere to the various protections and services allotted to a student with ED. But he adds that the label is not binding. Parents can and should request additional assessments outside the school if they feel their child is eligible under IDEA.
“There are a lot of kids that are served under the emotional/behavior disability disorders that do have a social maladjustment because it’s very difficult to discriminate between those,” he says. “It’s almost impossible, from an educational standpoint,” which means children can get wrongfully labeled or the time they go without needed services can be extended. This can also be used against students with ED when it comes to a school’s disciplinary methods. “Schools use predominantly exclusionary practices: leaving the classroom, sent to the principal’s office, suspension, expulsion — and schools, lots of times, don’t want to lose those options if someone is being served under IDEA.”
Dr. Pelangka adds that many schools are not well-versed in how to address a student’s mental health needs, whether or not they have a DSM-5 mental health diagnosis or IEP eligibility under emotional disability. Behaviors that educators may perceive as ED-related may manifest as a coping mechanism from traumatic events or temporary hardships in a child’s life that cannot necessarily be addressed by the same services that help students with ED. “Oftentimes they like to peg trauma as an emotional disability,” she says. “Trauma is not the same as emotional disability, but schools don’t recognize that. So when they see young kids coming in that might have been homeless or adopted or had in-utero exposure, they definitely like to explore emotional disability. But it’s really hard to label kids that young, because typically students who fall under that category . . . it’s more about mental health needs.”
Students who may have experienced trauma before or during their time at school can still access general counseling services with a school psychologist, even if they do not meet the criteria for special education. They are also still eligible for lower-level, school-wide accommodations that we will describe in more detail later in this article.
Research shows that recognition and diagnosis of ED isn’t always equitable. Race, gender, and cultural differences can all influence whether a student is assessed, diagnosed, or even noticed. Data collected for an article in Education Week shows that over half of students with ED don’t receive the appropriate assessment and services until they are between 13 and 17 years old. This later identification time, whether due to fear of stigma from parents or lack of ED understanding from educators, means that many children with ED may struggle in school without services until their behaviors become too intense to ignore.
Racial disproportionality
Decades of research have made it clear that students of color do not receive the same degree of attention or care at school as white students do. For students with disabilities, this can work in a number of negative ways. Black and Hispanic students, for example, are less likely to receive timely assessments for intellectual and learning disabilities as well as diagnoses for conditions that may fall under the OHI category, such as ADHD. Conversely, Black students are more than twice as likely as their white peers to be labeled with an emotional disability, which can lead to higher rates of discipline, isolation, and stigmatization.
“There are certain populations that are over-represented in the ED category,” says Dr. Pelangka. “Children of color, mainly boys of color. Because these students, males of color, may have just different cultural practices or different ways of articulating or communicating how they feel.”
Both Foster and Dr. Pelangka have observed how children of color, namely Black boys, receive disproportionally higher rates of diagnosis for behavioral disorders and subsequent discipline than their white peers do. Dr. Pelangka explains that different communities may use different communication styles or cultural behaviors in the classroom, which teachers may perceive as interference with learning. An extensive survey of research on emotional disability and Black student populations in the journal Behavioral Disorders found that Black students may be more quick to question authority, express themselves physically, or make less eye contact than their white peers, leading to bias from educators. In one case from the survey, even the walking style of Black students compared to white students was perceived as potentially indicative of emotional disability.
Furthermore, the label of ED and receiving services for it can also, in some cases, work against the child’s needs. Black children identified with ED are more often pulled out of the general classroom and segregated from the rest of the student population. In other cases, if a student is given a 1:1 aide as an accommodation, that aide may incorrectly attribute the student’s behavior to ED if they don’t understand how that student expresses themself.
Gender disparity in recognition/diagnosis
Across students of all races on a national scale, boys make up the vast majority of students served under the emotional disability category, at 76% per the National Longitudinal Transition Study, which makes ED “the highest proportion of males to females in any of the disability categories.” Lower identification rates among females have been attributed to bias in the assessment process. Dr. Maag believes the disparity is partially due to how boys and girls are socialized and how their disabilities and behaviors manifest.
