Journal of Pediatric Nursing
Volume 21, Issue 1 , Pages 1-3, February 2006

Examining the Status of Special Education Students: Implications for Pediatric Nurses

Journal of Pediatric Nursing, USC Center for Excellence in Developmental Disabilities, Los Angeles, CA 90027, USA

Article Outline

 

Recent national reports on the status of special education students have provided interesting information that nurses who provide services to infants, children, and youth who are special education students could use as evidence in their roles as advocate, clinician, educator, researcher, and policymaker. According to the 25th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act (IDEA, 1997), which reported data from the Special Education Elementary Longitudinal Study and the National Longitudinal Transition Study 2, during the 2001–2002 school year, 12.1% (5,867,257) of students received special education and related services. Students in elementary, middle, and high school (ages 6–21 years) who received special education services comprised 8.9% of the entire student population. The graduation rate in 2001–2002 for special education students was 47.6%, an increase of 4% since 1995. As would be expected, the graduation rate varied as to the type of disability the student had. Students with higher levels of involvement had lower rates of graduation ranging from 35% for students with mental retardation to 65.9% for students with visual impairments (SRI International, 2000, U.S. Department of Education, 2005, Wagner et al., 2005, Wagner et al., 1991). As these data demonstrate, the population of students who are in special education programs continues to grow and obviously their needs for support services for nursing care, speech and language services, mental health services, occupational and physical therapy services, social work services, and family counseling to name a few.

Examination of the sex distribution of special education students reveal striking trends. According to the sex distribution of special education students, boys outnumber girls by 67% versus 33% for ages 6–12 years and by 65.8% versus 34.2% for ages 12–17 years for all disabilities. Although boys outnumber girls in all categories of disabilities, the greatest level of difference between sexes are in the disability categories of emotional disturbance (80% for boys and 20% for girls, ages 6–12 years; 77% for boys and 22.9% for girls, ages 13–17 years) and autism (83% for boys and 17% for girls, ages 6–12 years; 84.8% for boys and 15.2% for girls, ages 13–17 years) and other health impairment (71% for boys and 29% for girls, ages 6–12 years; 73% for boys and 27% girls, ages 13–17 years). The definition for emotional disturbance that is used for the criteria for determining eligibility for special education services as specified in IDEA (1997) is presented in Table 1. The criteria used to determine eligibility for students with other health impairments for special education programs according to IDEA (1997) are listed in Table 2. The criteria for autism in determining special education eligibility are aligned with the widely used diagnostic criteria as found in Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 1994).

Table 1. Emotional Disturbance as Defined by IDEA
A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance
(a) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(b) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(c) Inappropriate types of behavior or feelings under normal circumstances.
(d) A general pervasive mood of unhappiness or depression.
(e) A tendency to develop physical symptoms or fears associated with personal or school problems (Code of Federal Regulations, Title 34, § 300.7 (c) (4) (1))
Table 2. Other Health Impairments
Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that
(a) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia and
(b) Adversely affects a child's educational performance

The prevalence rate of autism is four times greater in boys than it is in girls (APA, 1994, Autism Society of American, 2003). Evidence exists to explain the disproportion in the sex distribution of children with autism. The perplexing issue associated with the disproportionate greater numbers of boys who are determined for special education eligibility in the classifications of emotional disturbance and other health impairments cannot be simply answered. As the 25th Annual Report to Congress on the Implementation of the IDEA revealed, the criteria for classification used to determine special education eligibility vary according to state, so it is difficult to speak in absolute terms about the profile of children within these classification categories (U.S. Department of Education, Office of Special Education Programs, 2005). Nearly 50% of the students classified in the categories of emotional disturbance and other health impairments take psychotropic medications. The use of stimulants is also highest in these groups of students as well. It is beyond the scope of this editorial to engage in the discussion of stimulant use in children; however, this is an area of clinical concern for child health and pediatric professionals who work not only in school settings but also in primary and community care settings and in tertiary settings as well. This is an opportunity for professionals to educate parents, nonhealth providers, and the public on best practice and evidence-based approaches for care. Closer examination of the factors contributing to the vast numbers of boys in contrast to girls classified in the emotional disturbance and other health impairment categories is warranted. Many research questions could be explored by nurse researchers in terms of the behaviors manifested by boys in contrast to girls that are perceived as problematic, the process used to determine eligibility, and the long-term effects on the children themselves to name a few. Pediatric nursing organizations could use their influence to highlight the importance of this issue and provide the leadership necessary to involve their members in addressing this public health concern.

