Beyond psychopathology: assessing seriously disruptive students in school settings.
OBJECTIVE
To obtain a demographic profile of aggressive students in an urban setting and discern psychiatric diagnoses, functional impairment, and psychosocial stressors.


METHODS
Participants were 33 students in an urban public school district referred for comprehensive psychiatric evaluation by school staff because they were viewed as a threat to school safety. Evaluations included a review of records, interviews with school and mental health professionals, and student and parent interviews.


RESULTS
Students were characterized by severe and untreated or undertreated psychopathology together with high levels of psychosocial stressors and learning disorders. Thirty-two students received at least one Axis I diagnosis, and the mean number of diagnoses for each student was 3; 33% had substance abuse problems, and 30% had nonpsychiatric medical conditions.


CONCLUSIONS
The sample is a chronically impaired group of students confronting serious adversity in their daily lives, whose psychosocial and psychiatric needs are not met by current educational and mental health programming. Necessary interventions include prevention and early identification, substance abuse and family treatment, and appropriate psychopharmacological treatment. A comprehensive psychiatric assessment can help change the outcomes for this group of aggressive students.
Rappaport
Nancy
N
Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA. nrappaport@comcast.ne
Flaherty
Lois T
LT
Hauser
Stuart T
ST
D000124:Achievement; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002908:Chronic Disease; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005190:Family / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011584:Psychology; D012574:Schools; D012720:Severity of Illness Index; D012931:Social Environment; D013315:Stress, Psychological / Q000523:psychology; D013334:Students / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D014505:Urban Population