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Positive Behavioral
Supports for the Classroom
Third Edition

Brenda K. Scheuermann   Judy A. Hall

 Preface vii

explain how to determine when a behavior reductive intervention is needed, citing IDEA
disciplinary requirements and guidelines for the ethical use of behavior reductive proce-
dures. Finally, we describe a hierarchy of interventions to reduce challenging behavior,
including differential reinforcement, extinction, response cost, time-out, and presentation
of aversive stimuli. Although we discuss aversive stimuli, we advise readers to avoid these
techniques because of the problems associated with punishment and because other PBIS-
based interventions should be sufficient for most behavior management needs.

Features of the Book

To create a text that is user friendly and that readers are able to apply in the classroom,
we have incorporated a variety of pedagogical features that are based on effective instruc-
tion. These features are designed to help readers organize material, translate theory into
application, and get ideas for behavioral interventions for a wide range of purposes. Each
chapter includes the following features designed for this purpose:
• “Big ideas” to introduce each chapter.
• Chapter objectives to guide the reader.
• Margin notes that summarize important concepts.
• Multiple vignettes in each chapter to illustrate the concepts being described. The
vignettes include elementary, middle school, and high school applications.
• Dr. I. C. Everything, or Dr. ICE, is a consultant who helps educators improve their
positive behavioral support techniques. Throughout the book, we present vignettes
in which Dr. ICE works with one or more teachers to assess student behavioral
problems and to design an intervention to address those problems. In addition,
most chapters feature one or more substantial end-of-chapter vignettes featuring
Dr. ICE that synthesize the concepts and skills from the chapter.
• The Toolboxes, Demonstrations, and links to videos described previously.
• Tables or figures to illustrate and expand on content.
• End-of-chapter summaries that review how each chapter objective was addressed.
• End-of-chapter learning activities so that readers can extend and apply the concepts
presented in each chapter.
• Resources for each chapter, including websites, books, journal articles, reports, cur-
ricula, and materials.
• A self-assessment for readers to evaluate their own skills and knowledge level per-
tinent to the concepts presented in each chapter.

A Final Note
Both of us are passionate about using effective, positive behavioral intervention strategies
and teaching others to use better strategies. Too many children suffer because their teach-
ers and administrators are not fluent in using the best tools available to prevent challeng-
ing behavior or to efficiently manage it in its earliest stages. It is a joy to visit a classroom
taught by a skilled teacher. Such teachers make behavior management look easy! We
believe that behavior management is easy, but only if you use the right tools and use them
correctly. We hope that this book will provide those tools for many current and future
teachers and that those individuals will then teach others what they know.

Acknowledgments
Writing a book is a journey that is filled with both rewards and challenges. The most
exciting professional benefits are the requisite careful examination of a broad literature
base and learning from many other experts. The challenges are the incredible time com-
mitment required and the seemingly endless details. In our case, many people helped us
meet those challenges. Our editor, Ann Davis, quite artfully and creatively guided our
planning for this third edition. The task seemed daunting at first, but through Ann’s tactful
and succinct questions and suggestions, it gradually unfolded into a manageable task.
viii Preface

Thank you, Ann, for your enthusiasm for this project, for your wisdom, and especially for
your patience when we seemed baffled by how to conceptualize the changes that we
wanted to make.
In addition to Ann, many other professionals contributed to bringing this project to
fruition. We are indebted to the following individuals for their consummate professional-
ism, careful attention to detail, and mastery of their respective crafts. We recognize the
extent to which their work elevates and enhances our work. Also, we are grateful for their
unfailing patience with our schedules and questions. These individuals include Kerry
Rubadue, Joe Sweeney, Chris Boyer, Robyn Alvarez, Jogender Taneja, Kristin Landon, and
Emerson Probst.
The work of many outstanding teachers also contributed to this text. Through their
knowledge and expertise, they have provided us with a wealth of effective practices that
we are happy to be able to share with readers. Although there are too many to name, we
wish to acknowledge their influence. We have learned much from these master teachers.
The book benefited from invaluable feedback from many reviewers who undoubt-
edly spent long hours to help improve our book. Our reviewers gave us excellent
­suggestions, and our book is significantly better for their assistance. They are Paula
­Travers, George Mason University; Jerome J. Ammer, University of San Diego; and Michael
Humphrey, Boise State University.
 Brief Contents

