PROFESSIONAL LINKS
This chapter addresses the following:
Department for Education (2017) Statutory Framework for the Early Years Foundation Stage: Setting the Standards for Learning, Development and Care for Children from Birth to Five. London: DfE.
CHAPTER OBJECTIVES
By the end of this chapter you will understand:
the risk factors that can result in children developing mental ill-health;
your role as a practitioner in mitigating these risk factors.
INTRODUCTION
This chapter addresses the risk factors that increase the likelihood that children will develop mental ill-health. Some of these factors are related to adverse childhood experiences that children are exposed to in the home and the community. While you cannot always eradicate these from children’s lives, there are things that you can do within the context of the early years setting to compensate for the effects of these adverse experiences. This chapter addresses the individual, family and community factors that increase the risk of childhood mental ill-health. It also addresses the role of practitioners within the setting in mitigating some of these risks.
As a practitioner, you must understand the ways in which genes influence children’s learning. Developing this understanding allows the children you teach to thrive, become more fulfilled and thus experience positive mental health. Furthermore, children are individuals with their own traits, temperament, needs and preferences (Asbury and Plomin, 2013). Therefore, we need to acknowledge that more of the same is unlikely to be the most suitable approach for most children.
If a child is not learning in the same way as other children or is not making the progress they are expected to, you must adapt your approach and use your knowledge of children as individuals. This is likely to involve making decisions to allocate or target resources and support at specific children while withdrawing these from others. Through understanding the needs of all children, education can support all children and ensure that genetic influences are not a negative barrier to a child achieving successful outcomes (Asbury and Plomin, 2013).
Children may also seek learning opportunities on the basis of their preferences, which have been shaped by their genes (Asbury and Plomin, 2013), and as a practitioner you must look for and respond to these calls to maximise children’s chances of fulfilling their potential across all area of learning and development in the Early Years Foundation Stage framework. Doing so personalises a child’s learning, provides an inclusive environment for all and allows positive mental health to permeate the early years.
While research studies have confirmed that genetic factors have a substantial influence on children’s learning (Schumacher et al, 2007), the debate of nature and nurture remains critical. This debate continues to produce evidence that demonstrates the impact of environmental loci (Hart et al, 2014). These include the children themselves, as well as practitioners and parents who can work together and overcome many of the challenges of genetic influence (Hart et al, 2013).
LEARNING DISABILITIES
Children with learning disabilities have a higher risk of developing mental ill-health compared to the general population (Hackett et al, 2011). It has been argued that they are six times more likely to develop mental health difficulties (Emerson and Hatton, 2007), and for those with learning disabilities who are placed in the care system the likelihood of developing mental ill-health may be even higher than this (Taggart et al, 2007).
Children with learning disabilities may experience multiple forms of disadvantage. They are more likely to experience social deprivation and adverse childhood experiences. They may also have multiple and complex disabilities, and this can affect their feelings of self-worth. The rates of anxiety disorders in children with autistic spectrum conditions range from 11 per cent to 84 per cent (Brookman-Frazee et al, 2018) and research suggests that children with autism often access mental health services due to demonstrating challenging behaviour (Brookman-Frazee et al, 2012).
FOETAL ALCOHOL SPECTRUM DISORDER
Foetal alcohol spectrum disorder (FASD) is a term used to describe the range of mental and physical birth defects caused by alcohol exposure during pregnancy. Alcohol disrupts foetal development and FASD refers to the permanent brain damage that results from this pre-birth exposure (Catterick and Curran, 2014). The deficits caused by FASD are not fully understood, although exploring and understanding these is critical in supporting those affected (Rasmussen, 2005). Children with foetal alcohol spectrum disorder may exhibit physical anomalies including vision, hearing and motor problems (Stratton et al, 1996).
