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Sometimes patent medicine works: a reply to Braaten, Kauffman, Braaten, Polsgrove, and Nelson.

Sometimes Patent Medicine Works: A Reply to Braaten, Kauffman, Braaten, Polsgrove, and Nelson

According to the American Heritage Dictionary of the English Language, a patent medicine is "a drug or other medical preparation that is protected by a patent and can be bought without a prescription." * Concerned about the "reduction of special education services for behaviorally disordered (BD) students which may result from the movement known as the regular education initiative (REI)," Braaten et al. (1988) recently argued that (a) some students with behavioral disorders require special education, (b) such students can be identified in many cases on the basis of their problem behavior (s), (c) students with behavioral disorders are "notoriously" underserved, (d) these students are labeled before they enter special education, (e) these students require different educational technology, (f) teachers of students with behavioral disorders need different skills than most teachers, and (g) the "REI jeopardizes the meager services available to these students and probably would cause many to be shunted out of education altogether".

The fundamental concern that Braaten and his colleagues addressed was that proponents of the REI movement have proffered reform proposals with "little concern for available data or their political and pragmatic ramifications". They attacked proponents of the REI in such a manner that we are concerned that the REI perspective is misrepresented. In building a case to support their beliefs that the REI may be "patent medicine" to students with behavioral disorders, Braaten et al. addressed issues related to (a) integration and (b) right to treatment. We will review their arguments and point out inconsistencies with the basic tenets of the partnership movement to illustrate an alternative perspective on the REI.


These arguments by Braaten et al. are based on opinions about research on identification practices; opinions about labeling; opinions about the appropriateness of placing students with behavioral disorders in regular classrooms; opinions about teachers' attitudes, skills, and priorities; and opinions about the effects of the excellence-in-education movement.

The authors believe that students with behavioral disorders are not an overidentified group in special education (few have argued that they are). They share concerns about the stigma associated with the "behaviorally disordered" label (but they believe the stigma is more the result of what these children do rather than what they are called). They agree that "the mainstream is most appropriate for many handicapped students" (emphasis in original), but that research "clearly does not support the assertion that all students can be managed and taught effectively in regular classes" (emphasis added).

Moreover, they believe that "expecting general education teachers to welcome, successfully teach and manage, and tolerate the most disruptive and disturbed students is extremely naive and illogical, both from the viewpoint of common sense and from the perspective of available research". (With regard to their last concern, we believe that expecting any teachers to "welcome, successfully teach and manage, and tolerate the most disruptive and disturbed students" is asking a lot.)


The second group of arguments by Braaten et al. is based on opinions about eligibility for services, rights to privacy, and appropriate interventions. The authors believe that students with behavioral disorders are underidentified and that under the REI even more will be denied appropriate help. They fail to point out, however, how identifying them will solve their problems.

They believe that being served in special class settings affords these students privacy that they welcome in dealing with their problems (the argument that segregation is better than integration). The authors believe that research does not support the contention that the long list of complex interventions that are appropriate for use with such students can be effectively used in general education settings.


Braaten and his colleagues support efforts to provide effective, humane programs for all students, they encourage the strengthening of partnerships among those interested in education, they believe teacher training can and should be improved, and they encourage continued research on effective means of serving students with disabilities in regular classrooms. It is also their opinion, however, that

the REI threatens to undo much of the yet

unfinished advocacy for appropriate education

of BD students. We see it as an appealing but

ineffective remedy for special education's

painful and endemic ills, a patent medicine

"cure" with particularly hollow promise for

the serious complaints engendered by students'

behavioral disorders.

The authors offer no advice, however, about how to address the "painful and endemic ills" that plague special education other than by placing more students in it. They seem to be saying that principles they believe are engendered in the REI movement will not work. It is interesting that few data are presented among concerns regarding the REI. We also noted a conspicuous lack of reference to work that failed to support the special programs into which many of these students are being placed (Grosenick & Huntze, 1983; Lentz, 1985).