Part I Foundations of Behavior Management

and Positive Behavior Interventions
and Supports 1
Chapter 1 Introduction to Behavior Management and Positive
Behavior Interventions and Supports 2
Chapter 2 Theoretical Models to Explain Challenging Behavior 26

Part II Creating a Proactive Learning Environment

Through Universal-Level Supports and
Interventions 53
Chapter 3 Preventing Challenging Behavior Through Schoolwide Positive
Behavior Interventions and Supports 54
Chapter 4 Preventing Challenging Behavior Through Rules and
Procedures 74
Chapter 5 Preventing Challenging Behavior Through Effective Use of
Scheduling, Climate, and Classroom Planning and
Organization 88
Chapter 6 Preventing Challenging Behavior Through High-Quality
Instruction 102

Part III Assessment and Monitoring 141

Chapter 7 Preventing Challenging Behavior Through Behavioral
Monitoring 142
Chapter 8 Determining the Reasons for Challenging Behavior Through
Functional Assessment 158

Part IV Targeted and Tertiary-Level Interventions

and Supports 209
Chapter 9 Providing Support Through Social Skills Instruction 210
Chapter 10 Preventing Challenging Behavior Through Reinforcement:
Introduction to Reinforcement 222
Chapter 11 Preventing Challenging Behavior Through Specific Reinforcement
Applications 246
Chapter 12 Managing Challenging Behaviors by Using Behavior Reductive
Interventions 268

Glossary  302
References  309
Name Index   327
Subject Index   332

ix
 Contents

Part I F
 oundations of Behavior Management and
Positive Behavior Interventions and Supports 1

Chapter 1 Introduction to Behavior Management and Positive

Behavior Interventions and Supports 2
Behaviors That Teachers May Encounter 5
Diversity in the Classroom 8
The Critical Role of the Teacher 9
Concerns Regarding Traditional Approaches to Discipline 11
Making Schools More Effective for All Students 13
Assumptions About Student Behavior 16
Summary 23 • Learning Activities 24 • Resources 25

Chapter 2 Theoretical Models to Explain Challenging Behavior 26

Major Theories of Behavior and Their Usefulness in
Educational Settings 28
What Constitutes “Scientific Evidence” 28
Major Theoretical Models 30
The Biophysical Model 32
The Behavioral Model 37
Behavioral Explanations for Challenging Behaviors 42
Summary 49
Mr. Perry’s Inclusion Kindergarten Class 49
Mr. Ace’s Behavior Class 50
Ms. Scott’s Behavior Class 50
Learning Activities 50 • Resources 51

Part II Creating a Proactive Learning

Environment Through Universal-Level
Supports and Interventions 53

Chapter 3 Preventing Challenging Behavior Through Schoolwide Positive

Behavior Interventions and Supports 54
What are Schoolwide Positive Behavior Interventions and
Supports? 56
Research Support for Schoolwide Universal-Level Prevention 63
Features and Examples of Universal Interventions 64
Steps in Planning and Implementing Schoolwide SW-PBIS 70
Summary 70
Dr. ICE Helps a School District with PBIS 71
Learning Activities 73 • Resources 73

Chapter 4 Preventing Challenging Behavior Through Rules

and Procedures 74
Why Rules Are Important 75
Procedures 79

x
 Contents xi

Reminders 82
Implementing Rules and Procedures 83
Summary 85 • Learning Activities 86
Ms. Preston’s Kindergarten 86
Mr. Gonzalez’s 10th-Grade American History Class 86
Resources 87

Chapter 5 Preventing Challenging Behavior Through Effective Use of

Scheduling, Climate, and Classroom Planning and Organization 88
The Daily Schedule 90
The Classroom Climate 95
Classroom Organization 98
Summary 100 • Learning Activities 100
Ms. Morgan’s Elementary Class 101
Mr. Davis’s Resource Math Class 101
Resources 101

Chapter 6 Preventing Challenging Behavior Through High-Quality

Instruction 102
The Relationship Between Behavior and Instruction 103
The Characteristics of Students With Learning and Behavioral
Problems 104
Characteristics of Effective Instruction 108
Types of Instructional Arrangements and Activities 111
Instructional Arrangements 111
Instructional Activities 113
Practice Activities for Building Fluency and Facilitating
Maintenance and Generalization 119
Effective Instructional Practices 123
Common Instructional Problems and Suggested Solutions 134
Summary 135
Dr. ICE Helps Teachers Improve Instruction 136
Learning Activities 138 • Resources 138