As a practitioner, there any many strategies that you can use to support children with FASD and in doing so ensure their inclusion and thus support their positive mental health. Using children’s names to make sure that you have their attention before you speak to them can support those experiencing hearing difficulties. You should also use concisely chunked instructions and simple language to support children with cognitive and motor difficulties. Where possible, practitioners should also share with parents and carers any common language that can be used both at the child’s home and during their interactions at school.
Practitioners must also acknowledge the strengths and interests of those with FASD when considering their own planning, as this supports the provision of an inclusive environment for children who may otherwise by overwhelmed by sensory stimulation. Likewise, multisensory experiences can be based around students’ sensory strengths and these can promote positive mental health (Blackburn, 2010).
Children who are resilient can ‘bounce-back’ from adversity. Their response to a negative experience is to acknowledge it, recover from it and then learn from it. Resilient children are not permanently negatively affected by adverse experiences. They can move forward from situations and experiences to lead positive and fulfilling lives. Children who are less resilient may be negatively affected by adverse experiences for longer. It may take longer for them to recover from adversity and they may be permanently negatively affected by it. A variety of terms are used synonymously to denote resilience. These include perseverance, grit, determination, stickability, bounce-back and character.
Resilience in children is affected by their sense of self-worth. Those with a high self-worth may be able to recover from negative experiences more quickly than those with low self-worth. Confidence is also important. Children who lack confidence may take longer to recover from adversity compared to those who demonstrate high confidence. Additionally, children who adapt well to changes in their lives may be more resilient when they experience adversity compared to those who find change difficult.
CRITICAL QUESTIONS
How can practitioners promote resilience in the early years?
In what ways can practitioners support the development of physical and social and emotional resilience?
How can practitioners promote resilience in relation to perseverance after defeat; for example, when completing tasks such as building towers with bricks or completing jigsaws?
In 2017, 6.8 per cent of boys aged 2–4 years had mental ill-health.
In 2017, 4.2 per cent of girls aged 2–4 years had mental ill-health.
(Health and Social Care Information Centre, 2018)
CRITICAL QUESTIONS
FAMILY AND COMMUNITY FACTORS
Risk factors that detrimentally impact on young children’s mental health include:
parental conflict;
hostile or rejecting relationships;
parental psychiatric distress;
parental criminality;
children moving into care, being fostered or adopted;
As a practitioner you will need to be aware of which children are exposed to these risk factors. You will need to be aware of changes of mood and behaviour that may indicate that there are problems at home. Very young children may not be able to communicate their distress verbally. This is where key workers are important, as they will be attuned to the child’s usual behaviour and in a position to know when that changes. Sometimes children may alert you to situations at home, although this is rare. If you suspect that a child is being abused or neglected, you should always follow the guidance in the setting’s safeguarding policy. It is never acceptable to do nothing.
It is important that you provide a safe, nurturing environment for all children, but particularly for children who are experiencing adverse circumstances at home. The circumstances at home may result in the child developing low self-worth, high levels of anxiety or stress, depression, reduced confidence and social isolation. Adverse circumstances at home can also result in children developing social, emotional and behavioural difficulties.
Some children who experience adverse circumstances might be capable of working at or above age-related expectations across all areas of learning and development. It is important to have high expectations of all children in your care. If their progress suddenly stalls or declines, this might be an indication that the child is experiencing mental ill-health as a result of adverse experiences. You will need to observe the child in a range of contexts to ascertain whether there is sufficient evidence of mental ill-health or whether their mood and/or behaviour is triggered by something specific in the setting.
It is important that you do not stereotype families. Although adverse childhood circumstances take place in families that experience social deprivation, remember that abuse, neglect, domestic violence, family breakdown and parental criminality cut across all social backgrounds. Forms of neglect, for example, may vary across different social backgrounds but the impact on the child is still negative. Children may appear to be well-fed, clean and looked after, but sometimes these factors can mask adverse experiences that detrimentally impact on children.
Community factors also increase the likelihood of children developing mental ill-health. Socio-economic disadvantage has been associated with exposure to adverse childhood experiences that can increase the risk of childhood mental illness. In addition, community-related factors such as homelessness, national or community conflict can also increase the risk of children developing mental ill-health.
