Joey is a second grader who can explode at times, ripping down pictures from the classroom wall. At other times, he charges for the door if he gets frustrated with schoolwork and then lurks in the hallway. Once, when redirected to the principal’s office for “ bad behavior,” he bit the teacher’s hand.

As the consulting psychiatrist for the Cambridge Public Schools, I meet students like Joey all the time. Teachers can frequently feel they are fighting a losing battle when working with a challenging child. It’s hard to teach – and hard to learn – when class is repeatedly interrupted day after day. Teachers may even breathe a private sigh of relief when a turbulent student is transferred to a self-contained classroom, removed from the general education setting and isolated from his typically developing peers.

A new study highlights the fate of children like Joey, noting that a disproportionate number of low-income and minority students end up in substantially separate classrooms. The report, by Thomas Hehir of Harvard University’s Graduate School of Education, found that Massachusetts low-income students are nearly twice as likely to be given broadly defined “special education” labels than students from more affluent backgrounds. It also found that children who are isolated in self-contained classrooms score lower on the MCAS than students in mainstream classrooms.

Research has shown that many students who end up in self-contained classrooms, whether in a wealthy or poor district, suffer from attention and learning difficulties and have a family history of trauma. They often do not have adequate diagnostic evaluation and sustained treatment; on the contrary, they usually only have intermittent medication and sporadic therapy.

Teachers often recognize that students may have low frustration tolerance and need help learning how to change their behavior when they are overwhelmed. But teachers are not trained to identify or teach the necessary skills. Too often, students are disciplined with detentions and suspensions, which do not change the behavior of hostile students or help them learn how to communicate their distress without raising havoc.

Some students need self-contained classrooms for a number of reasons; for example, they may be unsafe or have medical/learning conditions with needs that cannot be met in general education. A well-run self-contained classroom with properly trained staff can make a big difference. But let’s say we plunked Joey in a room with other students who struggle with poor impulse control. This environment can encourage bad behavior, as students feed off each other. Too often students lose hope, feel marginalized, and don’t see a path for reentry into the general education classroom.

Things worked out differently for Joey. Cambridge is one of just a few districts that employ a child psychiatrist to provide a thorough diagnostic assessment and to work with the educational team to mobilize resources early on. I was fortunate to be called in to help this young boy change direction. Students like Joey demand sustained effort, combined with an investment of skilled diagnosis and targeted interventions. I performed a complete diagnostic assessment, interviewing Joey, his family, and school personnel.

After reviewing all the records, it became apparent that his disruptive behavior was signaling underlying anxiety and task avoidance. I facilitated access to wraparound services and a child psychiatrist. His family received support and advice on how to avoid harsh punishment and to provide praise and consistent discipline. His school social worker helped him learn self-calming strategies. His teacher previewed lessons in advance and incorporated assistive technology, which reduced his outbursts and his aversion to writing. He went from being a child who was described as “going from zero to a hundred in a split second” to a young boy who could stay on task and make academic progress. He was able to stay in his regular classroom, saving the district money and, more importantly, avoiding the stigma of separation and instilling the belief that he can, and will, succeed.

The recent study recommends that the state examine the disproportionate number of low-income students in special education programs and reduce the number of students in self-contained classrooms. Those are worthy goals. But we also need to remember that each student is an individual who needs a caring, supportive relationship with the teacher and who is given the opportunity to be “caught being good.” There needs to be greater emphasis on expanding the tools and resources available to each student and fortifying the family with therapy and, if necessary, medication. I call this approach a “passion for the possible,’’ a belief that there is hope – and help – for all the Joeys who struggle in classrooms statewide.

About the Author

Nancy Rappaport

Nancy Rappaport is associate professor of psychiatry at Harvard Medical School.

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