Part III Assessment and Monitoring 141

Chapter 7 Preventing Challenging Behavior Through Behavioral

Monitoring 142
Why Behavioral Measurement and Monitoring Is Important 143
How to Measure Behavior 146
Summary 155 • Learning Activities 156
Dr. ICE Behavioral Monitoring Case Study 156
Resources 157

Chapter 8 Determining the Reasons for Challenging Behavior Through

Functional Assessment 158
Functional Behavioral Assessment Versus Functional
Behavioral Analysis 160
The Functional Behavioral Assessment Requirements of the
Individuals with Disabilities Education Act 162
xii Contents

Using FBA as an Assessment and Planning Tool 163

The Functional Behavioral Assessment Process 163
Behavioral Intervention Plans 170
Problems and Limitations of Functional Behavioral Assessment 172
Summary 173 • Learning Activities 174
• Resources 174 • Appendix: Case Studies 175

Part IV Targeted and Tertiary-Level Interventions and

Supports 209

Chapter 9 Providing Support Through Social Skills Instruction 210

Socialization Interventions as Part of Universal-Level Systems 219
Summary 219 • Learning Activities 220 • Resources 221

Chapter 10 Preventing Challenging Behavior Through Reinforcement:

Introduction to Reinforcement 222
What Is Reinforcement? 224
Types of Reinforcers 227
How to Choose Reinforcers 228
Schedules of Reinforcement 231
How to Develop and Implement Reinforcement Systems 236
Problem Solving When a Reinforcement System Does Not Produce
the Desired Results 239
Negative Reinforcement 241
Summary 242
Dr. ICE Helps Teachers Learn About the Power of Positive
Reinforcement 243
Learning Activities 244 • Resources 245

Chapter 11 Preventing Challenging Behavior Through Specific Reinforcement

Applications 246
The Premack Principle 247
Praise 248
Token Economy 249
Contingency Contracting 252
Stimulus Control 253
Group Reinforcement Systems 256
Self-Management 260
Summary 264
Dr. ICE Helps Teachers Solve Classroom Management Problems
Through the Use of Reinforcement 265
Learning Activities 267 • Resources 267

Chapter 12 Managing Challenging Behaviors by Using Behavior Reductive

Interventions 268
What Types of Behavior Warrant the Use of Behavior Reductive
Techniques? 270
2004 IDEA Requirements for Disciplining of Students with
Disabilities 272
 Contents xiii

Alternatives for Behavior Reduction and Guidelines for Choosing

Behavior Reductive Techniques 273
Behavior Reductive Techniques 279
Summary 294
Dr. ICE Helps Teachers Manage Challenging Behaviors 296
Learning Activities 300 • Resources 301

Glossary 302
References 309
Name Index 327
Subject Index 332
This page intentionally left blank
PA R T

One
Foundations of Behavior
Management and Positive
Behavior Interventions
and Supports
Chapter 1
Introduction to Behavior Management and Positive
Behavior Interventions and Supports

Chapter 2
Theoretical Models to Explain Challenging Behavior
Introduction to Behavior
Management and Positive
1

CHAPTER
Behavior Interventions and
Supports

Wavebreak Media Ltd/123RF

After reading this chapter, you will be able to do the following:
1. Describe the common types of school-based challenging behaviors.
2. Describe why the teacher may be the most important variable in students’ classroom
behaviors.
3. Describe the diversity found in today’s classrooms and explain the implications of this
diversity for behavior management.
4. Describe traditional disciplinary methods and the concerns associated with those methods.
5. Define and explain positive behavior interventions and supports.
6. Define response to intervention and how this concept relates to positive behavior interven-
tions and supports.
7. Explain the nine Behavior Assumptions that form the foundation for managing behavior in
school settings.

Big ideas in behavior management and positive behavior interventions

and supports:
• All children exhibit undesirable behavior at times. Most children learn quickly what
is and what is not allowed in particular settings; other children need more assis-
tance to learn to exhibit appropriate, rule-following behaviors.
• A graduated model of increasingly more intensive supports, as needed, is an effec-
tive and efficient approach to increasing appropriate behavior and reducing chal-
lenging behaviors across all students in schools or other settings.
• Years of psychotherapy—for students or the teacher—are not the best way to man-
age unacceptable classroom behaviors! The most effective behavior management
approaches are those that emphasize teaching and supporting desired behaviors.
• Teachers’ beliefs about student behavior may determine effectiveness in classroom
management.
• Classroom management problems and challenging behaviors exhibited by individ-
ual students may result from teachers’ practices rather than students’ problems
(i.e., something about the teacher’s behavior may be contributing to the situation).
This is actually good news!
• Positive behavior interventions and supports represent the latest evolution in behav-
ior management for individual student, classroom, and schoolwide applications.
• The extent to which all educators understand positive behavior interventions and
supports and know how to use them in all types of school situations will make
behavior interventions for all students more effective and efficient.

