Academic Deficits in Emotionally Disturbed Children Revisited

STEVEN R. FORNESS, ED.D.,LINDA BENNETT, M.A.,

AND

JODI TOSE, B.A.

While some evidence exists that children with emotional disorders are deficient in
academic achievement compared to non-handicapped populations, the nature and extent of
these deficits remain unclear. For a sample of children admitted to a psychiatric hospital,
achievement scores in reading, arithmetic, and spelling were obtained; and underachievement was computed based on mental age. Findings suggested that only minimal academic
deficits exist but that wide variability is evident. Implications for differential diagnosis are
discussed.
Journal of the American Academy of Child Psychiatry, 22,2:140-144,1983.

Most professionals who work with emotionally disturbed children agree that adaptation to the school
environment is an important measure of these childrens overall functioning level. Subsequent adjustment of children with psychiatric problems tends, in
fact, to be best predicted by early school behavior
(Kohlberg et al., 1972; Robins, 1966). Under the rubric
of school behavior, classroom deportment and peer
relationships are frequently of primary concern, and
less attention has traditionally been devoted to the
academic progress of disturbed children. However,
recent federal legislation on schooling of emotionally
disturbed and other handicapped children now requires that specific goals be set for every child in each
academic area (Forness, 1979). Thus, the school
achievement of disturbed children becomes a matter
of renewed interest.
While past research has suggested that significant
academic deficits are indeed characteristic of children
with emotional disorders, the nature and extent of
these deficiencies remain unclear. For example, the
incidence of serious reading problems among disturbed
children in public school or outpatient clinic settings
has been reported to be anywhere from 50 t o 80%
Dr. Forness is Professor in Residence, UCLA Mental Retardation and Child Psychiatry Program, and Special Education Director, UCLA Neuropsychiatric Institute, 760 Westwood Plaza, Los
Angeles, CA 90024, where reprints may be requested. Ms. Bennett
is an educational psychologist in the Child Outpatient Department
of the UCLA Neuropsychiatric Institute, and Ms. Tose was a
special studies student in the UCLA Graduate School of Education
at the time the study was completed.
This study was supported in part by U S . Office of Special
Education Grant GOO8000989; National Institute of Child Health
and Development Grant 4 0 04612, 00345, and 05615; and U.S.
Public Health Service, Maternal and Child Health Project 927 to
the UCLA Mental Retardation and Child Psychiatry Program.
The authors would like to acknowledge the valuable statistical
assistance and consultation of Dr. Donald Guthrie, Computer
Resources Group, UCLA Mental Retardation and Child Psychiatry Program.
OOO2-7138/83/2202-0140$02.00/0 0 1983 by the American Academy of Child Psychiatry.

(Glavin and Annesley, 1971; Hinton and Knights, 1971;

Wright, 1974). Somewhat paradoxically, the same figure for children admitted for inpatient psychiatric
hospitalization appears to be below 50% (Forness et
al., 1980; Graubard, 1967; Motto and Lathan, 1966;
Stone and Rowley, 1964; Tamkin, 1960). Academic
gains made during psychiatric treatment tend nonetheless to be similar for both inpatient (Forness et al.,
1981) and outpatient populations (Ashcraft, 1971),
though when a particular group of disturbed children
is subsequently admitted to an inpatient program,
sharp increases in their rate of academic progress have
been observed (Abidon and Seltzer, 1981). Likewise,
children in special classes for the emotionally disturbed seem to have no advantages in eventual educational attainment over disturbed children left in
regular classes (Calhoun and Elliott, 1977; Carlberg
and Kavale, 1980; Vacc, 1972). It should be noted that
mean ages in all the studies just cited ranged approximately from 9 to 12 years; and mean I&, when reported, ranged from 88 to 105.
Careful examination of the above evidence, however, suggests that conclusions are frequently drawn
from samples of fewer than 50 children; many have
employed either group achievement tests or individual
tests which are no longer widely used; sex differences
are often not reported; and IQ data on children are
sometimes unavailable. While some attempts have
been made to study spelling errors (e.g., Glavin and
De Girolano, 1970), many studies are limited to measures of reading recognition and arithmetic, and very
few include measures of reading comprehension. Cullinan et al., (1981) have also made the point that age
differences need to be taken into account because,
while underachievement may not be great in the early
elementary years, it increases as disturbed children
grow older. Attempts to update our understanding of
this area seem particularly important when one considers the changes in diagnostic labels and criteria
which have occurred in the past few years (Forness
140