Boys who may be dealing with an unrecognized ED may express their emotions more physically and externally, such as by “fighting, other forms of aggression, destroying property and juvenile delinquency.” Girls, by comparison, are more likely to internalize their feelings in ways that do not usually interfere with classroom management. Dr. Maag says that this doesn’t mean that fewer girls qualify for IEP services with an ED, but that they are less likely to be referred for an assessment by a teacher.
One of the biggest misconceptions about emotional disabilities is that they are solely responsible for an eligible child’s behaviors; while no conclusive data exists, various studies indicate that children with emotional disability often qualify for an IEP under other categories or receive diagnoses for other disabilities.
A report from the Georgetown University Center for Child and Human Development indicates that “30-50% of children and adolescents with Intellectual Disability (ID) have co-occurring mental health disorders or challenging behavior. Very high rates of co-occurring emotional disorders are also found among children with developmental disorders such as Autism Spectrum Disorders (41-70%), Cerebral Palsy, and Epilepsy.”
Seeking assessment and services for only one potential disability that a child may have can create obstacles for the child’s learning in the long term. ED assessments largely come from observation and from conversations between parents, educators, and a local education agency (LEA), without the more in-depth and dynamic assessments that might indicate a co-occurring disability. Similarly, observable behaviors that apply to multiple IEP categories often get mischaracterized as ED.
“We can have multiple things going on,” says Dr. Pelangka. “It’s possible to have autism and an emotional disability,” but because schools by law cannot provide medical diagnoses for students with medical conditions, it can be easier for a school to assess for an ED rather than for autism or ADHD. However, schools can document their suspicions of other mental health needs or disabilities that require further assessments. When a child is found to have ED co-occurring with another disability category, “it’s not to say that they can’t coexist, but through an IEP in the state of California, the only way they can both be on the IEP is if autism (or another category) is primary.”
Kids with pathological demand avoidance (PDA)
Gone unaddressed or ineffectively supported, emotional disability can worsen when subjected to stronger demands or constraints. Children with ED and co-occurring conditions such as autism, ADHD, or a learning disability can be vulnerable to developing pathological demand avoidance (PDA) as a means of coping with their disability. Some aspects of PDA overlap with ED manifestations, such as struggles with authority and connecting with others, mood swings, and externalizing behaviors to avoid the task at hand, such as staying in class or completing schoolwork.
Foster advises parents to discuss how to address student avoidance as soon as possible. PDA is not an IEP category, but parents can work with their IEP team to add goals and accommodations that address both ED and PDA, such as more flexibility for school workload, breaks for completing goals, and a 1:1 aide.
“It’s hard, so we’re going to acknowledge that it’s hard, and we’re going to have goals for you to gain skills to deal with that. But you, as a student, have to participate in learning how to read or learning how to write. It’s not something you want to do. It’s been unpleasant for a very long time, but we need you to do it. . . . Ultimately, it’s about learning to feel the frustration and the discomfort and then trying something, even if it’s only for five minutes,” says Foster. “I’ve had some students who could do something for two minutes or three minutes, and we’re just growing attention span. Once the student has done something for two minutes, no matter what it is and what level of accomplishments they’ve had, they can stop, or they can have extra time to get something done. Accommodations are also incentives for getting something done that’s not preferred or [is] unpleasant.”
Even how school personnel and parents communicate with the student can make a huge impact on the student’s state of mind at school. Dr. Pelangka adds that parents should work with teachers and school personnel to identify potential behavioral triggers for children with ED that educators may not even be aware of, such as word choice, vocal tone when addressing students, and physicality in the classroom.