A ll children exhibit inappropriate behavior at times. Most undesirable behavior is a

normal, expected part of growing up. Fortunately, most children learn fairly quickly
which types of behaviors are tolerated and which are not, and when to stop inap-
propriate behaviors. They also learn that behavioral expectations vary among people,
places, and circumstances, meaning that they know with whom and where they can be
more rambunctious, silly, or noncompliant. By the time most children enter school, unde-
sirable behavior is more or less controlled by traditional means: reminders to behave,
relatively infrequent reinforcement, reprimands, time-outs, and parental contacts. Most
children need to experience minor consequences once in a while throughout their school
years, but for the most part, their behavior is appropriate and acceptable.
These strategies work for most children. However, anywhere from 10% to 30% of
school-age children may not respond to methods that work for other children (Martella &
Nelson, 2003; Office of Special Education Programs, 2010a). When faced with the behav-
iors of these children, educators often tend to view the child as the problem rather than
view the behavior management system as failing to meet the needs of that child (Martella,
Nelson, & Marchand-Martella, 2003). It is true that some children are less prepared than

3
4 Part 1 • Foundations of Behavior Management and Positive Behavior Interventions and Supports

their peers to meet both the behavioral and academic demands of school. Multiple indi-
vidual, family, and societal factors, which we discuss in Chapter 2, play a role in children’s
behavior. However, teachers have control over many other school-based factors that affect
behavior, including the design of classroom management and instructional systems. In fact,
most teachers and parents believe that teachers have the power to positively influence
student behavior (Public Agenda, 2004; Tillery, Varjas, Meyers, & Collins, 2012). This per-
ception is supported by research that indicates that teachers’ actions in their classrooms are
highly influential on student achievement—as much as or more than school administrative
and leadership policies (Marzano, 2003b). To achieve this positive influence, teachers need
to plan classroom and individual behavior management systems with the goal of creating
a meaningful, active instructional environment where rules and expectations are clear;
where more attention is given to desired behavior than to inappropriate behavior; and
where inappropriate behavior is dealt with systematically, consistently, and equitably.
Most of this text is devoted to explaining how to develop positive, proactive behavior
intervention systems and plan instruction in ways that are most likely to produce the desired
outcomes. The majority of the techniques that we describe for these purposes are based on
the philosophy and practices of positive behavior interventions and supports (PBIS).
According to the Office of Special Education Programs Technical Assistance Center on
Positive Behavioral Interventions and Supports:
A variety of factors can interfere
with a child’s school success. Positive behavioral support is a general term that refers to the application of
Teachers have control over positive behavioral interventions and systems to achieve socially important
many school-based factors that behavior change. . . . Positive behavioral support is not a new intervention
influence student behavior. package, nor a new theory of behavior, but an application of a behaviorally-
based systems approach to enhancing the capacity of schools, families, and
communities to design effective environments that improve the fit or link
between research-validated practices and the environments in which teaching
and learning occur. Attention is focused on creating and sustaining school
environments that improve lifestyle results (personal, health, social, family,
work, recreation, etc.) for all children and youth by making problem behavior
less effective, efficient, and relevant, and desired behavior more functional. In
addition, the use of culturally appropriate interventions is emphasized. (Sugai,
Sprague, Horner, & Walker, 2000, pp. 133–134)
PBIS represents a fundamental shift in managing unacceptable behavior from reac-
PBIS is a proactive, instruc-
tional, preventive approach for
tive, punitive responses to challenging behavior to a proactive emphasis on the prevention
improving outcomes for all of behavioral problems by using positive, instructional, research-based strategies to teach
students. and encourage appropriate behavior and manage the learning environment. PBIS is the
integrated application of (a) behavioral science, (b) practical interventions, (c) social val-
ues, and (d) a systems perspective (Office of Special Education Programs, 2010a) to design
interventions at the individual, classroom, and schoolwide levels for the purpose of increas-
ing success for all students. The techniques presented in this text reflect PBIS methods for
preventing inappropriate behavior, teaching and encouraging appropriate behavior, and
managing challenging behavior in all students, but particularly in students with mild to
moderate disabilities, at the individual, classroom, and schoolwide levels.
The goal of encouraging appropriate behavior and preventing and managing inap-
propriate behavior is a demanding task because teachers are expected to successfully
This video (www.­ teach a wide range of students, including students who are not well prepared for the
youtube.com/ demands of school and students who are not highly motivated to behave appropriately
watch?v=TUA__X4Uzz4) shows
and learn. The task is complicated by the fact that schools serve a diverse population of
how positive behavior interven-
tions and supports have students from varied cultural, ethnic, and religious backgrounds who have a range of
improved school discipline and abilities and learning histories. But the good news is that teachers have the power to meet
student learning in a Florida this challenge by using a wide array of research-based tools to support appropriate
­elementary school. behavior, to prevent and manage behavioral problems, and to deliver instruction. We
describe these tools, as well as the research to support their use with diverse populations
of students, in the remaining chapters of this text.
To illustrate the many concepts and skills presented throughout this text, each chap-
ter includes one or more classroom vignettes. These vignettes illustrate common classroom
 Chapter 1 • Introduction to Behavior Management and Positive Behavior Interventions and Supports 5

