introduction to children

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introduction to children young peoples mental
health wellbeing

• Cumbria County Council

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youngminds

• Parents Helpline 0808 802 5544
• Tel [phone]
• Website http//www.youngminds.org.uk and
• Publications
• Training Development marcella.verdi_at_youngminds.
  org.uk

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Learning objectives

• You will be able to
• Describe conceptual models for thinking about
  mental health, mental health problems and
  disorders in CYP
• Briefly describe theories and research relating
  to attachment and brain development and explore
  their relevance to your area of practice
• Explore your own perspectives on children and
  young peoples mental health and emotional
  wellbeing and establish a foundation for further
  learning

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THE MENTAL HEALTH SPECTRUM
From Huppert Ch.12 in Huppert et al. (Eds) The
Science of Well-being
Moderate mental health
Mental disorder
Flourishing
Languishing
Number of symptoms or risk factors
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EFFECT OF SHIFTING THE MEAN OF THE MH SPECTRUM
From Huppert Ch.12 in Huppert et al. (Eds) The
Science of Well-being
Flourishing
Moderate mental health
Mental disorder
Languishing
Number of symptoms or risk factors
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Mental health A definition

• the strength and capacity of our minds to grow
  and develop, to be able to overcome difficulties
  and challenges and to make the most of our
  abilities and opportunities
• YoungMinds 2006

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Child Mental Health

• A capacity to enter into, and sustain, mutually
  satisfying and sustaining personal relationships
• Continuing progression of psychological
  development
• An ability to play and to learn so that
  attainments are appropriate for age and
  intellectual level
• A developing moral sense of right and wrong
• A degree of psychological distress and
  maladaptive behaviour within normal limits for
  the childs age and context

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An Integrative Approach
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Prevalence among children aged 5 15 in the UK
Mental or psychiatric disorder
Risk factors but no obvious problems now
Mental health problems
1.5 million or 10
30,000 or 0.2
3 million or 20
Severe disorder or mental illness
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Most common problems

• Emotional and conduct disorders are by far the
  most common
• Co-morbidity is the norm not the exception
• Children who face 3 or more stressful life events
  (eg bereavement, divorce, serious illness) are 3
  times more likely than other children to develop
  emotional and behavioural disorders

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Problems Disorders

• Mental health problem
• A disturbance of function in one area of
  relationships, mood, behaviour or development, of
  sufficient severity to require professional
  intervention.
• Mental disorder
• A severe problem (commonly persistent) or the
  co-occurrence of a number of problems, usually in
  the presence of several risk factors

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A bio-psycho- social model
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Risk and protective factors

• Risk Factors
• Protective
• Factors

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What are risk factors?

• Conditions, events or circumstances that are
  known to be associated with emotional or
  behavioural disorders and may increase the
  likelihood of such difficulties
• Risk is cumulative
• Risk is not causal but can predispose children
  to mental health problems

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Predisposing factors - child

• Genetic influences
• Low IQ and learning disability
• Specific developmental delay
• Communication difficulty
• Difficult temperament
• Physical illness, especially if chronic and/or
  neurological
• Academic failure
• Low self-esteem

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Predisposing factors - family

• Overt parental conflict
• Family breakdown
• Inconsistent or unclear discipline
• Hostile and rejecting relationships
• Failure to adapt to child's changing
  developmental needs
• Abuse - physical, sexual and/or emotional
• Parental criminality, alcoholism personality
  disorder
• Parental psychiatric illness
• Death loss - including loss of friendships

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Predisposing factors - environment

• Socio-economic disadvantage
• Homelessness
• Disaster
• Discrimination
• Other significant life events

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Resilient Children

• can resist adversity, cope with uncertainty and
  recover more successfully from traumatic events
  or episodes
• Newman, T (2002)

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resilience

• Normal development under difficult circumstances.
  Relative good result despite experiences with
  situations that have been shown to carry
  substantial risk for the development of
  psychopathology (Rutter)
• The human capacity to face, overcome and
  ultimately be strengthened and even transformed
  by lifes adversities and challenges .. a complex
  relationship of psychological inner strengths and
  environmental social supports (Masten)
• Ordinary magic .. In the minds, brains and bodies
  of children, in their families and relationships
  and in their communities (Masten)

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Finding Resilience in Me

• Think of a time in your life when you have
  struggled to cope with emotional difficulties
• What did you think?
• How did you feel?
• What actions did you take?

