6.7 Other Childhood Conditions, Biological Influences & Evaluating Mental Health Services
Key Takeaways
Disruptive mood dysregulation disorder (DMDD) describes severe recurrent temper outbursts with persistent irritability, beginning before age 10; it was added to reduce overdiagnosis of bipolar disorder in children.
Since 2004, antidepressants have carried an FDA boxed warning about increased suicidal thinking and behavior in children and adolescents, so students starting them need monitoring.
School psychologists support medication decisions by sharing objective school data with families and prescribers, never by recommending specific medications.
Direct Behavior Rating and goal attainment scaling are practical tools for monitoring response to mental health interventions.
Identifying emotional and behavioral disabilities requires developmentally and culturally informed judgment, multiple sources, and attention to bias.
Why These Topics Are Tested
The ETS outline asks candidates to recognize common characteristics of mental health problems and related educational disabilities, understand the impact of mental health on educational outcomes, understand biological, cultural, developmental, and social influences on mental and behavioral health, identify emotional and behavioral disabilities with culturally responsive and developmentally appropriate techniques, and use data to evaluate the implementation and outcomes of mental and behavioral health interventions. Sections 6.1 and 6.2 cover internalizing, externalizing, and neurodevelopmental conditions; this section covers the rest and the evaluation of services.
Other Conditions School Psychologists Should Recognize
| Condition | Key Features (DSM-5-TR) | School Implications |
|---|---|---|
| Bipolar I and II disorders | Bipolar I requires at least one manic episode (abnormally elevated or irritable mood with increased energy lasting at least 1 week, or any duration if hospitalized); bipolar II requires hypomanic episodes (at least 4 days) and major depressive episodes | Episodic changes in sleep, energy, and judgment; coordinate with medical providers; plan for episodes and absences |
| Disruptive mood dysregulation disorder (DMDD) | Severe recurrent temper outbursts (on average three or more times per week) with persistently irritable or angry mood between outbursts, for at least 12 months; onset before age 10; first diagnosed between ages 6 and 18 | Added in DSM-5 partly to reduce overdiagnosis of bipolar disorder in children with chronic irritability; needs behavioral and emotion-regulation supports |
| Obsessive-compulsive disorder (OCD) | Obsessions (intrusive thoughts, urges, or images) and/or compulsions (repetitive behaviors or mental acts done to reduce distress) that are time-consuming or impairing | Rituals can slow work and cause lateness; CBT with exposure and response prevention (ERP) is the leading treatment |
| Eating disorders | Anorexia nervosa (restriction, intense fear of weight gain, distorted body image), bulimia nervosa (binge eating with compensatory behavior), binge-eating disorder, avoidant/restrictive food intake disorder (ARFID) | Medically serious; school role is recognition, communication with parents, referral, and support for treatment plans rather than treatment |
| Substance use | Problematic use of alcohol, cannabis, nicotine and vaping products, or other drugs | Screening (for example, the CRAFFT screener for adolescents), brief intervention, and referral (SBIRT); coordinate with families and treatment providers |
| Schizophrenia and psychosis | Delusions, hallucinations, disorganized speech or behavior, negative symptoms; onset usually late adolescence or early adulthood; childhood onset is rare | Schizophrenia is named in IDEA's emotional disturbance definition; watch for a decline in functioning (prodrome); urgent referral |
Biological, Cultural, Developmental, and Social Influences
Biological
- Genetics and heritability. Many disorders run in families. Twin studies estimate high heritability for ADHD (roughly 70–80%) and moderate heritability for depression and anxiety.
- Temperament. Thomas and Chess described easy, difficult, and slow-to-warm-up temperaments. Behavioral inhibition in early childhood is a risk factor for later anxiety.
- Diathesis-stress and gene-environment interaction. A biological vulnerability (diathesis) combined with stress raises risk; supportive environments can buffer vulnerability.
- Neurotransmitters and brain development. Serotonin, dopamine, and norepinephrine systems are targets of common medications. The prefrontal cortex matures into the mid-20s, which helps explain adolescent risk-taking.
- Puberty, sleep, and health. Hormonal changes, chronic sleep loss, and illness affect mood and behavior.
Cultural and Social
- Cultures differ in how distress is expressed (for example, more somatic complaints in some groups), in stigma, and in help-seeking.
- Minority stress (discrimination and rejection) helps explain elevated depression and suicide risk among LGBTQ+ youth.
- Social media, peer relationships, bullying, family conflict, and community violence all shape mental health.
Developmental
The same disorder can look different at different ages: depression often appears as irritability in children, and anxiety may appear as stomachaches or tantrums in young children. Judge symptoms against developmental norms; some fears, tantrums, and moodiness are typical at certain ages.