management issues and concerns. Many of the vignettes feature our expert behavior man-
agement consultant, Dr. I. C. Everything, known to his friends as Dr. ICE. Dr. ICE got his
nickname because he stayed cool during times of crisis. Dr. ICE began his work in the
early seventies, when special education was just beginning to be implemented in all public
schools across the country. Until then, many children with all types of disabilities did not
go to school. Dr. ICE’s university training was focused on learning about the characteristics
of major disabilities, with only a couple of classes on basic reading and mathematics
instruction. He took one class in behavior theory. Unfortunately, many of today’s teachers
are equally unprepared for the demands of teaching and classroom management (Darling-
Hammond, 2005), as we discuss later in this chapter.
Dr. ICE found out by lunchtime on the first day of teaching that he was underpre-
pared for classroom management. He was not able to make much progress in his lesson
plans because his students controlled his classroom. He had a rocky first year, to say the
least. He spent the summer researching the topic of classroom management and thinking
of changes that he could make in his classroom to make it a better learning environment.
The changes helped, and the second year was better. Still, Dr. ICE realized that he needed
more training if he was to stay in this challenging profession. His efforts in the area of
behavior management interested him a great deal, and he wanted to learn more. He has
spent the rest of his career going to school to learn about behavior, teaching and observ-
ing in classrooms, and training children and adults.

Behaviors That Teachers May Encounter

During their training, future teachers envision their classrooms as happy, productive envi-
ronments where students are interested in learning and where they eagerly participate in
lively discussions and exciting activities. Seldom do preservice teachers imagine class-
rooms that include students who do not do the assigned work, who show no interest in
what is being taught, who talk back to teachers or defy teachers’ instructions, who have
difficulty making friends or who are the target of peers’ taunts and derisive comments,
who talk or move too much, who come to school every day without the necessary sup-
plies, or who come from home environments where there is little support for the types of
behaviors that are expected at school. Such students abound, however, and every teacher
will encounter them. Failure to anticipate and prepare for such students’ behaviors may
leave teachers underprepared for the challenges of real-life classrooms.
The students just described are present in almost every classroom in every school in The most common behavioral
the nation. In a 2009 survey of almost 900 teachers by the nonprofit group Public Agenda, concerns reported by teachers
50% of respondents indicated that “too many kids with discipline and behavior issues” reflect relatively minor inappro-
was a major drawback to the teaching profession, yet 55% of respondents described the priate classroom behaviors.
working conditions of their school as “very good” in terms of order, safety, and respect
(Yarrow, 2009). We are particularly encouraged by the fact that 59% of respondents indi-
cated that student motivation is determined by teachers’ instruction.
A number of approaches have been used to attempt to quantify behavior problems
in American public schools. One comprehensive study compiled survey and incident data
from a number of sources and reported that, in the 2009–2010 school year, the most fre-
quently reported school discipline problems occurring in U.S. public schools at least once
per week were bullying (23% of schools), student acts of disrespect (8.6%), and student
verbal abuse of teachers (4.8%) (Robers, Kemp, & Truman, 2013). Gang activity (16.4% of
schools) and cult activities (1.7% of schools) were reported as occurring, but less fre-
quently than once per week. Other studies that have analyzed office discipline referrals
have found generally consistent patterns: Disruptive or aggressive behaviors are the most
common reasons for office referrals in elementary schools, and disrespect and attendance
issues (tardies, truancy) were most common in secondary schools (Kaufman et al., 2010;
Spaulding et al., 2010). Harrison, Vannest, Davis, and Reynolds (2012) surveyed a demo-
graphically representative sample of teachers to determine student behavior problems
commonly reported by those teachers, and then analyzed results according to age
­(children versus adolescents) and topography of the behavior problem (internalizing,
externalizing, academic). Table 1-1 lists these results. The good news for teachers is that
6 Part 1 • Foundations of Behavior Management and Positive Behavior Interventions and Supports