Examination of data of students in special education program related to their ethnic and racial diversity provided troubling insights as well. The percentage (17.4%) of Black (non-Hispanic) students with mental retardation enrolled in special education programs was much greater when compared with other ethnic/racial groups of students: 8.2% American Indian/Alaska native, 9.4% Asian/Pacific Islander, 8.1% Hispanic, and 8.6% White. Additionally, a markedly higher percentage (11.3%) of Black students with emotional disturbance were enrolled in special education as compared with other ethnic/racial groups of students in special education: 7.7% American Indian/Alaska Native, 5% Asian/Pacific Islander, 5% for Hispanic, and 8% for White students. Calculations of risk ratios revealed that Black students were 2.99 times more likely to be identified as having mental retardation than the other students according to ethnic/racial groups. Black students were 2.21 times more apt to be categorized with emotional disturbance as compared with all other ethnic/racial groups. According to parental reports, Black students (28%) were expelled or suspended from school substantially more often than Hispanic (13%) and White (10%) students. Black students (34.9%) were the least likely of any other group of students to be educated in inclusive general education settings: 49.7% American Indian/Alaska Native, 51.9% Asian/Pacific Islander, 43.8% Hispanic, and 50.7% White.

Graduation and dropout rates showed considerable differences between racial/ethnic groups as well. The highest graduation rates for students in special education were reported for Asian/Pacific Islander (60.6%) and White students (56.8%). In contrast, the graduation rates were lowest for Black students (36.5%). Graduation rates of Hispanic and Native American/Alaska Native students were 47.5% and 41.8%, respectively. Dropout rates were highest for Native American/Alaska Native students (52.2%) and lowest for Asian/Pacific Islander (28%) and White (33.9%) students. Blacks (44.5%) and Hispanics (43.5%) had similar dropout rates from school. School absenteeism, discipline problems, and suspension from school were identified as the leading factors associated with dropping out of high school. The dropout rate was significantly higher for special education students in contrast to general education students.

The issues associated with the overidentification of Black students in special education have been well documented, and a call to action has been advocated by educators, civil rights leaders and governmental officials, and elected representatives (Individuals with Disabilities Education Improvement Act of 2004, Losen & Orfield, 2002, Overidentification, 2001, Reister et al., 2002). As these data indicate, there is a constellation of serious problems impacting ethnically diverse students, especially Black students in special education. The data related to high school dropout rates are particularly troubling as the lost potential and long-term risks are costly not only to the students themselves but society as well. Again, the overidentification of Black students is not only a serious societal and civil rights concern, it is a public health concern as well, requiring the type of comprehensive response discussed above in relationship to the overidentification of boys in special education programs (IDEA, 2004).

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References 

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4th ed.. Washington, DC: Author; 1994;
  2. Autism Society of American. Retrieved December 8, 2005, from http://www.autism-society.org/site/PageServer?pagename=WhatisAutism#Signs2003;
  3. Individuals with Disabilities Education Act (IDEA) of 1997, PL 105-17 (Section 300.27(a)).
  4. Individuals with Disabilities Education Improvement Act of 2004, PL 108-446 (20 USC 1400 note).
  5. Losen DJ, Orfield G. Racial inequality in special education. Cambridge, MA: Harvard Education Press; 2002;
  6. Overidentification issues within the Individuals with Disabilities Education Act and the need for reform. Hearing Before the Committee on Education and the Workforce of the House of Representatives, 107th Congress, 1, 2001.
  7. Reister AF, Pursch V, Skria L. Principals for social justice: Leaders of school success for children from low-income homes. Journal of School Leadership. 2002;12:281–304
  8. SRI International . SEELS Parent Survey. Retrieved December 8, 2005, from http://www.seels.net/seels_textonly/infoproduct.htm2000;
  9. U.S. Department of Education, Office of Special Education Programs . 25th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Washington, DC: Author; 2005;
  10. Wagner J, Newman L, Cameto R, Levine P. National Longitudinal Transition Study 2: Changes over time in the early post-school outcomes of youth with disabilities: A report of the findings from the National Longitudinal Transition Study and National Longitudinal Study 2. Menlo Park, CA: SRI International; 2005;
  11. Wagner J, Newman L, D'Amico R, Jay E, Butler-Nalin P, Marder C, et al. Youth with disabilities: How are they doing? The first comprehensive report of the National Longitudinal Transition Study. Menlo Park, CA: SRI International Department of Education; 1991;

PII: S0882-5963(05)00434-3

doi:10.1016/j.pedn.2005.12.003

Journal of Pediatric Nursing
Volume 21, Issue 1 , Pages 1-3, February 2006

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