According to the Mental Health Foundation (2016, p 57):
A growing body of evidence, mainly from high-income countries, has shown that there is a strong socioeconomic gradient in mental health, with people of lower socioeconomic status having a higher likelihood of developing and experiencing mental health problems. In other words, social inequalities in society are strongly linked to mental health inequalities.
Thus, socio-economic disadvantage acts as a psychosocial stressor and can have a detrimental impact on children’s mental health and well-being. It is also associated with worse parental mental health, which is, in turn, a strong risk factor for poor child mental health and well-being (Education Policy Institute, 2018). Additionally, adverse childhood experiences, including experiences of abuse, neglect and parental conflict have a known and significant detrimental effect on children and young people’s mental health. These include trauma, poor attachment, parental alcohol and drug abuse, domestic violence, neglect and abuse (House of Commons, 2018).
CASE STUDY
Luke was four years old. He was attending the school nursery attached to the local community primary school and his father was an alcoholic. Consequently, Luke was, in the main, cared for by his mother. His parents argued on a daily basis and arguments frequently carried on into the night. Sometimes the arguments became physical. Often, Luke’s sleep was broken, and he was tired in the mornings, frequently resulting in him not wanting to attend the nursery. Luke was worried about his parents and he was reluctant to leave them during the day. He started to demonstrate uncooperative behaviour in the nursery and he became physically aggressive with practitioners and other children. Often, Luke would socially isolate himself away from other children and he pushed them away when his space was invaded. His progress across all areas of learning and development was below age-related expectations and his key worker, Emily, was concerned about his well-being.
Emily focused on establishing warm, positive and trusting relationships with Luke. She demonstrated unconditional positive regard towards him and she praised him when she noticed something positive. Sanctions were not applied, even when Luke demonstrated physical aggression. Emily decided to develop a social and emotional intervention programme for Luke and a small number of children in the nursery who were working below age-related expectations in personal, social and emotional development. The intervention focused on feelings. The children were taught, over several weeks, to name feelings and they were introduced to some strategies to regulate their own feelings. Emily also focused on developing their understanding of how other children’s feelings can be affected by things that are done to them or said to them. Sessions were interactive; Emily used a range of stories that focused on feelings and puppets. There was a strong focus on empathy, including how to show kindness to others. Emily then designed a series of sessions to focus on developing social skills. These sessions included themes such as turn-taking, sharing and being a good communicator.
After a term, all the children who had participated in the intervention, including Luke, were working at age-related expectations in personal, social and emotional development.
FACTORS RELATED TO THE SETTING
Establishing warm, positive and trusting relationships with all children is critical to develop children’s self-worth and confidence. Negative or hostile relationships can increase the likelihood of children becoming stressed, anxious or depressed and social learning theory suggests that children can imitate the behaviours that they observe.
Children who feel included in the setting and who experience a sense of belonging are less likely to develop mental ill-health. Displays and resources that reflect the lives and identities of children will facilitate a sense of inclusion. Young children often arrive in settings without the social, emotional, language and communication skills that they need to enable them to thrive within the setting. Responding to their behaviour through establishing sanctions is not an effective way of helping young children to learn how to adjust their behaviour to the context of the setting. Your role as a practitioner is to recognise that children have often not developed the social and emotional skills they need but with the right support they can learn to adjust their behaviour.
Effective settings in the early years provide opportunities for both adult-directed and child-initiated learning. Learning through play is more effective when practitioners intervene in children’s play to further develop their knowledge and skills. Children need exposure to child-initiated, adult-supported and adult-directed play as well as adult-directed learning. Achieving a balance between adult-directed and independent learning is crucial to support children’s learning and development. Providing children with access to a language and literacy rich environment in the early years will also facilitate the development of reading and writing skills. Children should have frequent opportunities to listen to stories and poems and to handle books. Providing children with choice in their activities will reduce stress and anxiety, although providing them with too much choice can restrict learning and development. Children need to be exposed to unfamiliar challenges to develop the skill of resilience. Practitioners can initially scaffold their learning in these tasks to support children to develop their skills and confidence.
