By Neale McDevitt
This week McGill is the centre of international scholarship on mental health for school children as it plays host to the 34th conference of the International School Psychology Association. By the time the conference wraps up on July 13, it will have drawn some 500 school psychologists from over 70 countries and will have featured some 260 scientific presentations and workshops. Topics to be covered at the conference are diverse, ranging from religion and the use of voodoo practices in Caribbean countries to learning disabilities with pictographic languages like Korean and Chinese.
Steven Shaw, from the Department of Educational and Counselling Psychology, is a member of the conference’s Scientific Committee. He recently sat down with the Reporter to discuss common mental health problems among young children, the importance of early detection and some of the ways he and other researchers are trying to help these children.
What percentage of kids contend with mental health issues?
Different estimates put the number between 18-25 per cent of Canadian children who have some sort of mental health issue.
A very small percentage, about one per cent, are considered to have an emotional disability. This is a mental health issue that is so severe that it requires extensive support.
What are some of the more common issues?
Anxiety disorders and depressive disorders are probably the two most common disorders and certainly Attention Deficit Hypertension Disorder (ADHD) is quite prevalent. But we also see post-traumatic stress in cases of abuse and neglect. And, though it is fairly rare in children, we still see cases of bipolar disorder.
What ages are we talking about here?
Anything from six to 16, although we see ADHD-type symptoms very early. They can start showing up even before children start going to school. Other issues tend to be later onset. Depression is much more common after puberty, but we still see it in young children as well.
What are some of the possible repercussions of mental health issues if left untreated?
If we don’t address these mental health issues then schooling and academic work suffer. Even those kids with a lot of academic skills are not able to function well in the classroom. As a result, they underperform in terms of their grades.
They frequently have high dropout rates even though they often are way above average academically. But without mental health support many of them still fail. Their reading, writing and math are fine, they can pass any test. But they are just not able to do the work for various reasons, including a high rate of absenteeism.
And later on in life?
Life does not work out too well for many of these kids. Later on we see a lot of drug and alcohol abuse, early unwanted pregnancies, etc.
Once they drop out of the system it’s really hard to find them again. Sometimes we don’t know what happens to them – although they certainly account for a large percentage of the prison population.
As a society we are wasting a lot of potential. These are often very talented people who can contribute so much. We are losing a lot of talent to untreated mental health issues.
So what can be done to help them?
Everything from early identification and prevention programs to helping develop with coping skills. A lot of these children with minor emotional issues lack the ability to cope effectively with things like impulse control and feelings of anxiety or depression. Once we give them the skill sets, we find that children improve dramatically.
Is it hard for some parents to accept the fact that their child has mental health issues?
We do have that. A lot of parents say things like ‘He’s seven years old. What does he have to be depressed about?’
But it’s not usually an accumulation of events. Quite often there is a genetic component. We’ve seen some children who are extraordinarily young, five or six years old, with severe depressive symptoms who have never gone through any horrible crisis or event but who just have a genetic predisposition for this.
And it’s not just parents. This is also an issue with policy makers who quite often don’t often believe that there are serious issues.
In that climate, how do you get policy makers get on board?
Ironically, what has proven to be a catalyst for support for the type of work we’re doing is the big emphasis on children’s test scores – especially in the U.S. and increasingly in Canada.
We have the evidence to show that when we work on preventing depressive issues, attention problems, anxiety issues or post-traumatic issues that test performances go up. It makes for a good sell.
In today’s economy, how feasible is it for a school to have a dedicated mental health professional on staff?
We see it as short-term investment for long-term savings. If we work on a child who has serious anxiety issues at the ages of five, six or seven, we have plenty of evidence that shows it will save costs down the road on things like special education services and intensive services such as having a one-on-one aid, which is extraordinarily expensive. If we can prevent that expense it really does save money for a district long-term.
We do save funds and most school boards are aware of this. They know that counselors, social workers and school psychologists actually do end up saving money and a lot of time and energy for teachers because they can prevent so many problems.
Are we guilty of over-diagnosing certain conditions like ADHD?
In my opinion, ADHD and autism also are both under-diagnosed and over-diagnosed because we are missing some of the children that may have atypical presentation. What about the child who is quiet and sits in the back and is ‘dans la lune’? They are often not noticed and don’t get the diagnosis. But the child who is energetic and rambunctious in a classroom where the teacher expects quiet may be over-diagnosed.
The percentage [of children diagnosed with ADHD] probably isn’t that far off. I just worry that we have picked the kids who are energetic because we have expectations that a five-year-old should sit still for five hours. Maybe the problem is with our expectations. Five- and six-year-olds like to run around. That’s their job. To expect them to sit for a long period is not realistic.
On the other hand we may be missing those quiet children who may not be paying attention at all. More than anything, we need to improve our accuracy.
What is the difference between an overabundance of energy and ADHD?
Someone who is just highly energetic can be highly productive. But someone with ADHD is faced with a problem – not just because they risk upsetting the teacher but also because they can’t function, they have social skills problems.
