Perspectives on Seminal Achievements and Challenges in the Field of Emotional and Behavioral Disorders

Abstract

This commentary for a special issue of Remedial and Special Education (RASE) on the perspectives of senior scholars (a) opens with some comments regarding the role of measures we use in behavioral science to pursue scientific truth and then (b) discusses the three most impactful developments in emotional and behavioral disorders over the past several decades, followed by commentary on three problems or issues that need addressing going forward. In the author’s view, the three most impactful developments have been the advent of school-wide positive behavior supports, the growth in approaches to conduct universal behavioral disorder screenings in schools, and the acceptance of teacher judgment in the appraisal of student behavior. Challenges going forward are the need to contextualize school interventions, solve the problem of decay of achieved intervention effects over time, and plan/manage school transitions better.

Keywords

positive behavior supports behavior assessment classroom behavior general education classroom emotional and behavioral disorders

Introduction

I am both honored and challenged by this invitation to contribute to the special issue of Remedial and Special Education (RASE) dealing with the following fundamental questions regarding the field of emotional and behavioral disorders (EBDs):

What have we done of note?

What should the future look like?

I do not presume to have special expertise regarding either question. However, given how long I have worked in the EBD field, one has a right to expect that I should have learned something and also acquired some modicum of wisdom along the way. So, I will briefly share what I think are the three most seminal achievements of the past two or three decades in EBDs and also speculate on what I think are the three most important problems or challenges to address and solve moving forward. Before proceeding, however, I would like to speak to the issue of bias in the practice of our craft.

During a discussion among colleagues about the meaning of science and truth, Gerald Patterson, a world-class psychologist at the Oregon Social Learning Center, said, “your observational coding system is merely your particular window on the world.” This was a profound statement for me about the search for truth through scientific methods and approaches. It highlights the importance of always maintaining a healthy skepticism regarding “scientific facts” that presume to define or reveal truth in a particular area of inquiry. There are many tools and methods used in behavioral science that have the aura of being scientific and that are normatively accepted among professionals as meeting a scientific usage standard. So, it presumably follows that the use of “scientific tools” combined with rigorous design and research methods should put one on the path to truth or at least some approximation of it. As research outcomes have demonstrated over and over, this is not necessarily the case and is indeed a slippery slope. As Kauffman (2014) has so cogently noted, “Science is indeed a harsh mistress,” and it is cruel in its intolerance of bias.

Those who practice the scientific arts in EBDs and education generally, myself included, are not immune from the influence of strong biases, for example, in their selection of measures to document the results of their inquiry. I was trained in graduate school to revere behavioral observation methods and data as superior to other measures, such as self-reports and ratings from informants in one’s context of inquiry (i.e., ratings contributed by teachers, parents, and peers). Observational measures do have substantial face validity as they are recorded in real time within target settings such as a classroom or a playground. However, they are not themselves immune from a host of methodological and measurement problems. It turns out that numerous observational coding systems are highly reactive to a range of stimuli in the target setting, often producing extreme forms of variability across sessions. The research on inter-observer agreement has clearly documented the phenomenon of “observer drift” over time, as well as the influence of bias resulting, for example, from observer expectations of outcomes or observer knowledge of experimental conditions. Recording in vivo behavioral observations is a highly intrusive process that can induce reactivity and poses a real risk of altering the ecology of the setting in which one is observing. Furthermore, observations are often relatively poor predictors of future behavioral and longitudinal outcomes. It has been said that teacher and peer ratings allow accurate prediction of student outcomes literally years into the future, whereas observations allow you to predict into the next 20 s interval. Over the years, my experience with a range of measures used in documenting the results of our longitudinal and intervention research, as well as reports in the literature, has led me to question my long-held assumption that behavioral observations are the method of first choice in behavioral research. However, behavioral observations continue to have strong advocates for their current status as the sine qua non for measuring the outcomes of our research in applied settings.

Why do I raise this issue? Because it highlights the role that bias can play in the selection of many of the measures we use in behavioral science research and the powerful impact of customary ways of thinking about approaches in which there has been a long history of unquestioned investment. I believe that it also reflects another cogent, recent observation by Kauffman (2014) when he argues that the reason we are so reluctant and slow to accept new scientific innovations (aside from our usual skepticism and inhibitions about change) is that we must first abandon some of our most cherished and long-held beliefs about how things are or should be. The debate among professionals regarding the validity of self-reports of informants, expressed as retrospective ratings, cast against the in vivo recording of behavioral observations is one that will continue for some time. However, I think we would be much better off to cease arguing about which is the superior tool or measure and focus instead on the conditions and situations in which one should be a primary measure and the other a secondary one. We can use both measures profitably—one does not have to be established as better than the other. So, I have just shared my first bias with you and in that regard I am subject to the same risk as any other advocate (i.e., of being totally wrong!).

