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The Reauthorization of the Individuals with Disabilities Act:
Its Impact on the Diagnosis and Treatment of Children with Mental and Emotional Disorders

October 29, 2002

International Center for the Study of Psychiatry and Psychology IDEA Task Force
Karen R. Effrem, M.D., chairperson and lead author
Doretta Hegg, M.A.
Grace Jackson, M.D.
Bob Jacobs, Psy.D.

SUMMARY: Although well intentioned, the Individuals with Disabilities Education Act has resulted in perverse financial and policy incentives for too many children to be labeled with mental and emotional disorders and learning disabilities whose criteria are extremely vague, controversial, and too easily misinterpreted. Besides burdening a child with a label that will stay for the rest of one's academic and employment career, far too many children are placed on powerful medications. These drugs have dangerous side effects with no long-term research to expose potential harm from chronic/acute use when there are many other reasons for that child's difficulties in school. These other causes include illiteracy, nutritional deficiencies, other medical problems, and social issues. Instead of reducing the number of children placed in special education, more and earlier behavioral screening will only result in more children being labeled and drugged, because the criteria are vague and the process is inaccurate. Before full funding is attained, IDEA needs massive reform that will change these perverse incentives. The needed reforms must prevent a disability or disorder label by prioritizing other interventions. First, literacy of children must be targeted using intensive systematic phonics. Second, parents must not be coerced into placing their children onto medications whose efficacy and safety remain questionable. Third, appropriate attention must be paid in identifying and ameliorating the medical, psychological, and social causes of a child's behavioral and emotional symptoms. Finally, medications must be seen as one of many possible interventions, and their use must be accompanied by fully informed consent. Families must be adequately warned about all of the potential serious side effects of these medications; ultimately, the prescription of these drugs must be chosen by families, and not coerced by school systems.

BACKGROUND: This "special education" legislation was passed in 1975 to allow all children with disabilities access to public education. All children with disabilities are to receive a "free appropriate public education" in the "least restrictive environment." Congress promised to pay forty percent of the expenses to allow that access, but has never paid more than about seventeen percent. This has resulted in a huge un-funded mandate for the states.

IDEA started with payments to schools for children with physical disabilities, such as blindness, cerebral palsy, and orthopedic problems. In 1991, the criteria were changed to include children with mental and emotional disorders. The definition of a child with a disability in the law, particularly regarding mental and emotional problems is terribly vague: "a child with mental retardation...serious emotional disturbance...autism, traumatic brain injury, other health impairments or specific learning disabilities..."(1)

Attention Deficit Hyperactivity "Disorder," the most common mental or behavioral label given to children, is in the "other health impairment" category.

The criteria for emotional disturbance, while trying to maintain the aura of clinical credibility, are appallingly vague. These criteria are completely in the eye of the beholder, and with the states and schools having incentives to identify children; it is rather like a fox guarding the henhouse. These criteria also leave open the possibility that a child could be labeled for political reasons. For example, what standards are to be applied, and who is authorized to determine whether or not a child displays "inappropriate types of behavior or feelings under normal circumstances," a "pervasive mood of unhappiness or depression," or an "inability to build or maintain satisfactory interpersonal relationships with peers and teachers"?(2)