The highly energetic boy probably has lots of friends and probably can do all the work, he just likes to run around a lot. But someone with ADHD doesn’t usually have many friends because other kids don’t want to be around them because they can’t play games well and they can’t do the basic social activities. They are unable to learn because they are so inattentive.
So the earlier a child can get treatment, the better the outcome?
No question. Once a child can control these behaviours then they can better profit from instruction and they can learn better from teachers. Generally, the more they learn in Grade One the more success they’ll have in Grade 10 and 11.
Is medication the answer?
Often it is, yes. As a psychologist I’d prefer not to medicate young children but the medications are effective in over 85 per cent of kids with ADHD. I think the evidence is fairly clear that the earlier an intervention, the better.
The problem is that a lot of people have an almost visceral reaction to a child being put on medication at a young age. The question becomes do we want early intervention or are we afraid to put very young children on medication. It’s a tough call. But we do find these children [who are receiving medication] do much, much better.
What you find is that these kids [who are receiving medication] are then are able to profit from learning the skills and coping mechanisms they need. It’s very difficult to do that without medication if a child has ADHD.
Suddenly these children are getting positive feedback from teachers and making friends – and that’s when their self-esteem is raised.
And making friends is just important as success in the classroom?
Success in the playground is more salient to children because a lot of them don’t really care about test scores. But if you have a lot of friends and you’re well liked – that really matters to a kid.
What does your current research focus on?
I work with children at-risk for school failure. These are often kids who fall into the cracks between having intellectual disabilities – mental retardation – and those who are normally functioning. There’s a group kind of in the middle – low-average kids. We don’t see a lot of support for them because they don’t have the label or diagnosis but often they don’t have a lot of success at school.
Is it just a question of improving these children’s academic skills?
We have strategies to improve their basic academics but we found that even if we improve those skills, they still have trouble in school. So that’s when we have to look at emotional issues. Can these children control their impulses and emotions? Can they be organized? A lot of these kids can read, write and do math well enough, but they forget to hand in their homework. It’s done and it’s done right but they don’t submit it. We all get mad at times but with this group of kids with lower abilities, we find once they get angry, they have a harder time recovering from it. They stay angry all day and it affects their academics.
So it’s not enough just to teach reading, writing and arithmetic, we have to teach these basic skills too.
Do parents of slow learners have to readjust their goals for these children in terms of academic success?
When you have risk factors such as low generally mental ability, mental health issues or parent issues such as parents who are incarcerated or who are alcoholics etc. – these are risk factors to overcome.
But we do know that the children who work hard and develop coping mechanisms can overcome these barriers. So the goal should be to teach them how to overcome the barriers – it is referred to as ‘being resilient.’
You have to be realistic – if a child has severe intellectual disabilities, they probably aren’t going to go to medical school. That’s a different thing. But for kids who are just struggling a little bit, I don’t think it is necessary to change those goals.
So what does that mean for parents?
It means getting the parents idea to realize that this isn’t going to be easy but you can still keep those same goals.
But parents have to be part of the team and they need to be motivated like everybody else. They can’t throw up just their hands and give up. They have to understand that they can keep the same goals and their child can go to university. There are hurdles to overcome, no doubt, but these goals are not out of reach.
Do parents put too much pressure on kids to be successful in everything to give them a better chance at being admitted to the best universities?
I’ve seen a lot of it. I don’t know if parents really understand what it takes to get into McGill or Harvard. It certainly doesn’t take over-scheduling the child so that from the time they leave school they are in piano lessons, karate, Girl Guides, etc. It is kind of a new thing, over the last 20 years we’re seeing parents moving towards this feeling the need to have children constantly engaged.
Kids can be kids and still get into Harvard and McGill. I’m a firm believer that kids should be allowed to daydream and play.
Which begs the question; how important is it for them to have kids-only time?
There’s no question that we have to give kids the chance to have fun and to get together by themselves. You used to get six kids on the local rink by themselves, organize some three-on-three and play for six hours. Now there’s always some coach getting in the way.
Talk about social skills and conflict resolution… you get some kids together to play some pickup football and – guess what? – they learn how to solve problems. Sure, it gets a little Lord of the Flies occasionally [laughing] but most of the time they get to solve the problem. And when children are by themselves, they get to be creative. To me the most exciting thing of all is when a child comes up with their own concepts or solves their own social problems.
Why is this important?
If children get guidance to learn these skills and they actually apply them on their own, that’s when they move toward becoming independent individuals with healthy self-esteem. This independence will serve them well in terms of studying and eventually for jobs.
If everything is spoon fed to them, they never learn these skills on their own. Parents should understand that it is OK to teach the skills but let kids apply them themselves.
What do you say to parents who worry about their children being online?
A lot of parents are afraid of online problems like cyber bullying and intimidation – and those are concerns for sure. But there is a lot of good to be found online as well. Kids are solving all sorts of social skills issues online and they’re being creative.
The bottom line is that there are lots of mechanisms out there for kids to learn important skills – pickup sports, the Internet, recess. Generally, the more skills they acquire, the healthier they will be as adults.