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Children at risk

Coughlan (2010) highlights the fact that young people with special education needs are at high risk of developing mental health problems that frequently go unrecognised.
Those with unrecognised mental health problems cannot receive appropriate assessment, diagnosis or treatment.
There is now an awareness that young people with intellectual disability are subject to the entire range of mental health difficulties that are present in the general population (and with greater frequency).
These difficulties tend to present in atypical or unusual ways.

Difficulties in detection

Difficulties in detection may include:

- Delayed diagnosis;
- Unclear referral pathways;
- Falling between mainstream and specialist services;
- Falling between child and adult services;

- Lack of availability of support and information for families;
- Difficulty in accessing mental health services for young people;
- Lack of recognition of difficulty;
- Case recognition (This is the most crucial part of the overall assessment process. Cases which are not detected, cannot be referred, and so cannot be assessed).

Exploring behaviour

This is crucial in terms of enabling school-based staff to pick up on difficulties and then refer a child on at the earliest possible stage.
Coughlan (2010) states that early detection and identification is the most important aspect of the overall assessment process. Hence the importance of case recognition, which involves picking up on the early signs and symptoms of underlying mental health problems.

Consequently, teachers and school staff need to feel and be skilled in terms of observing and assessing behaviour in the school context.

Key pointers

- What are we observing?
- How does the student make sense of their behaviour?
- What are others observing or saying about the behaviour (staff, family, friends, etc.)?
- Is the behaviour contextually specific?
- Is the behaviour developmentally appropriate?
- Is this first onset, or have we seen patterns emerging?

Making sense of behaviour

There’s often a tendency to make sense of ‘unusual’ or ‘bizarre’ behaviour, purely from a behavioural perspective or framework and to describe these as being:

- Attention-seeking;
- Cheekiness.

As practitioners and educators, we need to challenge these assumptions and examine other possible frameworks for investigating underlying causes of behaviour. Unusual behaviour may be observed, but there may be an underlying mental health component to a child’s presentation.

There needs to be good communication and close liaison between educators and members of the multi-disciplinary team.
This is vital when trying to make sense of behaviour and developing an intervention plan.

Putting the jigsaw together
Undertake a comprehensive assessment by:

- Building up a picture of a child's behaviour (looking at symptoms, contextual factors, etc.);
- Developing a number of hypotheses to be tested;
- Always referring to the diagnostic criteria (ie do the symptoms match the criteria?);
- Taking a team approach (the entire team should be seen as 'information gatherers').

Your role in diagnosis
Bearing in mind what you have learned so far about the issues and strategies for identifying potential mental health issues, ask yourself the following questions:

- What role do you think you might play in terms of contributing to a comprehensive assessment?
- How could your observations be used and structured?
- Could you contribute to data collection and the formulation of hypotheses?

Find out more

Coughlan, B.J. (2010) Critical Issues in the Emotional Wellbeing of Students with Special Educational Needs. London: Special Schools & Academies Trust.

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