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"Children Do Well...If They Can"

May 16, 2018

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The Complex Case of Autism and Emotional Disturbance


During my 20 years in special education as both Teacher and Supervisor perhaps the most complex students I serve have been those whose exceptionalities are identified as both Autism Spectrum Disorder (ASD) and Emotional Disturbance (ED).  The interventions we put into place based on ED models prove ineffective. Confused, but determined, the Team orders an even more inflexible program aimed at extinguishing behaviors (which often flows from inappropriate placement and intervention).


Team discussions involving the parents of children with ASD and ED often follow a chicken and egg debate: which exceptionality, Autism or Emotional Disturbance, is driving the behavioral challenges? Because little research on the problem exists, and accurate diagnosis of children who express both exceptionalities is difficult, both parents and professionals can make wrong decisions.  We all want to be clear and focus on the correct interventions for this child and the stress of both parents and professionals is heightened by the mystery.


My blog today is not just about an interesting complexity. It is about the dire consequences that can flow from our current inability to address these co-existing exceptionalities.


The result of misdiagnosis is often severe.


Further exacerbating the problem is Special Education law which only allows one primary exceptionality as all others are considered “secondary.” Educators naturally focus on the primary disability. If this disability happens to be ED, with a secondary of Autism, guess which exceptionality gets addressed.

Many, if not most, of these children are served in special educations schools. But they are often admitted to programs for children with ED. Such programs, many of which I have worked in, are typically designed to address behavior with highly verbal and cognitive approaches; approaches which are not typically conducive to the needs of those with ASD.


These programs are often rigid about challenging behavior. A rigidity which can further disturb the child with ASD whose exceptionality belies the intervention.  The lack of the child’s responsiveness confounds the Team and, often, even more stringent limits are put into place; limits that the ASD child cannot possibly meet.


Also, within this context, the ED student, often far more socially adept. Their exceptionalities revolve around the need to develop emotional flexibility and skills to work through non-preferred activity. These students may often prod the ASD student into perseverating or compulsive behavior that then annoys the rest of the students. Other students then complain about the ASD student, further escalating the child. The motivator for the ED student is control and avoidance of non-preferred activity.


In these scenarios, the Teacher, unable to assign the appropriate intervention to the appropriate need, often focuses on the disruption caused by the child with ASD and is frustrated by the lack of an appropriate model for intervention. Thus, the cycle continues and too often the children are damaged.

The lack of teacher and administrator training on the complexity of coexisting needs also leads to a silo effect. They see the interventions and programs as ones that should address either ASD or ED. A more comprehensive system is needed.


I am not arguing that students with ED and students with ASD, or that students with both exceptionalities, cannot be supported by the same program. I also don’t mean to suggest that there are no effective models currently being implemented. I only indicate that few programs exist and that professionals are often not clear about what they are to do with such children. Research into effective practices (including effective assessment, training and coaching professionals, and interventions) can and will lead to more appropriate models.


Research also suggests that addressing both exceptionalities at a preschool age, where programs are typically more flexible, can benefit children with both exceptionalities. To this end, parents and educators should intervene as soon as possible. There should be no shame or fear in ensuring a child gets the right support. It may take some time to adjust interventions but it is worth the challenge in the end. The earlier services start, the better the chance of finding the correct intervention


It is crucial that parents have access to programs ( I would argue that schools need to offer this) that can reduce their stress regarding the existence of behavior and social challenges. Such challenges are to be expected and there are methods and strategies to address ASD students with behavioral challenges. There is no need for these things to continue to be a mystery if we increase our understanding and correctly identify the characteristics in the coexistence of Autism and Emotional Disturbance.


Finally, if you believe your child is not in the program or setting that offers them an ambitious opportunity to access and gain the skills they need (often characterized by similar goals year to year), advocate strongly and loudly for a change in placement. It is likely that a more appropriate alternative can be found and it is the responsibility of your School District, along with you, to find the correct program and setting.


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