Achievements of Note in the EBD Field

The achievements I highlight below grew originally out of the EBD field. Two of these achievements were developed and contributed by behavioral researchers; the third simply evolved over time among the school-based community of researchers and policy makers but was prompted by a reconceptualization of the teacher referral process and the role of teacher judgment therein. It turns out that these contributions and developments have as much or more relevance for the field of general education as they do for EBDs. In my view, the most impactful achievements over the past several decades have been, in order, (a) the adaptation of the U.S. Public Health System’s (PHS) prevention framework to schools and the related development of the three-tiered model of school interventions; (b) the explosion in models and approaches for accomplishing the proactive, universal screening for EBD students in general education settings; and (c) the changed perception of the value and accuracy of teacher judgment in the appraisal of student behavior.

Development of the Three-Tiered Model of School Interventions

Walker et al. (1996) were the first to adapt the U.S. PHS’s classification system of prevention for use in school settings. We made the case in our 1996 article that (a) this scheme was ideally suited for the structure and ecology of schooling and that (b) it made sense to implement a system for accommodating school interventions that combined universal, small-group, and individualized approaches in the context of an integrated delivery system. As it turned out, this delivery system made sense to educators, and other professionals, as a way of organizing and allocating intervention resources in a manner that was fair, equitable, and cost efficient. Currently, the U.S. PHS taxonomy has been adopted by diverse entities such as federal and state agencies in procuring/awarding grant applications to residential settings for delinquents, to the Girls and Boys Town Program of Nebraska, and to the Boy and Girl Scouts of America, to mention a just few of the adaptations that have occurred to date.

In the late 1990s and early 2000s, Sugai, Horner, and their colleagues used the three-tiered model as a scaffold for the school-wide positive behavior supports (SWPBS) approach that (a) integrated universal, selected, and indicated interventions into a coordinated delivery system and (b) gave professionals the means to accommodate the needs of the great majority of students, representing the full range of severity (including students with EBDs), who struggle with the ordinary demands of schooling (Sugai & Horner, 1999). These investigators based their SWPBS model on elements of substantial prior work they had conducted on school discipline, functional behavioral supports, and the inclusion of students with severe behavior problems into general educational settings (Horner & Carr, 1997). The researchers also carefully analyzed the structure of schools and the preferred values and priorities of school staff, and they adapted the SWPBS model to those schools and staff rather than requiring specialized alterations by schools to accommodate this approach. Importantly, they infused SWPBS with the essential theme or value of positive behavioral support that came from the field of developmental disabilities and which argues that individuals with severe disabilities have a basic right to continuous positive supports in their lives, educational and otherwise.

The wisdom of their design and implementation template is apparent on a number of dimensions. But, in my view, the most telling is the adoption rate of this approach that now well exceeds 20,000 U.S. public schools and shows no signs—as many innovations do—of burning out. In my 40-plus-year career, I have never seen an innovation to rival the impact of SWPBS. It is a testament to the power of conceptualizations and adaptations that can allow professionals to organize and deliver their expertise in very different and more effective ways.

Emergence and Acceptance of Universal, Proactive Screening

Approaches to universal, proactive screening for school-related behavior problems first began to be described and appear in the professional literature over 25-plus years ago (Kettler, Glover, Albers, & Feeney-Kettler, 2014; Walker & Severson, 1990, 2014). These approaches were not exactly welcomed at the time or perceived as meeting a high priority need. I would say that some sectors of the professional community regarded this as a controversial development as reflected in such oft-heard commentaries as “It makes no sense to identify students as having behavior disorders for whom services do not exist,” “It is a questionable professional practice to stigmatize students as emotionally or behaviorally disordered through such behavioral screening,” “Teachers are biased judges of student conduct and should not be allowed to exercise those biases in their ratings of students they probably do not like,” or “Students with internalizing problems should not be formally characterized as having a behavior disorder that may prompt a referral to special education or mental health.”

It is remarkable how things can change so dramatically regarding a professional practice over several decades, but that has certainly been the case with proactive universal screening for school-related behavior problems and disorders. This screening process is now widely regarded as the best or preferred professional practice by a majority of professionals working in today’s schools. Some excellent models of such proactive screening are now available and widely used. Dvorsky (2014) recently provided a comprehensive review of universal behavioral screening, and the various published models for doing so, and recommended a framework for conducting universal mental health screening in schools. Books are now being written that are devoted entirely to issues and approaches involved in school-related behavioral screening (see Kettler et al., 2014; Lane, Menzies, Oakes, & Kalberg, 2012). It is difficult to imagine such developments as these occurring two decades ago.

