Abstract
In South Korea, there is no consensus on the definition of emotional and behavioral disorders (EBD). This column focuses on how the definition has affected the prevalence rates and services available for students with EBDs. Of the legal, clinical, and educational definitions, the legal definition of EBDs is currently in common use, which raises two issues: First, using this definition results in limitations in terms of interventions for and understanding of EBDs. Second, the definition represents a departure from how EBDs have been used to classify children and adolescents for the purposes of prevention. In short, it was found that administrative adjustments of the legal agents are required and that mutual cooperation is needed between service professionals and reformers. The role of each expert is stressed in the establishment of a concrete definition and service delivery system.
The South Korean educational system has maintained a 6-3-3 system (i.e., six elementary grades, three middle school grades, and three high school grades) since 1945, and it is based on academically oriented, competitive entrance examinations. The entrance examination–oriented education climate creates both stress and frustration for students (Ryu, Kim, Shn, Jung, & Choi, 2010). Student frustration often results in attacks on others who are perceived to be weaker than themselves, such as bullying (Oh, 2013). In fact, 43.2% of South Korean teenagers reported feeling stressed; 37.5% felt depressed to the extent that it interfered with their daily lives; 19.1% reported seriously considering suicide; and 4.7% had actually attempted suicide (Gyeonggi Provincial Office of Education, 2010).
In light of this situation, school districts, under the Municipal Department of Education, have been actively screening students for early detection of emotional and behavioral disorders (EBDs) and trying to improve their mental health with the help of relevant institutions. Determining the prevalence of EBDs is very important, because this provides information about the degree of need for prevention, treatment, intervention, and research while establishing a basis for policy development.
Although a number of definitions for EBDs have been discussed, a consensus on the appropriate definition has yet to be reached. It is agreed that a clear definition would contribute to better services in the educational field for students with EBDs. Accordingly, this column discusses the definitions of EBDs considered in South Korea, the prevalence thereof, and the types of support provided to students with EBDs.
Legal Definitions
The definitions under the South Korean law are similar to those of the American Individuals with Disabilities Education Act (IDEA 2004 Regulations, 2004). The legal definitions neither specify the duration of EBDs, despite experts’ emphasis on “a long duration,” nor consider the possibility of comorbid EBDs, such as conduct disorder. The legal definition of EBDs is as follows:
A person who has difficulty studying due to intellectual, sensory, and health factors
A person who experiences difficulty studying due to the inability to build or maintain satisfactory relationships with peers and teachers
A person who experiences difficulty studying because of inappropriate types of behavior or feelings under normal circumstances
A person who experiences difficulty studying because of a general pervasive mood of unhappiness or depression
A person who experiences difficulty studying because of a tendency to develop physical symptoms or fears associated with personal or school problems (Korean Ministry of Education, 2013)
These definitions tend to focus on internalizing the disorders without reference to their severity. Despite the severity of emotional/behavioral problems, students cannot be classified as having special needs and EBDs as long as they are able to adequately manage their academic performance (Park, 2012). In addition, while the Korean Special Education Act (Korean Ministry of Education, 2013) distinguished autistic disorders from emotional disturbance, only one detached term is still used in the official government information because it is obvious that the definition and recognition of EBDs have not yet been clearly established.
A total of 2,754 students were receiving special education based on the legal definition as of 2013. These students compose 0.037% of the total school-age population of 7,601,544. However, on the Mandatory Screening Test for EBD, which was administered to first- to fourth-grade elementary school students (7–11 years old), first-grade middle school students (13 years old), and freshmen in high school (16 years old) for emotional and behavioral characteristics, 10% to 20% of students showed emotional and behavioral problems, while 2.2% of those students appeared to have a higher risk for suicide, indicating the need for immediate intervention (Korean Ministry of Education, 2014).
Clinical Definition
This refers to the definition used by mental health specialists and subsequently specified in the diagnostic system to enable the clinical diagnosis of psychological conditions. Thus, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is generally used by mental health specialists, is applicable.
With regard to the clinical definition of EBDs, it is worth nothing that individuals diagnosed with certain psychological conditions based on this scale may still not be regarded as having special needs. South Korea is still using the DSM-IV-TR (i.e., fourth edition, text revision; American Psychiatric Association, 2000), and we are waiting to see what will happen to the DSM-5 (i.e., fifth edition).
Educational Definition
Educators use an unofficial educational definition of EBDs for the purposes of prevention and treatment. The reason that special educators prefer this definition is not because it is adopted by a certain legal or diagnostic system as a legal or clinical definition. Although there is no clear educational definition, the current tendency is to emphasize the prevention of behavioral problems or challenging behaviors (e.g., self-injury, yelling, tantrums) and to emphasize early intervention.
One aspect of the educational definition of EBDs is worth noting. This definition includes the students who do not currently show disabilities but are at risk of developing them. Therefore, it can be concluded that the educational definition is broader than both the legal and clinical definitions. According to the Mandatory Screening Test for EBD, 74,380 students met the criteria (e.g., Child Problem–Behavior Screening Questionnaire, Adolescent Mental Health and Problem Behavior Screening Questionnaire II) based on the educational definition, indicating that the prevalence of EBDs among this sample is estimated at 13%; this is much higher than the 0.037% based on the legal definition.
In summary, as illustrated above, EBDs take on three definitions, each distinct in substance, so it would be preferable to understand the differences among them and to operate efficiently, rather than trying to come up with one consensual definition. For example, a student diagnosed with a mental disorder based on the clinical definition may not be eligible for special education under the legal definition. The clinical definition is broader than the legal definition, while the educational definition is even broader. Because its goals encompass both intervention and prevention, the educational definition must include at-risk students as well as those with disabilities.
