Cumbria County Council

Parents Helpline: 0808 802 5544 Tel: 020 7089 5050 Website: http://www.youngminds.org.uk and

Publications Training & Development:

marcella.verdi@youngminds.org.uk

You will be able to:

• Describe conceptual models for thinking about mental health, mental health problems and disorders in C&YP

• 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 people’s mental health and emotional wellbeing and establish a foundation for further learning

THE MENTAL HEALTH SPECTRUM

FlourishingModerate

mental health

LanguishingMental

disorder

From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being

Number of symptoms or risk factors

EFFECT OF SHIFTING THE MEAN OF THE MH SPECTRUM

Flourishing Moderate mental health Languishing

Mental disorder

From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being

Number of symptoms or risk factors

‘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

• 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 child’s age and context

Prevalence among children aged 5 – 15 in the UK

Risk factorsbut no obvious problems now

Mental healthproblems

Mental orpsychiatric disorder

Severe disorder or mental illness

3 million or 20%

1.5 million or 10%

30,000 or 0.2%

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

Mental health problemA disturbance of function in one area of; relationships, mood, behaviour or development, of sufficient severity to require professional intervention.

Mental disorderA severe problem (commonly persistent) or the co-occurrence of a number of problems, usually in the presence of several risk factors

Risk FactorsProtective 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

• 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

• 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

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

“can resist adversity, cope with uncertainty and recover more successfully from traumatic events or episodes”

Newman, T (2002)

• 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 life’s 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)

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?

• 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

• 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

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

of severe discord

• 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

need

high arousal

satisfyneed

relaxationtrustsecurityattachment

arousal - relaxation cycle

Is associated with;• Emotional regulation and containment of anxiety• Capacity to tolerate uncertainty• Trust, adaptability, hope and belonging• The child’s ‘internal working model’• The child’s 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

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

• Caregiver subtly or overtly reject child’s 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

• Caregiver will be inadequate at meeting child attachment needs (caregiver is passive, unresponsive and ineffective)

• Child’s 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.

• 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

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

• 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’

• 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

• 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

• 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

• 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

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

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

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, Everybody’s Business

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