ACADEMIC DEFICITS AND EMOTIONAL DISTURBANCE

and Cantwell, 1982) at a point when much of the work

cited above had already been completed.
The present study, therefore, was intended to reexamine the question of underachievement in emotionally disturbed children with reference to the above
issues. A sizable sample of children was drawn from a
psychiatric hospital in which patients were admitted
for evaluation and short-term treatment. This sample
had certain characteristics in common with both inpatient and outpatient populations in previous studies
since, although hospitalized, children in the present
study were generally admitted for a brief period of 2
to 4 months, whereupon they were usually returned to
community school settings. The achievement test used
was the Peabody Individual Achievement Test (Dunn
and Markwardt, 1970) as opposed to previous studies
which employed either group tests (the California
Achievement Test, Metropolitan Achievement Test,
or Stanford Achievement Test) or, in most cases, an
individual achievement test (Wide Range Achievement Test) which has since been revised because of
certain long-standing problems in standardization (Silverstein, 1978). The PIAT has not only been recognized as an increasingly widely used and more recent
test of achievement for clinical populations (Wilson
and Spangler, 1974) but has also been shown to produce somewhat different scores from the WRAT when
used with the same group of children (Jenkins and
Pany, 1978). Both boys and girls served as subjects in
the present study; and I& data were available as well
so that variables such as sex and intelligence could be
considered along with age and achivement in various
academic areas.

Method
Subjects for the study were selected from a sample
of children, aged 7 through 12 years, who were admitted to an inpatient ward for latency-aged children in
the UCLA Neuropsychiatric Institute over a 4-year
period, from January 1977 to February 1981. All children were hospitalized for serious emotional or behavior disorders; no children with early childhood autism
were included in the sample. Racial distribution of the
sample was as follows: 82% Caucasian, 10% black, 5%
Spanish surname, 3% other racial designations. Although specific socioeconomic data were unavailable
on some 10%of the subjects, available family income
figures indicated a median income of $13,500 per year
with a range from families on welfare to income in the
$38,000 range. Occupations of principal wage earners
appeared to cluster in the areas of craftsmen and
service workers with apparently fewer than 15%in the
professional or managerial series. A complete description of the hospital treatment program and school
approaches is provided in Forness (1977, 1978); but,

141

for purposes here, it should be mentioned that these

children were admitted primarily for short-term evaluation or treatment of a variety of psychiatric problems. Most psychiatric diagnoses clustered primarily
in the areas of conduct or adjustment disorders with
a second small cluster in disorders of affect or anxiety,
according to DSM-I11 criteria (Forness and Cantwell,
1982).
Achievement testing of each child was done during
the first week of hospital admission. All tests were
administered either by one of two credentialled classroom teachers with masters degrees or by the team
leader who had a Ph.D. in special education. The
achievement test used was the Peabody Individual
Achievement Test (Dunn and Markwardt, 1970). Four
subtests, Reading Recognition, Reading Comprehension, Mathematics, and Spelling, were used in the
analysis of data. Current WISC-R IQs were obtained
from each childs medical records. Although 134 subjects had been admitted over the study period, complete sets of scores were unavailable on 42 subjects
whose achievement testing could not be completed or
for whom recent I& data were not available. Comparison of the data on these subjects with the remaining
subjects in the sample did not reveal any systematic
bias in sex or age.
As a measure of the level of underachievement a t
admission, each childs level of achievement at that
point was subtracted from his or her expected grade
level. Expected grade level was computed by converting I& and chronological age to mental age (unless a
mental age had already been reported along with I&
data) and then subtracting 5 from the mental age.
Although this formula has some limitations in determining significant educational underachievement related to establishing the presence of a learning disability (Elliott, 1981; McLeod, 1979), it was used herein
primarily because it was the formula used most frequently, if at all, in previous studies and therefore
allowed at least some comparison with past findings.

Results
Over the 4-year period 92 subjects, 23 girls and 69
boys, were available for study, i.e., had complete intelligence and achievement test results. Mean age of
the sample was 10.1 years (range 6.5 to 13.1 years; S D
1.6 years); and there were no statistically significant
differences between boys and girls in terms of age.
Table 1 presents a summary of achievement and intelligence test scores. Note that on the average subjects I& scores were in the low 90s and that, while
there was an apparent difference in I& between boys
and girls, this difference was not statistically significant.
Table 2 presents the mean number of years below

142

FORNESS ET AL.