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Finding Resilience in me

• Talk to family or friends
• Sleep
• Eat
• Walk away, take time out
• Counselling
• Educate self about situation
• Laugh
• Throw self into new stuff
• Seek company or solitude
• Realise you have choices
• Use own skills positively
• Relate to past experience
• Break into manageable bits

• Peer support
• Positive feedback
• Retail therapy
• Chocolate
• Self expression
• Diary writing
• Spend time with animals
• Take time for yourself
• Spirituality
• Exercise
• Focus on work
• Meditation
• Medication

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Resilience in the child

• being female
• secure attachment experience
• an outgoing temperament as an infant
• good communication skills, sociability
• planner, belief in control
• humour
• problem solving skills, positive attitude
• experience of success and achievement
• religious faith
• capacity to reflect

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Resilience in families

• At least one good parent-child relationship
• Affection
• Clear, firm consistent discipline
• Support for education
• Supportive long term relationship/absence of
  severe discord

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Resilience in communities

• Wide supportive network
• Good housing
• High standard of living
• High morale school with positive policies for
  behaviour, attitudes and anti-bullying
• Schools with strong academic and non-academic
  opportunities
• Range of sport/leisure activities
• Anti-discriminatory practice

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Way attachment develops
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Secure attachment

• Is associated with
• Emotional regulation and containment of anxiety
• Capacity to tolerate uncertainty
• Trust, adaptability, hope and belonging
• The childs internal working model
• The childs capacity to mentalize
• A securely attached child is likely when faced
  with potentially alarming situations .... To
  tackle them effectively or seek help in doing so
• J Bowlby (1980) Attachment and loss Vol 3

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Insecure attachment

• Children whose needs have not been adequately
  met see the world as
• comfortless and unpredictable and they respond
  by either shrinking from it or doing battle with
  it.
• John Bowlby (1973) Attachment and loss Vol 2

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Avoidant attachment

• Caregiver subtly or overtly reject childs
  attachment needs at time of stress
• Bids for comfort will be rebuffed
• Child keeps his/her attention directed away from
  their caregivers in an effort not to arouse
  anxiety and frustration
• Child is in control because of the need for self
  reliance
• Comfort self rather than accept it from others

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Ambivalent (or anxious) attachment

• Caregiver will be inadequate at meeting child
  attachment needs (caregiver is passive,
  unresponsive and ineffective)
• Childs strategy is to amplify attachment needs
  and signals in an effort to arouse a response
  (verbal and behavioural bubbly affection to
  rage, anger, panic and despair. All experienced
  as controlling)
• Unlovable and helpless selves unpredictable and
  withholding others.

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Disorganised attachment

• Child experiences the carer giver as the source
  of alarm and its only solution.
• Child in these circumstances is unable to be
  guided by their mental model of the world because
  it offers few directions.
• Frightened, helpless, fragile and sad
• At risk of mental health problems or anti-social
  behaviour

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Positive brain development

• The way a child is stimulated shapes the brains
  neurobiological structure. Experience has a
  direct impact on a childs capacity for learning,
  developing and relating as a social being.

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Early Brain Development

• At birth the brain is 25 of its adult weight -
  by the age of 2 this has increased to 75 and by
  age 3 it is 90 of adult weight but this is not
  about new neurons
• This growth is largely the result of the
  formation and hard wiring of synapses (700 new
  neural connections every second for the first few
  years)
• Babies brains are both experience expectant
  and experience dependent

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Feeling and Thinking

• Circuits involved in the regulation of emotion
  are highly interactive with those associated with
  executive functions which are intimately
  involved in the development of problem solving
  skills
• Well regulated emotions support executive
  functions
• Poorly regulated emotions interfere with
  attention and decision making

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The Learning Years 5-10

• Synaptic pathways that are regularly used are
  reinforced. This is the basis of learning.
  Reinforcement leads to increasingly permanent
  neurological pathways.
• Neural connections needed for abstract reasoning
  are developed
• Motor skills are refined
• A child learns through interacting with the world
  and making meaning out of it

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ADOLESCENT BRAIN DEVELOPMENT

• Brain development continues up to at least the
  age of 20
• There is a significant remodelling of the brain
  in adolescence, particularly the frontal lobes
  and connections between these and the limbic
  system
• The frequency and intensity of experiences shapes
  this remodelling as the brain adapts to the
  environment in which it is functioning and
  becomes more efficient

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emotionaL FUNCTIONING IN ADOLESCENCE

• There is a mismatch between emotional and
  cognitive regulatory modes in adolescence
• Brain structures mediating emotional experiences
  change rapidly at the onset of puberty
• Maturation of the frontal brain structures
  underpinning cognitive control lag behind by
  several years
• Adolescents are left with powerful emotional
  responses to social stimuli that they cannot
  easily regulate, contextualise, create plans
  about or inhibit

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The triune brain

• The Neo-cortex associated with executive
  function - is the last to mature

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TRAUMATIC STRESS

• The automatic response to trauma, involving the
  production of toxic amounts of stress hormones
  which affect
• Brain function
• All major body systems
• Social functioning
• A bio-psycho-social injury

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Impact of trauma

• In the face of interpersonal trauma, all the
  systems of the social brain become shaped for
  offensive and defensive purposes. A child growing
  up surrounded by trauma and unpredictability will
  only be able to develop neural systems and
  functional capabilities that reflect this
  disorganisation.
• Source National CAMHS Support Service,
  Everybodys Business

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EFFECTS ON BRAIN DEVELOPMENT AND FUNCTION

• These functions may be diminished or lost
• Language, especially spoken language
• Words for feelings
• Sense of meaning and connection
• Empathy
• Impulse control
• Mood regulation
• Short term memory
• Capacity for joy