Today, one rarely hears the commentaries and criticisms alluded to above regarding universal behavioral screening. Professionals such as Kathleen Lane, Sandy Chafouleas, Randy Kamphaus, Todd Glover, Ryan Kettler, and Craig Albers have built substantial portions of their programs of scholarly research around proactive universal screening. Their work has been instrumental in broadly promoting this practice, and their research has substantially expanded the knowledge base regarding this topic. I believe the advances in universal behavioral screening over the past two decades have made it possible to identify and much better serve the approximately 20% of the K-12 student population that struggles with emotional and behavioral problems. These advances also enable the development and adoption of a true prevention agenda by U.S. public schools.

Changes in Perception and Value of Teacher Judgment of Student Behavior

In 1984, Gerber and Semmel published a now classic article with the title “Teacher as Imperfect Test,” in which they made a compelling case for reconceptualizing the teacher referral process and reevaluating the teacher’s role in this process. Controversially, they proposed validating the judgments and referral decisions of child-study teams and related services personnel against those of teachers, thereby reversing the long-held practice of doing the opposite. Thus, they viewed teacher judgment of student behavior and performance as the criterion against which other important decision making about students would be validated. These authors assembled a sizable amount of evidence to support their position, and their claims stimulated numerous articles and commentaries on this topic. Importantly, I believe the work of Gerber and Semmel was responsible for a large-scale reexamination of the role of teacher judgments in student appraisal that continues to this day 30 years later.

As Gerber and Semmel have so insightfully observed, teacher judgments were regarded with suspicion and commonly required confirmation by other data sources. However, there is a long-standing body of research showing that teacher ratings predict important student outcomes, such as academic achievement and peer social status, well into the future (French & Waas, 1985; Landau, Milich, & Whitten, 1984). Breslau et al. (2009), for example, reported a long-term, well-conducted study in which they found that teacher ratings of attention, internalizing, and externalizing problems at age 6 significantly predicted math and reading achievement at age 17. Even against the so-called gold standard of direct classroom observations, teacher ratings predict longitudinal outcomes quite well (Lane et al., 2012). For example, in one of the important studies in this area, Forness, Gutherie, and Hall (1976) found that three brief teacher rating items of academic or behavioral readiness predicted student achievement scores and behavioral ratings effectively nearly 2 years later. Furthermore, these brief teacher ratings were either just as or slightly more robust in their predictive power over time than were in vivo behavioral observations recorded in the participating teachers’ classrooms. It is also important to note that the observation categories used in this study (i.e., attention, verbal interaction, and disruption) required a minimum of 10 morning sessions of observer time for each participating classroom, whereas initial classroom-wide teacher ratings required only about 20 min of the teacher’s time.

There is ample empirical evidence supporting the validity, accuracy, and cost efficiency of teacher appraisal of student behavior (Kettler et al., 2014; Lane et al., 2012; Walker et al., 2014). It is a solid predictor, sensitive discriminator, and far less expensive measure of student performance than many of the measures we regard as more valid. I am glad to see a strong trend for its much more expanded use by behavioral researchers in school settings, especially in the context of screening.

Challenges Going Forward

It is a daunting task to select the two to three steps that need to be taken going forward that will improve the educational experiences, outcomes, and quality of life of students for whom typical instruction is not effective. This is an investment decision of sorts. My bets are as follows: (a) contextualizing direct, applied interventions so they are maximally compatible with the ongoing routines, schedules, and operations of schools and classrooms; (b) solving the continuing problem of sustaining and maintaining student gains achieved through behavioral interventions; and (c) doing better at planning and managing key transitions in a student’s school career so as to reduce risks of failure. Each of these topics is briefly described next.

Contextualizing School Interventions

Hoagwood and her colleagues have contributed some very important work regarding why evidence-based interventions are often relegated to gathering dust on shelves and are not adopted and implemented by school personnel (Vidair, Sauro, Blocher, Scudellari, & Hoagwood, 2014). Two major types of school intervention approaches are implemented, respectively, outside versus inside the classroom setting: (a) those such as counseling and psychopharmacological treatments and (b) direct behavioral interventions that are implemented within the classroom context. Educators are generally tolerant of the first type of intervention approach because it does not disrupt or make demands upon the educational setting. This is usually not the case for the second type. Type 2 intervention approaches are often implemented within the classroom setting and require the teacher’s direct involvement in the delivery and implementation process. Furthermore, Type 2 interventions typically disrupt classroom routines, make demands on the teacher’s time, and may require mild to extensive accommodations in instructional or management routines.