TABLE 1
Intelligence and Achievement Data
Boys
Mean
Achievement scores:
Reading recognition
Reading comprehension
Mathematics
Spelling
Intelligence quotients

4.52
4.37
4.35
4.06
95.43

Range

Girls
SD

(1.2-12.9) 2.7
2.5
(1.3-12.8)
2.4
(0.4-12.9)
2.5
(1.1-12.9)
(69-133) 13.8

Total

Mean

Range

SD

Mean

Range

SD

3.99
3.80
3.70
3.95
90.30

(1.3-9.4)
(1.2-12.8)
(0.6-12.9)
(1.2-8.4)
(67-129)

2.3
2.4
2.6
2.1
17.4

4.39
4.2
4.19
4.03
94.15

(1.2-12.9)
(1.2-12.8)
(0.4-12.9)
(1.1-12.9)
(67-133)

2.6
2.5
2.5
2.4
14.9

TABLE 2
AchievementDeficits in Years

Boys

Girls

Academic Area
Mean
Reading recognition
Reading comprehension
Mathematics
SDelline

Total
~

-0.14
-0.29
-0.31
-1.03

Range_.
(-4.9-8.7)
(-4.8-4.7)
(-4.8-7.2)
(-5.2-8.2)

SD
2.4
1.8
1.6
2.6

grade level (corrected for mental age as described

above) in each area of academic achievement. A twoway analysis of variance was used to analyze differences between sexes, both within each subject area
and between subject areas; and significant differences
were further analyzed using Duncans post hoc comparisons. There were no statistically significant differences between boys and girls within any academic
area or between academic areas, i.e., boys and girls
displayed a similar degree of underachievement in
each of the four academic areas.
To examine the question of age as it relates to
achievement deficits, the sample was divided into six
relatively equally distributed chronological age groupings (with the exception of the youngest group which
had only six subjects) as depicted in Table 3. Using
the statistical analyses described above, differences
between age groups for males and females, within and
between each subject area, were analyzed. Ten year
olds were found to display significantly greater underachievement in math (F = 2.9, df = 5/80, p < 0.01)
than the 7-, 8- or 12-year-olds.There were significant
age X sex interactions for reading recognition (F =
2.55, df = 5/80, p < 0.03) and reading comprehension
(F = 2.75, df = 5/80, p < 0.02) such that 12-year-old
boys displayed significant underachievement in both
areas while 12-year-oldgirls displayed significant overachievement. This pattern of male underachievement
and female overachievement tended also to be the
case for 9-year-olds, though it was not statistically
significant.
In addition, there was a significant age X sex interaction when total mean deficits per age group (reading

Mean
-0.09
-0.28
-0.38
-0.13

-.

Range
__

SD

Mean

Range

SD

(-3.3-3.4)
(-3.5-3.5)
(-3.6-3.6)
(-4.4-3.2)

1.9
1.5
1.5
2.1

-0.13
-0.29
-0.33
-0.48

(-4.9-8.7)
(-4.8-4.7)
(-4.8-7.2)
(-5.6-8.2)

2.2
1.8

1.6
2.1

spelling + math) were compared for girls versus

boys (F = 3.27, df = 5/80,p < 0.0098). Further analysis
revealed this interaction was due to an age effect
among girls (F = 3.05, df = 5/17, p < 0.03), while no
age differences were found among boys. Specifically,
the 10-year-old girls displayed a mean overall deficit
of 2.1 years while 12-year-old girls displayed mean
overachievement of 1.7 years.
Finally, to compare the degree of underachievement
found in our sample versus that found in previous
studies, adjusted achievement scores were classified
according to severe underachievement (more than
1 year), moderate underachievement (between ?h
and 1 year), and minimal or no underachievement
(less than ?hyear). Percentages in each of these categories were then computed for each subject area as
depicted in table 4.The majority of children displayed
either negligible or only moderate underachievement
in reading and math, while in spelling equal numbers
of children fell within the minimal and severe categories.