“I think a common one that has become more prominent as of late is use of declarative language for both people with autism and/or the ED profile. So rather than telling kids what to do or formulating it as a demand — for example, instead of saying, ‘Push your chair in,’ [say,] ‘How do we feel about pushing our chair in?’ It makes kids feel more safe or like they have some power and some autonomy, and that can be really important for many kids.”
Emotional disability doesn’t exist in a vacuum. Beyond IEP eligibility and classroom supports, broader systems — such as school discipline practices, access to mental health care, and crisis response policies — can deeply influence a child’s long-term outcomes. Students with emotional disability are a vulnerable population who need supports at school (and at home).
Dropout rates and the school-to-prison pipeline
Protections put in place to protect students with disabilities from excessive disciplinary action do not always work as intended. External factors can negatively impact children’s mental health, leading to an exacerbation of their emotional disabilities. Students receiving IDEA services under ED are more likely to have grown up in single-parent homes or foster care. Lack of support both at home and at school can lead to an increase in disruptive behavior and even to criminal activity in adult or teen life.
Data shows that students identified with ED have lower graduation rates and higher dropout rates than other students served by special education. They are more likely than other students with disabilities to face long-term suspension or expulsion.
A study published in the American Journal of Orthopsychiatry indicates that nearly half of students in the juvenile justice system qualify for special education services under emotional disability. They are also, compared to their peers, more likely to reoffend, leading to a cycle that prevents them from achieving educational and societal integration.
Even if a student with ED does not end up facing legal issues, lack of support and lack of effective IEP interventions can lead to negative educational outcomes. Students with ED are around five times as likely to drop out of school before graduation compared to the national average (28% versus 5.3%). A comprehensive statistical analysis by Losen & Gillespie (2012) illustrates the correlation between low graduation rates and early behavioral issues among students with ED. Their findings suggest that interventions tailored to address the emotional and behavioral needs of these students are crucial for improving educational outcomes and facilitating successful transitions to adulthood. This is a correlation issue, not a causation issue. With the appropriate accommodations and supports in place, students with ED can thrive in the classroom and at school.
Changing these statistics for the better requires interventions not only within a student’s IEP team, but with the institutions at large. No student, with or without ED, is above discipline, but the restrictive ways it has been wielded against students with disabilities has had enduring consequences. Parents can always include discussions of alternative methods, such as restorative justice, in the IEP, and both Foster and Dr. Pelangka believe that, in tandem with other higher-tier services, a professional education advocate can steer conversations, assessments, and the goals of an IEP in a holistic direction.
Suicide prevention and 5585 holds for students with ED
Many of the behaviors that FBAs and BIPs can help address apply, in some cases, to children experiencing a mental health crisis or students who may be at risk of suicide and require a involuntary 5585 psychiatric hold, which is the code for a 5150 hold for a minor. California legislation requires schools to intervene if they suspect a student is a risk to themselves or others, be it through violent behavior or verbal threats. However, because students are minors, the school must receive parental consent before the child is removed for a hold in a psychiatric unit temporarily for their own protection.
While 5585 holds are uncommon in minors and very rare in preadolescent children, research indicates that early intervention and the implementation of mental health services, such as counseling therapy and accommodations, can be addressed within an IEP. Once a child is released from a 5585 hold, their family and the facility they were held in are required to implement an aftercare plan to minimize any possibility of recurrence. Parents and students should absolutely discuss aftercare plans with their IEP team to modify services and resources that best suit the child’s needs. Schools can implement a safety plan for a student at risk of suicide or self-harm, which can include adding more ERMHS or ERICS services, supervision by an adult, or, in some cases, a change to a residential placement.
As wonderful as it sounds, there is no magic formula or shortcut to success for a child with ED. But actively accepting a child’s ED and seeking out supports within both a child’s school and their broader social world can make a huge difference in the long term.
Support them at home
Applying the same kinds of accommodations that a student receives at school in the home helps establish a consistent system for their learning and mental health. Some services that are easy to adapt to the home are giving children movement or play breaks between homework assignments, for example, or allowing them to do their work with music on. Parents should also remain in contact with educators and IEP team members outside of scheduled meetings as their schedules allow.