Table 1-1   Most Commonly Reported Disciplinary Problems

Children Adolescents
Internalizing Anxiety (worrying about mistakes, general worrying) Anxiety (self-doubt, perfectionism, worrying
about what others think)
Externalizing Distractibility, poor concentration Distractibility
Hyperactivity (excessive movement, rushing through tasks) Hyperactivity (overactivity, rushing through tasks)
Disruptive behaviors (not following directions) Silly or immature behavior
Academic Deficits in reading, math, spelling Not following task directions
Careless errors
Source: Harrison et al. (2012).

minor misbehavior is easily preventable and manageable using the techniques described
throughout this text; more serious behaviors will need more intensive interventions, such
as those described in Chapters 8 through 12 of this text. All students can benefit from the
schoolwide or systems-level preventive techniques discussed in Chapter 3.
Of course, not all school misbehavior is minor. Serious problems that threaten stu-
dent and staff safety can and do occur, and although these incidents are not widespread,
they must be considered in any discussion of school discipline. According to the 2012
Indicators of School Crime and Safety report (Robers et al., 2013), during the 2009–2010
school year, 1,396 youth ages 5 to 18 were victims of homicide; 19 of these homicides
occurred at school. Nonfatal victimizations are more common. In 2011, there were 1,246,000
reports of nonfatal victimizations of students ages 12 to 18 that occurred at school. These
incidents included thefts and threats or injury with a weapon of some type. Other major
discipline problems described in this report include fighting, use of illegal substances,
bringing a weapon to school, and bullying. During 2009–2010, 85% of public schools indi-
cated that one or more crimes had occurred at school, or a rate of approximately 40 crimes
per 1,000 students. During that same period, 60% of public schools reported a crime to the
police (15 reported crimes per 1,000 students). As a result of real and perceived threats to
school safety, schools now commonly employ multiple measures to enhance school secu-
rity. The most common safety precautions reported in schools (elementary and secondary)
are restricting access to the building, prohibiting student use of cell phones, limiting access
to Internet social networking sites, requiring staff to wear IDs, having an electronic warn-
ing system for schoolwide emergencies, and use of security cameras (Robers et al., 2013).
Approximately 60% of high schools also report using dogs to detect drugs.
Emotional/Behavioral Disorders in Children and Youth.   Most student behavioral problems
present relatively minor challenges for educators. However, in 1999, U.S. Surgeon General
David Satcher released a report estimating that as many as 20% of children ages 9 to 17 may
have diagnosable mental or addictive disorders (U.S. Department of Health and Human Ser-
vices, 1999). More recent estimates of the prevalence of mental health disorders in young
people support the figures reported by the surgeon general (National Advisory Mental Health
Council Workgroup on Child and Adolescent Mental Health Intervention Development and
Deployment, 2001). For example, the National Alliance on Mental Illness (NAMI) reports that
3 to 5 million children ages 5 to 17 (or 5% to 9% of this population) in the United States are
affected by serious mental disorders (National Alliance on Mental Illness, n.d.). Researchers
from the National Institute of Mental Health report that 20% of children and youth are affected
by a mental disorder that interferes with functioning, and 40% of those young people have
more than one disorder (Merikangas et al., 2010). Many reports on the prevalence of child-
hood behavioral disorders state that 12% to 22% of children under age 18 are in need of ser-
vices for emotional, mental, or behavioral problems (Center for Mental Health in Schools,
2003). A 2009 report from the National Research Council and Institute of Medicine states that
most mental, emotional, and behavioral disorders of adults begin in childhood or adoles-
cence, and that in any given year, 20% to 40% of children and youth have a mental, emotional,
or behavioral disorder (National Research Council and Institute of Medicine, 2009). These
disorders include diagnosable disorders, such as anxiety disorders or depressive disorders, as
well as behavioral difficulties that may not meet formal diagnostic criteria.
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