Mental and Physical Health in children – working with the whole child
According to the most recent NHS statistics, 12.8% (one in 8) of 5-19 year olds were diagnosed with a mental health condition (which met the criteria for a recognised disorder) in the UK in 2017. Of these, 7.8% had one mental health condition while 5% had two or more.
Interestingly, the survey also examines the links between children with mental disorders (their term not mine – meaning a recognised mental health condition or other neurological condition such as Autism) and physical conditions or developmental delays. They found that children with a ‘mental disorder’ were eight times more likely to report having difficulties with co-ordination (10.6%) than those without (1.3%), and about five times more likely to have speech or language problems (14.9% compared to 3.2%). Children with special educational needs were also were found to have a higher rate of emotional disorders (20.3%) than the average population.
So, what does this all mean?
Firstly, these statistics highlight the high prevalence of mental health conditions in children and young people (approximately 2-3 children per classroom depending on the age group). Secondly, these statistics also show the overlap between different aspects of mental health and more importantly (in my opinion) the interplay between mental and physical health.
As Occupational Therapists, we are trained to take a holistic view of the child and consider both the child’s psychological and physical needs in our assessment and intervention. However, it has been my experience that the Western model of healthcare (not just for children, for adults too) does not operate like this.
Most children’s services operate under a family or child centred model (such as Bronfenbrenner’s ecological systems model) which consider the child in the context of their environment (home, school and community). However, few health services (that I know of) provide services to address both the mental health and physical health of the child or of a condition. I’ll explain what I mean…
Children with a physical or language delay (whether part of another condition or not) are likely to experience difficulties performing everyday tasks and navigating social situations at the same level as their peers. This can be particularly evident in school where they may have handwriting difficulties, motor coordination deficits, and/or written and spoken language delays. This makes it more difficult for them to achieve their full academic potential and make and keep friends. Subsequently, difficulties in both of these areas (school and friends) can have a hugely negative impact on a child’s self-esteem and mood i.e. their mental health and wellbeing.
Similarly, children with a mental health condition such as anxiety or depression may withdraw socially or miss a lot of school, decreasing their opportunities to practise language, academic or motor skills which may create a ‘skills gap’ in these areas. Some mental health conditions themselves by their nature, such as Attention Deficit Hyperactivity Disorder (ADHD) for example, can lead to developmental delays due to the child’s difficulty maintaining attention on a task for long enough to master it. Hence the cycle continues (not keeping up with peers, poor self-esteem, etc.) and the child may end up with other mental health issues.
Autism Spectrum Disorder (ASD) in particular, is a condition which has many ‘physical’ features such as coordination, language and learning difficulties and many ‘mental health’ issues such as anxiety, social skills difficulties and behavioural difficulties. However, instead of ASD being considered both a mental and physical condition, it is often considered to be neither.
As health professionals and educators, what can we do?
I’m sure if you work in health or education or have a child with a physical or mental health condition, what I’m saying here is no surprise to you. The question is - as health professionals and educators, what can we do? How do we work together to try and address all aspects of the child’s development so the child can achieve their full potential and decrease the impact of their physical or mental condition on other aspects of their health and learning?
As little fish in a big pond, it may be beyond our reach to try and change the whole model of health care delivery. But perhaps within your own team, department, school or clinic, you might start to find ways to work with other services in your area and be the first fish that changes the whole school’s (a school of fish I mean!) direction.
And finally, if you are a parent of a child who needs additional supports - you are the glue that holds all the ‘pieces’ of your child together. You always see the whole child, because they are your whole child… so keep doing what you’re doing. If you see a need say it (even if a professional tell you it’s not their area), focus on the positive attributes your child brings to the world and hopefully the rest of us will eventually catch up!
The books ‘Max and Me - a story about sensory processing’ and ‘Dexter and Me – a story about motor coordination’ show how sensory and motor issues can affect a child’s emotional health and wellbeing and participation in school. Available from www.ldalearning.com.
Ines Lawlor