We might oppose a complete restructuring of education primarily on the grounds that it would not be possible or profitable for most students currently receiving support in special education programs; but we are not convinced that it is impossible to serve many more students in general education classes. We agree that sometimes it will be necessary to remove some students, but this should not be done until repeated efforts with data-based interventions have failed to maintain students in regular classroom environments. It does not make sense to put a person in a hospital to reduce a fever that could be managed by carefully controlled and monitored administration of aspirin in his home.


We are troubled by the "patent medicine" arguments. First, we were unaware of a growing movement to place students with behavioral disorders in the "overidentified" groups. We were unable to determine the basis for the contention that they are. We checked the citations Braaten and his colleagues provided as evidence that "students now receiving special education--including those considered BD--have been misidentified and inappropriately placed". We reviewed Biklen and Zollers (1986) and found only one reference to students who may be considered disturbed.

The article is about advocacy in the learning disabilities field; the authors "offer a critical look at the current focus of advocacy, highlight alternative practices intended to reshape that focus, and recommend a blueprint for the future". There was no suggestion that students with behavioral disorders are misidentified and inappropriately placed. Algozzine, Ysseldyke, and Christenson (1983) also did not suggest that these students have been misidentified or inappropriately placed. They did cite information from the U.S. Department of Education's Second Annual Report to Congress on the Implementation of Public Law 94-142: The Education for All Handicapped Children Act (published in 1980) indicating that "the majority of children between the ages of 3 and 21 being served in school year 1979-80 were either learning disabled (32 percent of the total), speech impaired (29.5 percent), or mentally retarded (22 percent)," and that the largest increases occurred in the categories of "learning disabled and seriously emotionally disturbed". They add that the authors of the federal report believed the "increase in services for emotionally disturbed children is particularly noteworthy, since these children traditionally have been among the least served".

It appears that Braaten and his colleagues have interpreted this information to mean that Algozzine and his colleagues are suggesting that students with behavior disorders are being overidentified. Our reading is that more students were being identified, but that "more" does not mean overidentification in the context of students representing approximately 8% of the students with disabilities (less than 1% of the school population) being served in special education programs.

We do not know if students with behavioral disorders are either overidentified or underidentified; in fact, we have not studied that question in any of our research. We do know that the population with serious emotional disorders (as percent of total enrollment) increased from 1978-1986 (World Almanac, 1988). We also know that "with changes in the overall population of children in the last 10 years taken into account, the data on percentage of population served under the two laws [Part B of the Education of the Handicapped Act and Chapter 1 of the Education Consolidation and Improvement Act--State Operated Programs] show a more or less steady increase between 1977 and 1987" (U.S. Department of Education, 1988).

Moreover, we know that the largest increase in number of children counted under various classifications of disabilities was evident for students classified as learning disabled. We also know that the change in the other categories was much less, but that the next "largest increase was in the category of emotional disturbance, with 35.9 percent more children". We hope the movement to identify more students as emotionally disturbed will ultimately result in more services, and we hope this will be good for special education. We have never thought that disturbed students were being overidentified--and we do not think they are today. If a conservative prevalence estimate of 3% of the school population becomes a reality, however, there probably will be some professional outcries of overidentification.

We agree with Braaten and his colleagues that efforts to provide effective, humane programs for all students should be supported; that strengthening partnerships among those interested in education is a noble, necessary goal; that teacher training can and should be improved; and that continued research on effective means of serving students with disabilities in regular classrooms should be encouraged. We are less concerned than they seem to be about trying to educate a few more students in regular classrooms than in special classrooms. Our primary concern after reading the "patent medicine" article was that the underlying principles of the REI are being misrepresented. We reviewed Educating Students with Learning Problems: A Shared Responsibility by Madeleine Will (1986) and noted the following points from Ms. Will's position paper: 1. The term learning problem was used