CRITICAL QUESTIONS
Should the pedagogical approaches adopted in the early years be adapted for children in the Reception year? Explain your answer.
Do you agree that formal learning in the early years can result in children developing mental ill-health? Explain your answer.
How can resilience be developed in the early years?
CASE STUDY
Jane was a practitioner working in the early years in an area of social deprivation. She had identified a group of children at the start of the academic year who were displaying signs of conduct disorder. They were defiant to the practitioners in the setting and destructive to the physical environment. Other children in the setting had started to replicate the negative behaviours that they had observed. Jane noticed that the children were not using the resources in the continuous provision appropriately. Resources were not handled with care, were frequently broken and the children did not persist with self-chosen activities.
Jane realised that the children’s progress across all areas of learning and development in the Early Years Foundation Stage framework would be detrimentally affected by the children’s skills in personal, social and emotional development. The children did not know how to play, and they were not able to follow the rules of the setting. Children frequently moved from one activity to another without engaging in any meaningful learning opportunities and this meant that they were not exploiting the learning opportunities that were available to them.
Jane decided that all practitioners in the setting would be responsible for locating themselves in specific areas of continuous provision. The role of the practitioners was to model how to use the resources in the provision, how to play and persist with self-chosen activities. The practitioners also modelled vocabulary, language and communication skills while playing alongside the children. This adult intervention in children’s play was a way of scaffolding the children’s learning. Initially, the children were restricted to using two areas of provision; for example, they were permitted to move between the sand area and the water area. Using a planning board, they had access to different areas of provision on different days, but on a single day they were required to learn in two areas.
Over a period of four weeks the children demonstrated improvements in their behaviour. They had started to use the resources appropriately and they were persisting for longer in self-chosen activities. Eventually, Jane extended the range of areas to three and then to four. After seven weeks, Jane was confident that the children could have free access to all areas of provision and adult intervention in child-initiated play was reduced. Their behaviour improved, and they demonstrated progress in all areas of learning and development.
Research demonstrates that the physical, social and emotional environment in the setting impacts on children’s physical, emotional and mental health and well-being as well as impacting on their learning and development (Jamal et al, 2013).
In addition, research suggests that relationships between staff and children, and between children, are critical in promoting well-being and in helping to engender a sense of belonging to the setting (Calear and Christensen, 2010).
In 2017, 3.1 per cent of boys aged 2–4 years had a conduct disorder.
In 2017, 1.9 per cent of girls aged 2–4 years had a conduct disorder.
(Health and Social Care Information Centre, 2018)
CRITICAL QUESTIONS
SUMMARY
This chapter has identified the risk factors that increase the likelihood of children developing mental ill-health. The role and influence of foetal alcohol disorder syndrome, genetics and learning disabilities has been explored and the impact of these on children’s mental health has been highlighted. Practical strategies have been provided to equip practitioners with a toolkit to compensate for the effects of children’s adverse experiences. Individual, family and community factors that increase the risk of childhood mental ill-health have also been explained.
CHECKLIST
This chapter has addressed:
the risk factors that increase the likelihood of children developing mental ill-health;
the importance of practitioners responding to the needs of children affected by foetal alcohol disorder syndrome, genetic influences and learning disabilities;
the strategies available to you as a practitioner in supporting students with diverse needs;
the individual and family and community factors that increase the likelihood of children developing mental ill-health.
FURTHER READING
Asbury, K and Plomin, R (2013) G is for Genes: The Impact of Genetics on Education and Achievement (Understanding Children’s Worlds). Oxford: Wiley Blackwell.
Catterick, M and Curran, L (2014) Understanding Fetal Alcohol Spectrum Disorder: A Guide to FASD for Parents, Carers and Professionals. London: Jessica Kingsley Publishers.