Pathway to Care

What is a Serious Emotional Disturbance (SED)?

What is a Serious Emotional Disturbance (SED)?

Serious Emotional Disturbances encompass a range of mental health disorders in children and adolescents that significantly disrupt daily functioning in family, school, or community settings. Recognizing a SED involves identifying persistent symptoms that go beyond typical developmental challenges, and affect a child’s emotional well-being and ability to function. Understanding and learning to recognize a Serious Emotional Disturbance (SED) is crucial for accessing Home and Community-Based Services (HCBS).  Home and Community-Based Services (HCBS) extends its support to individuals with Serious Emotional Disturbance (SED), recognizing it as a significant emotional disability that can impair daily functioning in various settings. If you have a family member who is struggling with emotional distress, you may wonder if it qualifies as a serious emotional disturbance. 

What does a Serious Emotional Disturbance look like?

A Serious Emotional Disturbance (SED) is a diagnosable mental, behavioral, or emotional disorder found in children and adolescents. Specifically, the disorder significantly interferes with their ability to function socially, academically, and personally. SED goes beyond temporary responses to stressful events, representing a substantial disruption in daily activities across various settings such as home, school, and in interactions with peers. Many symptoms might indicate an SED and by recognizing these you can determine whether further evaluation or guidance is needed. 

Some common symptoms indicative of an SED:

  • Depression: The individual may feel overwhelmingly sad or hopeless most of the time, regardless of circumstances. They are unmotivated and no longer find joy in activities or relationships.
  • Thoughts of self-harm and suicide: Someone who is struggling with recurrent thoughts of death, dying, or suicide, or engaging in self-harming behaviors such as cutting or burning oneself. These thoughts and behaviors indicate a significant level of distress and require immediate attention.
  • Aggressive Behavior: Engaging in verbal or physical aggression towards others, such as yelling, hitting, or breaking objects during fits of anger or frustration. A person with serious emotional disturbance might lash out during a disagreement, shouting insults and slamming doors.
  • Severe Anxiety or Panic Attacks: Intense, overwhelming feelings of fear or apprehension, often accompanied by physical symptoms such as rapid heartbeat, sweating, and shortness of breath.
  • Difficulty Managing Emotions: Finding it challenging to regulate emotions, leading to frequent mood swings or emotional outbursts disproportionate to the situation.
  • Self-Destructive Behaviors: Engaging in behaviors that harm oneself physically or emotionally, such as substance abuse, cutting, or recklessness. Impulsively acting out in school or ignoring important tasks can be another sign of self-sabotage.
  • Obsessive Thoughts or Compulsive Behaviors: Persistent, intrusive thoughts or repetitive behaviors that the individual feels driven to perform to alleviate anxiety or distress. Someone with serious emotional disturbance might obsessively wash their hands dozens of times a day or repeatedly check that doors are locked to ease their fears of contamination or intrusion.
  • Psychotic Symptoms: Experiencing hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs), which may cause significant distress or impair functioning.
  • Severe Social Anxiety: Intense fear or anxiety about social situations, leading to avoidance of social interactions or significant distress when faced with them.
    A person with severe social anxiety may experience physical symptoms such as sweating, trembling, or nausea in social settings.
  • Lack of Social Skills: Difficulty in understanding social cues, maintaining appropriate boundaries, or forming meaningful connections with others.
    An individual with serious emotional disturbance might struggle to engage in small talk or initiate conversations, leading to awkward interactions with peers. They may have trouble understanding nonverbal communication cues, such as facial expressions, eye contact or body language, which can hinder their ability to build relationships.
  • Manipulative Behavior: Using deceit, guilt-tripping, or other tactics to control or exploit others for personal gain or to avoid facing consequences. They may use emotional manipulation tactics, such as guilt-tripping or gaslighting, to avoid taking responsibility for their actions or to fulfill their own needs or desires, even at the expense of others’ well-being.

These are some of the ways that a serious emotional disturbance may be displayed. If you recognize these behaviors in your child or teen, you may be concerned and wondering how to get them help. Emotional distress is very difficult to manage and impacts the entire family, which is why accessing available services and support is crucial. 

What are the most common examples of diagnoses that qualify as SED?

