Never before have we heard so much about child and adolescent mental health in the news, and for good reason. A recent survey of nearly 8000 children and young people found that one in eight children aged 5-19 have at least one diagnosable mental health disorder (1). In other words, three children out of an average school class may be experiencing a mental health difficulty.
Emotional disorders such as anxiety and depression are most common, with the number of children aged 5-15 experiencing these difficulties having increased from 3.9% in 2004 to 5.8% in 2017. It follows then that the number of referrals made to Child and Adolescent Mental Health Services (CAMHS) is also increasing, along with A&E hospital admissions for young people who have self-harmed (2, 3).
When we stop and think about what may have contributed to this increase, it is likely that a number factors are at play. More people including GPs, school teachers, parents and young people themselves are increasingly aware of the signs and symptoms of mental health difficulties and where to seek support. Campaigns like Scotland’s See Me social movement to end the stigma around mental health are helping to improve reporting of mental health difficulties, by raising awareness and promoting equality between mental and physical health. In addition to this, there has also been a recognised increase in mental health difficulties in children and young people (4).
Working with children and young people I am constantly learning about how they interpret and understand the world they live in. As adults we may experience anxiety when faced with looming deadlines and a growing to do list at work or feeling low when comparing ourselves to others on social media. Similar issues such as Cyber bullying (5), the effects of social media (6) and a culture of increasing academic pressure (7) have all been found to impact on children and young people’s mental health and wellbeing across all ages and developmental stages.
As children start primary school, they’re at an age when they are developing some responsibility to do things by themselves, and it may be the first time they have spent a significant amount of time away from their parents. Their peer group start to become important and being accepted by others helps develop positive self-esteem. Bullying or repeated academic failure can impact on their developing confidence and self-esteem. As children grow older, they become increasingly aware of the world around them. The messages they receive from social media can contribute to their understanding of what society values. If children start to feel they are unable to meet the demands of society, whether looking a particular shape or size, following a certain diet or reaching high academic expectations, it can impact on their confidence and self-esteem and contribute to the development of mental health difficulties such as social anxiety, depression and eating disorders.
As children transition from childhood to adolescence and into adulthood, they follow a typical pattern of increasing independence and autonomy. They will also be forming their own identify, separate to that of their parents and peers. Stressful and distressing experiences during this time of life can interrupt this trajectory. The loss of a loved one, the diagnosis of a chronic illness or living in poverty can all impact on all areas of a child’s life, including school attendance and academic attainment, peer and family relationships and participation in sport and social groups. Difficulties in these areas can limit the opportunities to experience successes and failures, both of which help build resilience. Experiences such as these can leave children more vulnerable to developing mental health difficulties.
In addition, a developing teenage brain can make this period of life increasingly tricky to navigate. The final part of the brain to fully develop is the prefrontal cortex. This is the part of the brain that is responsible for decision making, organisation, problem solving and impulse control. While the prefrontal cortex is continuing to develop, young people might need help from the amygdala to make decisions and problem solve. The amygdala is the part of the brain which is linked with the ability to process and regulate emotions. It also controls our fight or flight anxiety responses when we believe we are faced with a threat. This can help explain why at times an adolescent’s actions can seem impulsive, risky and illogical. Without supports such as age appropriate boundaries, problem solving skills and help to regulate emotions, children and young people can struggle to build the skills to manage the difficulties they may face throughout life.
Over half of life time mental health difficulties (excluding dementia) are established by age 14, and three quarters by the age of 24 (8). In light of this it is important to consider what helps children and young people to develop positive mental health and wellbeing.
- Talking about mental health
Encouraging open and non judgemental conversations about emotions is really important to create an environment where children and young people feel it is safe e to let the adults in their life know how they are feeling. Talking about mental health in an open and non judgemental way in school, at home and in community settings will help to break down stigma associated with mental health difficulties.
- Encourage mindfulness practice
Mindfulness has been shown to reduce stress and build resilience in children and young people. Mindfulness can take the shape of creative activities or link with movement. It’s even better if you can be present in the moment with a child or young person and engage in a mindfulness activity with them.
- Be a role model
Ultimately children learn how to express and regulate their emotions from the adults around them. At times everyone will feel upset or angry and it’s normal to experience this range of emotions. Modelling how you remain calm, resolve conflict without confrontation and problem solve difficulties will help children and young people to develop their emotional regulation skills.
- Seek support for children and young people
Discuss your concerns with the child or young person and ask them how they’re doing. This may be enough to understand the cause of the difficulties and know how to address them. However, if you still have concerns seek advice from your GP who can offer guidance and refer if necessary to appropriate agencies.
(1) Mental Health of Children and Young people in England, 2017 [Internet]. 24 Nov 2018. Available from:https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017
(2) Page, Z. CAMHS benchmarking 2016. NHS England. [Internet] 24 November 2018. Available from: https://www.nhsbenchmarking.nhs.uk/news/camhs-benchmarking-2016findings-published
(3) National Society for Prevention of Cruelty to Children. Rise in children hospitalised for self-harm as thousands contact Childline. London: NSPCC, 2016.
(4) Collishaw S. Annual Research Review: secular trends in child and adolescent mental health. Journal of Child Psychology and Psychiatry. 2015;56:370 –393.
(5) Bottino SM, Bottino CM, Regina CG, Correia AV, and Ribeiro WS. Cyberbullying and adolescent mental health: systematic review. Cadernos de Saude Publica. 2015;31:463–475.
(6) Bell V, Bishop DVM, and Przybylski AK. The debate over digital technology and young people. British Medical Journal. 2015;351:h3064
(7) Lessof C, Ross A, Brind R, Bell E, and Newton S. Longitudinal Study of Young People in England cohort 2: health and wellbeing at wave 2. Department of Education Research report 2016 [Internet]. 24 November 2018. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/599871/LSYPE2_w2-research_report.pdf
(1) Hales CN, Barker DJP, Clark PMS, Cox LJ, Fall C, Osmond C, et al. Fetal and Infant Growth and Impaired Glucose Tolerance at age 64. British Medical Journal. 1991;303(6809):1019-22.
(8) Kessler RC, Berglund P, Demler O, Jin R, Merikangas, KR, Walters, EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):593-602.
National Centre for Social Research, the Office for National Statistics and Youth in mind. (2017).
feature image: Piron Guillaume via Unsplash