A Support System in South Korea
In support for students with EBDs, in 2013 the Korean government announced the school health reform titled “School Violence and Student Zero Risk Environment.” Annual emotional and behavioral screening services were provided, including those of professional counseling agencies or in conjunction with medical institutions (Korean Ministry of Education, 2013).
Placement and Management
Once a student with an EBD is identified, an individualized family support plan and individualized education program (IEP) are provided. In total, 2,754 students with EBDs were diagnosed and received special education in 2013 (Korean Ministry of Education, 2014). Of these, 279 (10.13%) were enrolled in special education schools, 1,760 (63.9%) in special classes in general education schools, and 715 (25.96%) in general education schools. Most of the students were allocated to general schools. In South Korea, the cognitive ability of students diagnosed with EBDs is considerably higher than that of students with intellectual developmental disorders or autism spectrum disorder; thus, they would not be guaranteed appropriate services even if sent to special education schools. However, the public has continuously raised concerns regarding the educational and intervention services for students with EBDs, and those with EBDs currently benefit the least from early screening, diagnosis, assessment, and IEPs. Figure 1 explains the management system for students with EBDs, which was created by the Korean government and has been in place since 2011.
Management system for students with emotional and behavioral disorders.
Services
Since 2001, the Korean Ministry of Education has requested school districts to install special education support centers (SESC) to offer services, including early screening, diagnosis, teaching and learning support, and special education and related services. In total, there were 1,847 personnel at SESCs, consisting of 730 teachers, 6 regular officers, and 1,111 extra support staff consisting of therapists and assistants (Korean Ministry of Education, 2013).
Recently, in addition to SESCs, general programs (e.g., psychological testing, a counseling program, special programs, education/workshops) have been offered through the Wee Center, which is supervised by the District Educational Office. Due to problems with the continuity of the Wee Center, programs for the treatment and counseling of children with EBDs have been offered in related, nonspecialist institutions in local communities. These institutions include, for example, psychiatric hospitals, social welfare institutions, local children’s centers, mental health promotion centers, youth counseling centers, children’s counseling centers, and child and adolescent mental health centers.
Since 2013, school districts across the country have installed SESCs to offer the intended services (early screening, diagnosis, etc.); however, due to the lack of capacity for direct support of general or special education teachers in each district, the Wee Center is the only place where teachers are provided support (e.g., counseling, screening) and in-depth evaluation. When the assessment identifies students in need of intervention, they can get treatment and follow-up from the Council of Student Mental Health Support, which is part of the Department of Education and the Department of Education Support Services (Korean Ministry of Education, 2013). Wee is basically a three-step integration support service in which schools, school boards, and the local community support students’ healthy and enjoyable school life. However, because of the irregularity with which the programs at the Wee Center are offered, related organizations are instead offering treatment and counseling to students with EBDs.
Experimental Intervention Research
Since the beginning of 2000, more than 1,000 experimental intervention studies have been conducted with the keyword of EBD in the special education field in South Korea. However, most of them focused on emotional and behavioral interventions, targeting people without disabilities, with part of the research targeting those with autism. Only 42 experimental studies focused on the population with EBDs. Examination of the research associated with social interventions for students with EBDs revealed that the following notable experimental interventions have been reported: person-centered intervention (i.e., peer tutoring, play-centered intervention, group intervention, and augmentative and alternative communication), treatment-based intervention (i.e., music therapy, art therapy), video modeling, and cognitive intervention (i.e., script, cartooning, power card, mind reading; Kim & Kim, 2013). In terms of behavioral interventions, person-centered intervention (i.e., peer tutoring, play-centered intervention) and skill-centered intervention (i.e., applied behavior analysis, discrete trial training) have mostly been conducted. Recently, research on positive behavioral interventions and supports was reported by several researchers in South Korea (Kim & Lee, 2013). Despite the efforts of experimental studies, only some were shown to be effective, indicating that more studies are needed in the educational field to establish effective evidence-based practices.
Conclusion
Students with special needs in South Korea can receive general support and appropriate educational services through an IEP. However, because the students with EBDs and their families require various types of support (e.g., psychological consultation, emotional support, legal advice, medical treatment, cultural activity support), IEPs are simply insufficient. At the same time, the legal definition within the law is blocking these students from being registered as persons with disabilities (Park, 2012). In other words, even if students with EBDs are identified as having special needs, they would not be considered as persons with disabilities in a general sense and therefore would be excluded from support relating to health and welfare. Educators and specialists in the field appeal to the government for decrees and procedural rules intended to mobilize actual support for students with special needs and their families. There is a need for public clarification of special education laws (Park, 2012). This would enable the inclusion of intervention plans within an IEP, should students’ problematic behavior negatively affect their and other students’ studies.
The low prevalence of EBDs is strongly related to the ambiguities of the diagnostic criteria specified under the special education law, as well as the lack of understanding and awareness of EBDs present by general teachers and the public. Furthermore, EBD is not included in the Welfare of Disabled Persons Act in South Korea, so students with EBDs cannot obtain any welfare services provided to other students with disabilities.
Given these issues, it can be expected that less diagnosis will be achieved than the actual prevalence in the population. Even if a student qualifies for special education service due to a diagnosis of an EBD, IEPs include only academic, not behavioral, problems; thus, the students with EBDs cannot obtain any intervention or treatment for their emotional and/or behavioral issues. Therefore, to provide necessary support for students with EBDs, the educational office and the government should reform the special education law in a practical way.
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
This research was supported by the Soonchunhyang University Reserach Fund.