Discussion
When expected achievement was adusted for mental
age, only about a third of the children in this sample
had deficits of a year or more in reading and math.
More than half of the sample had either negligible
deficits or none whatsoever, although there was wide
variability. Spelling deficits were somewhat more common. These findings are consistent with earlier results
of Tamkin (1960) for an inpatient sample, though he
did not employ mental age in computing underachievement. Later studies, which did utilize a mental

143

ACADEMIC DEFICITS AND EMOTIONAL DISTURBANCE

TABLE 3
Mean Achieuement Deficits by Age and Sex
Reading Recognition
Reading Comprehension
Mathematics
Age in Years
7 and below
8
9
10
11

12andabove

Boys

Girls

Boys

Girls

Boys

Girls

Boys

Girls

0.46
0.38
-0.68
-0.11
0.77
-2.01

-0.19
0.02
0.50
-2.03
-0.97
1.82

1.41
0.11
-0.96
-0.26
0.08
-1.44

-0.59
0.22
0.06
-1.70
-1.17
1.52

0.94
0.01
-0.36
-1.14
-0.23
-0.46

-0.29
-0.07
-0.27
-2.27
-1.09
2.06

0.11
-0.09
-1.02
-0.62
-0.29
-1.59

-0.89
0.35
0.83
-2.57
-1.01
1.49

TABLE 4
Percent of Children _
Underachieving
in Each Subject Area
_ ~ _ _ _ _ ~ _ _ _
Degree of Underachievement
Minimal (<% yr)
Moderate (%-1 yr)
Severe (>1 yr)

Spelling

Reading Reading
Recogni- Compretion
hension
57.61
4.35
38.04

59.78
9.78
30.43

Mathematics
54.35
15.22
30.43

comprehension while boys in the same age group were

almost 2 years below. When overall underachievement
spelling + math) was considered, boys
(reading
showed no age differences while 10-year-old girls, on
the average, were 2 years below grade level and 12year-old girls were 2 years above.
Finally, in terms of the four academic areas tested,
no differences were noted among reading, spelling, and
math deficits for the sample as a whole or for different
age and sex groups. Although earlier studies did find
math scores to be lower than reading and spelling
scores (Forness et al., 1980; Stone and Rowley, 1964),
these either did not use a mental age adjustment or
used the WRAT which measures written math computation rather than math reasoning.
The present study has attempted to clarify the
nature and extent of underachievement among emotionally disturbed children. It should be noted that
most of these children tended to display a rather
homogeneous pattern of underachievement across all
subject areas, rather than a specific disability in one
area, the pattern often found among learning disabled
children (Forness, 1981). While these data were not
analyzed systematically by DSM-I11 psychiatric diagnoses, informal examination of the findings did not
suggest any particular pattern of achievement by diagnostic category. It is of interest to note, moreover,
that of 15 subjects with either a primary or secondary
diagnosis of attention deficit disorder only 7 were in
the group of subjects with achievement more than a
year below expected grade level. Previous research
with inpatient psychiatric patients (Barnes and Forness, 1982) also found no statistically significant differences in underachievement by DSM-111 diagnoses.
The point to be made, however, is that, compared to
previous findings on disturbed children, the level of
underachievement found in the present study is considerably less severe. Apparently when I&is controlled
for and a clinically more relevant, individual measure
of achievement is used, the achievement of emotionally disturbed children may not be as low as previously
assumed.

_ . ~

Spelling
46.74
6.52
46.74

age adjustment, found somewhat greater degress of

underachievement than the present study (Glavin and
Annesley, 1971; Motto and Lathan, 1966; Stone and
Rowley, 1964). One possible explanation for such differences might be in the use of the PIAT (rather than
the WRAT) which apparently provides a more accurate assessment of underachievement among clinical
populations (Silverstein, 1978; Wilson and Spangler,
1974).
A second possible explanation is that mean ages in
earlier studies tended to be somewhat older (close to
12 years) than in the present study; and underachievement tends to increase with age (Cullinan et al., 1981).
This pattern was clearly evident in the present study
in which the youngest children displayed varying degrees of overachievement in reading and math. By age
9, academic deficits were beginning to emerge. Despite
this age trend, however, the only significant age difference found was among the 10-year-olds who displayed greater underachievement in math than the
7-, 8-, or 12-year-olds. This might be explained by the
greater difficulties encountered when fractions and
division are introduced during 4th and 5th grades.
Also, this study did not consider grade retention when
computing underachievement. Since math skills, perhaps more so than reading, may be influenced by
opportunity for classroom instruction, lower math
scores may have simply reflected lack of exposure due
to retention in lower grades.
In addition to age differences, there were also significant sex differences within particular age groups.
Twelve-year-old girls were found to be almost 2 years
above grade level in reading recognition and reading

144

FORNESS ET AL.

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