Original article
Beyond psychopathology: Assessing seriously disruptive students in school settings

https://doi.org/10.1016/j.jpeds.2006.03.018Get rights and content

Objective

To obtain a demographic profile of aggressive students in an urban setting and discern psychiatric diagnoses, functional impairment, and psychosocial stressors.

Study design

Participants were 33 students in an urban public school district referred for comprehensive psychiatric evaluation by school staff because they were viewed as a threat to school safety. Evaluations included a review of records, interviews with school and mental health professionals, and student and parent interviews.

Results

Students were characterized by severe and untreated or undertreated psychopathology together with high levels of psychosocial stressors and learning disorders. Thirty-two students received at least one Axis I diagnosis, and the mean number of diagnoses for each student was 3; 33% had substance abuse problems, and 30% had nonpsychiatric medical conditions.

Conclusions

The sample is a chronically impaired group of students confronting serious adversity in their daily lives, whose psychosocial and psychiatric needs are not met by current educational and mental health programming. Necessary interventions include prevention and early identification, substance abuse and family treatment, and appropriate psychopharmacological treatment. A comprehensive psychiatric assessment can help change the outcomes for this group of aggressive students.

Section snippets

Study Sample

The urban school district from which our sample was drawn had 6437 students enrolled in grades Kindergarten through 12 in 2004; 50% of the students are from low-income families, and 33% come from homes where English is not the first language. The proportion of special education students in this district, 22%, is among the highest in the state; and 67% of the students receiving special education services are racial minorities. The study sample of 28 boys and 5 girls are students who were

Impaired Functioning

The most common psychiatric diagnoses are shown in the Table. Comorbidity was common; the median number of diagnoses for each child was three. Current substance abuse was identified in 11 students, and in all cases the substance involved was alcohol or marijuana. The 11 students who had substance abuse problems significantly differed from those who did not with respect to being older and having legal problems and problems with primary support group but not with respect to psychosocial or

Discussion

These students had varied and comorbid psychiatric disorders, CGAS scores in the severely impaired range, and severe psychosocial stressors (such as death of a parent or a mentally ill parent). Classification of students as severely emotionally disturbed or behaviorally disordered (eg, ADHD, bipolar disorder) did not increase the likelihood of adequate treatment. In light of our findings that nearly all of the referred youngsters had serious yet undertreated psychopathology, a possible

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