As a rule, teachers want interventions that make few demands upon them, involve implementation procedures that do not disrupt the classroom environment, do not require excessive amounts of time, and solve a difficult problem efficiently. Unfortunately, many of the interventions promoted for the EBD school population, especially in the general education context, do not come close to meeting this standard. I do not have any magical answers for solving this ongoing problem. I am at the stage of describing and admiring it! But my own experience and the professional literature on this topic tell me that Hoagwood and her colleagues have a valid point. It is likely that this factor may be a cause of poor implementation fidelity in many cases. I think it is an issue that we should prioritize and devote more research attention and resources to investigating going forward.

Addressing the Sustainability and Maintenance Conundrum

Even the most rigorous and efficacious behavioral interventions must confront the problems of sustainability and maintenance of achieved intervention effects within implementation settings or contexts, much less insuring their generalization or transfer to nonintervention settings and contexts. For me, sustainability refers to the procedures and interventions that account for empirical outcomes; maintenance, on the contrary, refers to the durability of achieved outcomes in student behavior or performance attributable to their implementation. The problem of maintenance has been a persistent one in behavioral research for the better part of the last half century. Walker et al. (2014) recently addressed the challenges posed by this ongoing problem in our field. We argued that behavioral interventions perhaps suffer from unrealistic expectations; that is, robust outcomes are expected during an intervention’s implementation and its achieved effects are expected to be sustained after the intervention has ended. Regarding this issue, we have previously suggested that behavior change is a two-stage process: (a) There are a set of procedures for producing it and (b) a second set of perhaps differing procedures for maintaining the achieved effects. Barkley (2007) noted that maintenance may be an unrealistic expectation of our applied intervention efforts as an intervention invariably artificially rearranges contingencies within the implementation setting. Following termination of the intervention, one should actually expect these contingencies to return to their preintervention status or condition and likely be followed by a corresponding decline in achieved effects for target students. This seems to be the dynamic that actually plays out in most cases—at least in the EBD arena. In schools, the problem is further exacerbated in trying to foster maintenance effects across school years as both teachers and peers are likely to change from year to year. However, this is not the case for home or family-based intervention approaches. Again, I describe and admire this problem but do not have at my disposal solutions for solving it.

Planning and Managing School Transitions Better

The fields of special education and developmental disabilities have invested enormous research attention and resources to the problem of effecting transitions for vulnerable individuals. The transition literature is replete with descriptions of the risks and side effects associated with transition. I think the risks are no less real and destructive for students in general, especially for students with EBDs. Research has amply demonstrated that the transition from middle to high school is the point of greatest school dropout for marginalized students. I think we can do much better than we currently have in this regard, especially with students who suffer from EBDs.

In the 1980s, my colleagues and I conducted extensive research on the reintegration of students with social–emotional disabilities back into the referral settings (i.e., general education) from which they came following a 3- to 4-month intensive intervention in a specialized classroom setting (Walker, 1986). We designed a reintegration model or process that I think could work well in planning and managing the key transitions that students must make in their K-12 school careers. The most important transitions in my view are from preschool-kindergarten to first grade, from elementary to middle school, from middle school to high school, and from high school to the worlds of work and further schooling. This basic approach is easily applied to these critical transition points that are so important to a student’s school success and ultimate life course. Essentially, the process involves preassessing and identifying the critically important behavioral competencies and/or skills that students must have to be successful in the next or receiving setting. In my view, this goal can best be achieved by (a) preteaching those skills within the sending setting prior to the transition and (b) providing follow-up and technical assistance in making sure that they can be demonstrated appropriately within the receiving setting. For this approach to work well, it must be jointly owned and carefully planned: Transition from the sending to the receiving setting would be continuously monitored and well managed from start to finish. In my view, this basic model has the potential to contribute substantially to school success for marginalized students and to help reduce adolescent school failure and dropout.

Concluding Remarks

I have great optimism about the EBD field. It is populated by behavioral researchers who come from a variety of disciplinary backgrounds and bring to bear considerable diversity of expertise and perspectives concerning the myriad challenges facing the field. I would like to see a continuation and further growth of emerging interdisciplinary, collaborative initiatives among professionals representing school mental health, juvenile justice, and both general and special education. I am confident that the EBD field will grow and prosper in the future as a result. But those students with EBDs, who struggle daily with the challenges of schooling, will be the ultimate beneficiaries of these collaborative efforts.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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