Psychopharmacology Basics
School psychologists do not prescribe or recommend specific medications, but they should know the main classes, why they are used, and what to monitor.
| Class | Examples | Common Uses | School-Relevant Side Effects and Cautions |
|---|---|---|---|
| Stimulants | Methylphenidate, amphetamine salts | ADHD | Appetite suppression, sleep problems, headaches, possible rebound irritability as doses wear off |
| Non-stimulants for ADHD | Atomoxetine; alpha-2 agonists (guanfacine, clonidine) | ADHD, sometimes tics | Sedation (alpha-2 agonists), gradual onset of effect |
| Selective serotonin reuptake inhibitors (SSRIs) | Fluoxetine, sertraline, escitalopram | Depression, anxiety, OCD | FDA boxed warning since 2004 about increased suicidal thinking and behavior in children and adolescents (later extended to young adults under 25); monitor closely, especially early in treatment |
| Antipsychotics | Risperidone, aripiprazole | Psychosis, bipolar disorder; FDA-approved for irritability associated with autism | Weight gain, metabolic changes, sedation, movement side effects |
| Mood stabilizers | Lithium, some anticonvulsants | Bipolar disorder | Require medical monitoring; side effects can affect alertness |
The school psychologist's role (Section 6.2) is to collect objective school data, such as behavior ratings, work completion, and attendance, before and during medication trials, share it with the family and prescriber with permission, report possible side effects, and keep interventions going alongside medication. Medication alone rarely addresses skill deficits.
Culturally Responsive, Developmentally Appropriate Identification of EBD
Emotional disturbance is one of the IDEA categories most affected by disproportionality (Section 9.2). Good practice:
- Use multiple sources (rating scales from several informants, interviews, observations across settings, and history), not one referral or one score.
- Compare behavior with developmental norms and with peers from similar backgrounds in the same setting.
- Consider cultural norms for emotional expression, activity level, eye contact, and communication with adults before labeling behavior as inappropriate.
- Rule out situational explanations such as trauma, a recent loss, a poor instructional match, or classroom management problems.
- Apply the social maladjustment exclusion carefully and avoid using it to exclude students who also have emotional disturbance (Section 6.1).
- Check whether Tier 1 and Tier 2 supports were adequate and culturally responsive before concluding a disability exists.
Using Data to Evaluate Mental Health Interventions
| Tool | Description | Use |
|---|---|---|
| Direct Behavior Rating (DBR) | Brief teacher ratings of a target behavior (for example, academic engagement or disruption) on a 0–10 scale after an activity (Chafouleas and colleagues) | Frequent, efficient progress monitoring |
| Brief repeated rating scales | Short symptom scales or subscales given at intervals | Track anxiety or depression symptoms over time |
| Goal attainment scaling (GAS) | Individual goals scaled from −2 (much worse than expected) to +2 (much better than expected), with 0 as the expected outcome (Kiresuk & Sherman, 1968) | Compare progress across different goals and students |
| Self-report ratings | Subjective Units of Distress (SUDS), mood ratings, session rating scales | Student perspective; exposure progress |
| School records | Attendance, office referrals, grades, nurse visits | Functional outcomes |
Apply the same logic as academic progress monitoring: set a baseline, define the goal, graph data, and use decision rules. Single-case designs (Section 9.3) can show whether the intervention caused the change. For group programs, compare pre- and post-measures with a comparison group when possible, and check fidelity before concluding that a program did not work (Section 7.3). NASP Standard II.2.2 requires school psychologists to monitor the effects of their recommendations and interventions and to revise them when data show goals are not being met.
An 8-year-old has severe temper outbursts about four times a week and is irritable and angry most of the day between outbursts. The pattern began at age 6 and has lasted more than a year; he has never had a distinct episode of elevated mood or decreased need for sleep. Which DSM-5-TR diagnosis best fits this description?
Bipolar I disorder
Disruptive mood dysregulation disorder
Obsessive-compulsive disorder
Adjustment disorder
A parent tells the school psychologist that her 15-year-old son has just started an SSRI for depression. What is the school psychologist's most appropriate role?
Recommend a different medication that has fewer side effects.
Tell the parent that antidepressants are unsafe for adolescents and should be stopped.
With permission, share objective school data with the family and prescriber, watch for changes in mood or behavior (including suicidal thinking, given the FDA boxed warning), and continue school-based supports.
Stop school counseling, because medication makes it unnecessary.
A school psychologist wants a quick, repeatable way for a teacher to rate a student's academic engagement after each class period to monitor response to a counseling intervention. Which tool fits best?
A projective sentence-completion test given monthly
Direct Behavior Rating (DBR)
A full broadband rating scale completed every day
An annual state achievement test
Sections you finish are checked off in the contents.