"broadly to address children who are having

learning difficulties, including those who

are learning slowly; those with behavioral

problems; those who may be educationally

disadvantaged; and those who have mild

specific learning disabilities and emotional

problems; and perhaps, as we improve our

knowledge, those with more severe

disabilities" (Will, 1986). The intent to limit

the universe of students being discussed was

obvious and, in our opinion, very

appropriate. 2. There is no failure to recognize the

unserved. For example, Will points out that large

numbers of students with disabilities were

placed in special classes in recent years and

adds that "another 10-20 percent of the

students who are not classified as

handicapped, have learning, language, or

behavior problems that impede their educational

progress" (Will, 1986). 3. Although much has been accomplished in

special education programs, "problems have

emerged which create obstacles to effective

education of students with learning

problems" (Will, 1986). She did not use

the term "obstacle" to "imply that special

programs have failed dismally in their

mission to educate children with learning

problems," nor to suggest that the "existing

general system of education for these

children warrants radical reform and

redesign". She did use the term to

"convey the idea that the creation of special

programs has produced unintended effects,

some of which make it unnecessarily

cumbersome for educators to teach--as

effectively as they desire--and children to

learn--as much and as well as they can".

The obstacles include the following:

a. Problems created by a fragmented

approach that fails to provide services to

many students who are "often not served

adequately in the regular classroom and

are not `eligible' for special education or

other special programs because they do

not meet State or Federal eligibility

requirements" (Will, 1986). (Here

is clear concern for yet another group of

unserved students.)

b. Problems created by dual (perhaps

dueling) administrative systems for special

programs that "contribute to a lack of

coordination, raise questions about

leadership, cloud areas of responsibility, and

obscure lines of accountability within

schools" (Will, 1986).

c. Problems created by segregating students

from their peers and attaching labels to

them that sometimes result in lowered

expectations for success--which "have

been fully described in the literature"

(Will, 1986).

d. Problems created by a decision-making

process that sometimes turns a valuable

partnership between parents and teachers

into a series of "adversarial, hit-and-run

encounters" (Will, 1986) that leave

everybody tallying points instead of

considering unique learning needs and

most appropriate educational services to

the greatest extent possible.

In describing "a solution to the problem," Will provided an important qualification for her argument. She stated: "Although for some students the `pullout approach' may be appropriate, it is driven by a conceptual fallacy: that poor performance in learning can be understood solely in terms of deficiencies in the student rather than deficiencies in the learning environment" (Will, 1986). She believes the premise that creating new educational environments as the primary way to improve student performance is flawed; the alternative she advocated would "adapt the regular classroom to make it possible for the student to learn in that environment".

In closing, she challenged states "to renew their commitment to serve [children with learning problems] effectively" and points to the heart of the commitment as being a "search for ways to serve as many of these children as possible in the regular classroom by encouraging special education and other special programs to form a partnership with regular education" (Will, 1986). She added:

The basic educational issue for serving this

growing group of young people is not finding

something to call them so we can put money

in a pot with that label on it. The basic issue

is providing an educational program that will

allow them to learn better.

From that point, we can construct an

educational environment that is a broad and

rich continuum, rather than a series of discrete

programming slots and funding pots. Within

that range of available services, we can then

pick and choose what we need to construct the

program the child needs. We can deliver the

resources and provide the personalized

instruction each child must have to achieve to his or

her greatest potential. In short, we need to

visualize a system that will bring the program

to the child rather than one that brings the child

to the program. (Will, 1986).

It seems clear to us on this recent review that Will's position on the REI (which is not a phrase that is prominently used in the document we reviewed) is not particularly radical. Frankly, most of us (including Braaten and his colleagues) agree with the basic premises of her position. We think we all fully understand the problems faced by teachers in managing problem behaviors in any classrooms. We are not ready to give up the idea that some of these problems can be addressed by more effectively organizing the classrooms where they occur rather than removing the students who demonstrate them from those classrooms.