The symptoms indicative of Serious Emotional Disturbance (SED) represent a spectrum of mental health disorders that qualify for HCBS services due to their profound impact on daily functioning. These symptoms—ranging from extreme anxiety and depression to behavioral challenges—signal deep emotional distress that significantly hampers a child’s social, academic, and personal life. The inclusion of various mental health disorders under SED in HCBS eligibility highlights the recognition of these symptoms as markers of serious  emotional disability requiring specialized support and intervention.

Mandatory Eligibility Requirements for the HCBS Children's Waiver:

Children and youth seeking to access the HCBS Children’s Waiver must adhere to the following criteria:

Some of the most common diagnoses:

  • Major Depressive Disorder (MDD): Characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities, which significantly interfere with daily functioning.

  • Generalized Anxiety Disorder (GAD): Involves excessive worry or anxiety about various aspects of life, accompanied by physical symptoms such as muscle tension, restlessness, and difficulty concentrating.

  • Attention-Deficit/Hyperactivity Disorder (ADHD): Involves persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development, typically diagnosed in childhood but can persist into adulthood.

  • Post-Traumatic Stress Disorder (PTSD): Develops in response to experiencing or witnessing a traumatic event and involves symptoms such as intrusive memories, flashbacks, hypervigilance, and avoidance of triggers related to the trauma.

  • Borderline Personality Disorder (BPD): Characterized by unstable moods, relationships, and self-image, as well as impulsive behavior, intense fear of abandonment, and difficulty regulating emotions.

  • Obsessive-Compulsive Disorder (OCD): Involves recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in response to these obsessions, causing significant distress and impairment in daily life.

  • Bipolar Disorder: Marked by episodes of mood swings between periods of depression and mania (elevated mood, increased energy, and impulsive behavior) that significantly impact behavior and functioning.

  • Schizophrenia Spectrum Disorders: Include a range of conditions characterized by disturbances in thinking, perception, emotions, and behavior, such as hallucinations, delusions, disorganized thinking, and social withdrawal.

  • Conduct Disorder: Seen in children and adolescents and involves persistent patterns of behavior that violate societal norms and the rights of others, such as aggression, destruction of property, deceitfulness, and disregard for rules.
  • Eating Disorders (e.g., Anorexia Nervosa, Bulimia Nervosa): Characterized by unhealthy patterns of eating behavior and distorted body image, leading to significant physical and psychological consequences.

How would I test for an SED and what would my next steps be?

  • Initial Contact: The first step involves reaching out to an organization specializing in psychiatric evaluations. If you need guidance in finding one, an HCBS agency can assist you with a referral. You can also reach out to us at Pathway to Care, and our case managers can help you with a referral for psychiatric evaluations. 
  • Psychiatric Evaluation: Once you have chosen a psychiatrist, they will schedule an evaluation to gain clarity through a diagnosis. This is an essential part of the process. Our clinic can also offer evaluations to better understand the individual’s needs and the severity of their condition.
  • Case Manager Assignment: Once you’ve received a diagnosis, you will be assigned a case manager through your HCBS agency. This professional will serve as your main point of contact, helping you navigate the system, understand the processes involved, and answer any questions you might have.
  • Finding a Therapist: Your next step would be to find a therapist who can support and help you towards emotional healing. Based your unique situation and needs, you can look for someone who specializes in the specific issues you are dealing with. Our agency is partnered with a therapy clinic on-site, so if you have a case manager through us you can reach out to them to guide you through this process.
  • Case Coordinator Guidance: Finally, a case coordinator will provide detailed information on the types of HCBS services the individual qualifies for and can receive. This step ensures that you’re aware of all available support and how it can be accessed.

Each of these steps is designed to provide guidance and support, ensuring that individuals with SED receive the targeted help they need. This is not an easy situation to deal with, and you should not feel alone during the process. 


Dealing with Serious Emotional Disturbance (SED) can be challenging for families, but thankfully, help is available. HCBS programs offer comprehensive support within the community, including case management, to assist families in navigating these difficult situations. Whether you’re at the beginning of seeking a diagnosis or further along in managing SED, Pathway To Care is here to guide you every step of the way. We encourage you to reach out to us, so we can help you access the benefits of the HCBS program and the community resources available to you.

Tags :
Diagnoses, Serious Emotional Disturbance
Share This :