Like teachers do at school, parents can establish or adopt goals for their children to strive for at home, such as:
Finding therapists who are well-versed in emotional disability for the child and the parents
Help them with self-acceptance and self-advocacy
Some parents may feel hesitant to accept the results of an ED eligibility assessment due to preconceived notions about ED or the fear that their child will be stigmatized at school. For Tugsjargal, she herself was in denial for years, desiring a sense of normalcy in her life.
The turning point in her life was accepting her disabilities and embracing how to best address them. This came when she began attending her IEP meetings, which helped her better understand how her services and accommodations were helping her. It was also how she learned that, at some point, her emotional disability services had been reduced due to lack of need. Her enduring relationship with her psychologist went beyond IEP meetings and therapeutic sessions, to the point that Tugsjargal considers her a mother figure. The support she received helped set her on her path of advocacy for other students with disabilities, including founding the Mongolian American Disability Mentorship Program, which has helped dozens of families navigate the IEP process, build community across cultural gaps, and access resources.
Part of a successful IEP, per Foster, is helping a child learn to accept and execute the things they don’t want to do. Finding a child’s motivation and tailoring educational goals around that, while also building tolerance for non-preferred tasks, sets that child up for success in the long term. “We learn how to manage our feelings, our negative feelings, about whatever task we’re being asked to do.”
Get supports early
There are effective ways to support students with emotional disabilities, but too often help comes later than it should. More than half of students with ED (52%) in 2016-2017 were identified between the ages of 13 and 17; by comparison, children with other disabilities such as autism or cerebral palsy, can receive a diagnosis at as young as two years old. That’s partly because some mental health challenges show up in adolescence, and others aren’t diagnosed until behaviors become hard to ignore.
However, schools can support students earlier and more effectively. Proven approaches include bringing mental health providers into schools, increasing access to trained counselors, and using universal mental health screening. These aren’t quick fixes, but they work — and they focus on connection and support, not on punishment.
Some of the biggest obstacles for students with emotional disabilities are not necessarily the manifestations of their disabilities, but the anxieties, stereotypes, and self-fulfilling prophecies that come with the ED label. Outcomes improve immensely with early and active intervention, when parents are engaged with their child’s IEP team and school. There is nothing to lose by speaking up, asking questions, and learning more.
“Don’t be afraid to use your voice. That’s a very important one, because people need to hear your voices. Policymakers need to hear your voices. There’s a reason why we have town halls. There’s a reason why we call our representatives,” says Tugsjargal. “They’re elected policymakers. And if they don’t know what’s happening in the areas that you live, then how the heck do they make policies that better support our communities? Policy changes must mirror what people live through. Don’t be afraid to use your voices, and don’t be afraid to advocate for your kids. This is our future on the line.”
Supporting students with emotional disabilities doesn’t end when a student leaves school. Researchers, advocates, and education professionals have known for decades that children with ED are more prone to mental health struggles, self-harm, and even suicidal ideation. Implementing mental health supports at home while maintaining open communication with your child creates a safe base for them to thrive. Families experiencing mental health crises can access both national and state resources, as also listed in our Supporting Kids’ Mental Health at Home and in Crisis article:
National resources:
California resources:
Many districts across California offer similar support networks and resources for families. Some of these specialize in emotional disability and children’s mental health:
Additional resources for families who want to learn more about emotional disability:
Many books exist on parenting children with mental health needs, but some of them may unwittingly perpetuate negative stereotypes of children with emotional disabilities. For specific book recommendations, sources recommend consulting with your child’s mental health providers and members of your IEP team. There are some book options in our article “Supporting Kids’ Mental Health at Home and in Crisis”; they are not explicitly for children with ED but can provide insight about mental health and how a child’s potential co-occurring conditions can impact their mental health.
Save your favorite resources and access a custom Roadmap.
Get Started