We think it is understandable to have misrepresented the REI perspective. In our reading of literature other than Will's (1986) original paper, either the goals and perspectives of the shared responsibility initiative have not been clearly articulated or they have been represented by interpretations in secondary sources (cf, Gartner & Lipsky, 1987; Lipsky & Gartner, 1987; Pugach, 1987; Reynolds, Wang, & Walberg, 1987; Stainback & Stainback, 1984, 1987).

For example, Will did not suggest the hope of "better education for all students, all in regular class settings" (Braaten et al., 1988, emphasis in original). She did not suggest that "no student should be segregated from the peer group" (Braaten et al., emphasis in original) or that "integration of behaviorally disordered students" should be forced on teachers. Will did not suggest that denying special teachers and programs for students in need of them is best or recommended practice (Braaten, et al.). Again, as we read Will's position, it is essentially very similar to that of Braaten and his colleagues.


A new "controversy" has appeared in special education. Like much before it, the REI has the potential to polarize special education, alienate professionals, and stifle scientific inquiry (cf., Sapon-Shevin, 1988; Trent, 1989). The initiative designed to adopt a shared responsibility for special students may also provide a golden opportunity for putting our collective, creative minds to work. Educators are greatly in need of more effective instructional options for working with diverse student populations, more systematic procedures for increasing teacher use of instructional alternatives, and more coherent administrative policies and arrangements to support and maintain the use of these interventions. It is quite apparent that such knowledge can be acquired through experimental trials within the context of an "alternative to special education initiative."

In comparing the REI efforts to patent medicine, Braaten et al. seemed to suggest that as a prescription for the endemic ills of special education, it will fail, because patent medicine is not good. They seemed to forget that many medicines available without prescription work. They also seemed to suggest that special education, as the prescribed treatment for students with behavior disorders, is therefore good (i.e., if medicine available without prescription is bad, medicine available with prescription is good). We have trouble with this argument. In The People's Pharmacy, Joe Graedon (1976) argued,

There is no such thing as a safe drug. Each

medication is a double-edge sword, with a

good side and a bad side. Successful treatment

is a careful balance between the beneficial and

harmful effects, hopefully weighted in favor

of the beneficial. Unfortunately, just the

opposite is often the case. The original disease

may be less of a problem than the reaction to

the treatment, and the old dictum "the cure

was worse than the disease" has frequently

been all too true. With any controversial topic,

it is possible to find groups of scientists or

"experts" who can quote studies and statistics

on both sides of the issue.

Is there a safe treatment for students with behavior disorders? Braaten et al. argued that interventions within the REI are unsafe and imply that special education is a safer treatment of choice. We think it is time to subject all prescriptions for improvement of special education to ongoing empirical trials. We are not convinced that the course of our field's condition is so promising that we can freely ignore any medicine, even those available without prescriptions that may not as yet be "doctor-tested."

Special education today cannot afford the luxury of accepting only prescribed interventions that have been demonstrated to be effective. If it did, much of what passed as "special education" in the past would be unacceptable; the risks of continuing the present course while waiting are simply too great. We can afford to redirect our own efforts to establishing the effectiveness of interventions prescribed by others. We may just find out that patent medicine works.

BOB ALGOZZINE is Professor of Teaching Specialties, Department of Teaching Specialties, University of North Carolina at Charlotte. LARRY MAHEADY is Associate Professor of Special Education, Department of Education, State University of New York at Fredonia. KATHERINE C. SACCA is Director of Collaborative Teacher Preparation Grant, University College, Buffalo. LARRY O'SHEA is Associate Professor of Special Education, Department of Special Education, Florida Atlantic University, Boca Raton, Florida.
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Title Annotation:Comment
Author:Algozzine, Bob; Maheady, Larry; Sacca, Katherine C.; O'Shea, Larry; O'Shea, Doris
Publication:Exceptional Children
Date:Apr 1, 1990
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