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Exceptionality

I. How do we know things?

“epistemology: the study or a theory of the nature and grounds of knowledge especially with reference to its limits and validity”, also “Study of the origin, nature, and limits of human knowledge.”

(Merriam-Webster)

“Defined narrowly, epistemology is the study of knowledge and justified belief. As the study of knowledge, epistemology is concerned with the following questions: What are the necessary and sufficient conditions of knowledge? What are its sources? What is its structure, and what are its limits?”

(Stanford Dictionary of Philosophy)

“The branch of philosophy that studies the nature of knowledge, its presuppositions and foundations, and its extent and validity.”

(The Free Dictionary)
  • authority
  • tradition
  • revelation
  • reasoning (Plato)
  • experience (Aristotle)
  • scientific investigation
    • observation and experiment — empiricism

II. Being exceptional

  • exceptional adj. 1. Unusual; esp., unusually good 2. requiring special education, as because mentally handicapped
  • exception n. 1. an excepting 2. a person or a thing different from others of the same class; the case to which a rule does not apply 3. an objection
    • Webster’s New World Compact School and Office Dictionary (1982)
  • differences:
    • Physical
      • appearance
      • sensory
      • motor
      • health
    • Behavioral
      • ability
      • actions
      • emotions & thoughts
      • attitudes & beliefs
    • Relational
      • family, tribe, nation, species
      • religion, political party, college major

III. Aspects of how exceptionality is viewed

  • Standards of difference: on what basis do we judge someone to be exceptional?
    • Relative standards: vary with culture, society, time
      • Distress–pain & suffering [DSM-5]
      • Sociological–violating rules (deviance)
      • Mathematical or Statistical–unusual
      • Tolerance–bothers us (the audience)
        • Leo Kanner: “annoyance threshold of the child’s environment”
        • Caretaker concerns (Achenbach, 1982)
          • enduring trait
          • perceived change
          • developmental comparison
    • Absolute standards: universal across cultures and time
      • Idealistic: using maximum psychological adjustment and functioning as your reference standard
      • Pathogonomic: actions which always reflect maladjustment
  • The nature of the exceptionality: how are the exceptional different from the rest of us?
    • categorical–qualitative difference (difference is of kind)
    • dimensional–quantitative difference (difference is of degree)
    • comparison of categorical vs. dimensional systems: 
      • Seven Children:
        • A: Andrew–no problems
        • B: Bart–mild discipline problems
        • C: Cindy–slow learner, no behavior problems
        • D: Drew–behavior problems
        • E: Edward–learning disability
        • F: Felicia–mentally retarded
        • G: Gloria–autistic
  • Level of analysis: what do we pay attention to?
    • symptom or sign: a behavior, an action, a characteristic
    • syndrome: a pattern of symptoms
    • disorder: a syndrome that persists and has negative consequences
    • disease: a disorder that where we fully understand the mechanisms, in medicine this means the pathophysiology, etiology, and course are understood

IV. Unique features of childhood and adolescence affecting our understanding of exceptionality in youth

  • Source of referral
    • children are referred by adults because of concerns that adults have
  • Language
    • the most common/pervasively used assessment tool for adults is an interview
  • Environmental dependence
    • children’s behavior is more situationally specific than adults
  • Developmental status
    • developmental milestones (the age we roll over, stand, walk, speak, use two word sentences, show cooperative play) offer gauges of development do not have comparable equivalents in adulthood (we do not all go to college, get married, have careers outside the home, live independently)
  • Rapidity of change
    • qualitative & quantitate changes with growth

V. Classification and diagnosis of exceptional states in childhood and adolescence

  • Purposes of classification (advantages/strengths of classification)
    • advance understanding
    • communicate among professionals
    • make dispositions
    • statistical record keeping
  • Possible negative effects of classification
    • inaccuracy and invalidity
    • stigma & shame
    • negative bias & expectations
  • sign & symptom, syndrome, disorder, disease
  • DSM 5 & ICD-9-CM (ICD-10)
    • American Psychiatric Association (APA)
      • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) (APA, 2013)
        • “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.” (DSM 5, p. 20)
      • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DMS-IV-TR) (APA, 2000)
    • DSM-IV-TR
    • American Psychiatric Association (APA), American Medical Association (AMA), World Health Organization (WHO), United Nations (UN)
      • International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM)
      • International Classification of Diseases, Tenth Edition (ICD-10)
  • IDEA
    • PL 94-142 the federal Education for all Handicapped Children Act
      • now titled the Individuals with Disabilities Education Act (IDEA)
      • 1975 PL 94-142 (Part B of the Education of the Handicapped Act)
      • a “free and appropriate public education” for school-aged children with disabilities
      • 1986 PL 99-457 extended the rights and protections of school aged children to preschoolers aged 3-5
      • 1997 reauthorization of IDEA
      • 2004 reauthorization of IDEA
    • Eligibility under IDEA
      • The student must be identified as having 1 of 12 disability conditions and demonstrate a need for special education and related services
        • mental retardation
        • specific learning disabilities
        • serious emotional disturbance
        • speech or language impairments
        • vision loss
        • hearing loss
        • orthopedic impairments
        • other health impairments
        • deaf-blindness
        • multiple disabilities
        • autism
        • traumatic brain injury
      • 1986 reauthorization of IDEA gave states and local educational agencies the option of dropping categories for children ages 3-5
        • Could define a child with a disability as a child experiencing developmental delays in one or more of the major life activities and needing special education and related services
        • 5 basic tenets of IDEA drive eligibility
          • 1. nondiscriminatory & multidisciplinary assessment
          • 2. parental safeguards & involvement in the educational process
          • 3. a free and appropriate public education (FAPE) based upon the student’s IEP
          • 4. the development & implementation of an individualized education plan (IEP)
          • 5. right to learn in the least restrictive environment (LRE)
      • Section 504 of the Vocational Rehabilitation Act of 1973
        • Provides coverage for some children who would not fall within IDEA
      • PL 101-336 The Americans With Disabilities Act of 1990
        • provides a mandate to provide reasonable accommodations or modifications to students who would not qualify under IDEA to create a fair and level playing field in their educational program

DSM-IV-TR Multiaxial Assessment

  • Axis I
    • Clinical Syndromes
    • Other Conditions That May Be a Focus of Clinical Attention
  • Axis II
    • Mental Retardation
    • Personality Disorders
      • personality traits
  • Axis III
    • General Medical Conditions
  • Axis IV
    • Psychosocial & Environmental Problems
  • Axis V
    • Global Assessment of Functioning (GAF) Scale

DSM conceptualization of Mental Disorder

DSM-IV (1994) and DSM-IV-TR (2000)

“In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.”

(DSM-IV-TR, 2000, p. xxxi)
  • clinically significant
  • syndrome/pattern
  • occurs in an individual
  • not expectable & culturally sanctioned response to a particular event
  • conflicts between individual and society are not mental disorders, unless the deviance or conflict is a symptom of a dysfunction in the individual
  • classified disorders that people have, not people

DSM 5 (2013)

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

(DSM 5, 2013, p. 20)
  • syndrome
  • clinically significant
  • in an individual’s
  • usually assocaited with significant distress or disability
  • social, occupational, or other important activities
  • expectable or culturally approved response to a common stresor or loss . . . . is not a mental disorder
  • socially deviant behavior/conflicts with society are not a mental disorder, unless
  • caution about legal judgments, eligibility for disability, competency
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