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Understanding and addressing the mental health
and bullying of young people with autism: is school connectedness the missing link?
DR JUDITH HEBRON
LEEDS TRINITY UNIVERSITY
Overview and aims
Overview of what we know about mental health
problems among young people with autism
spectrum conditions (ASC)
Discuss links to bullying victimisation and how this
can affect young people with ASC
Propose school connectedness as one potential
way to help protect against/alleviate some of the
issues of mental health and bullying
Questions and discussion
Mental health of young people
A neglected area for all young people nationally and internationally
Most mental health problems begin between 12 and 24 but often formally diagnosed later (Patel et al., 2007)
Most recent comprehensive study in UK dates back to 2004 (Green et al., 2004)
School-age population (5-16) prevalence estimates = 10% with a diagnosable mental health disorder:
4% emotional disorder (anxiety of depression); 6% conduct disorder; 2%
hyperkinetic disorder; 1% less common disorder
Children with mental health problems more likely to:
Be absent from school (including truancy/school refusal) or excluded; have
poorer general health; lack social networks and social support
Mental health of young
people with ASC
Mental health problems recognised as disproportionately
high among young people with ASC (e.g. Green et al., 2004)
Prevalence estimates of 30%, but 78% of parents reported mental
health concerns for their child
77% found to have comorbid psychiatric disorders (Simonoff
et al., 2008):
Anxiety (42%), ADHD (28%), conduct disorder (28%)
Is anxiety a comorbidity or a core component?
Anxiety is a known risk factor for bullying
Anxiety depression
Major issue to be addressed – untreated can lead to risk of
self-harm and suicide, and long-term problems in adulthood
Hebron & Humphrey, 2014
Non-clinical groups of YP with ASC (22), no-SEN
(23), and dyslexia (21)
Secondary age (11-16)
Attending mainstream schools
Completed the Beck Youth Inventories (BYI)
Anxiety, depression, anger, self-concept, disruptive
behaviour
Sub-group of students with ASC interviewed (5)
BYI findings
Anxiety
Depression
Anger
Self-
concept
Interview findings
Qualitative model of influences on, experiences of, and responses to mental health difficulties among adolescents with ASC (Hebron & Humphrey, 2014)
Social relationships - friendship - isolation - bullying - interpreting social situations
Understanding AS - an explanatory label - feeling different - not wanting to be treated different to others
Mental health difficulties - anxiety - depression - anger
Coping - self-reliance - internalisation - predictability and routine
School bullying – what do we know?
Around 1 in 10 children and young people in
England report being bullied every day in school
(Chamberlain et al., 2010)
Bullying can lead to mental health problems (Turner
et al., 2006)and suicidal thoughts (Nansel et al.,
2001), as well as lower academic attainment and
attendance at school (Green et al., 2010)
Educational and public health concern in the UK
and internationally
Bullying of young people with
ASC
70% of young people with ASC attend mainstream schools
Anywhere from 7% to 94% has been reported, but most estimates are much higher than the 10% average
Parents consistently report higher rates than teachers
Emergent research examining the various factors associated with the extent of exposure to bullying in ASC
e.g Sofronoff et al. (2011): social vulnerability, anger, anxiety, behaviour difficulties and social skills contributed significantly to the variation of parent-reported bullying
“Perfect victims”? (Klin, Volkmar, & Sparrow, 2000)
Bullying and SEN
0
1
2
3
4
5
6
7
8
SPLD MLD SLD PMLD BESD SCLN ASD VI HI MSI PD Other Don't
know
SEND primary type
Teacher
Parent
Mean teacher-reported and parent-reported bullying scores in the monitoring sample by
primary SEND type (AfA interim report, 2010)
Risk factors for bullying
Being male
May peak at around age 13
Asperger syndrome / high-functioning autism
Social vulnerability (e.g. getting tricked into things)
Attending a mainstream school
Behaviour difficulties
Using public transport
School Action Plus – not yet known for School Support
But, as no two children with have an identical risk profile, is the number of risks more important than the risks themselves (Hebron, Oldfield, & Humphrey, 2016)?
Consequences
• Lower attendance and school refusal
• Poorer academic outcomes
• Fewer friendships
• Low self-esteem
• Risk to well-being:
Anxiety
Depression
• Risk of self-harm and suicide (ideation)
• ‘Chicken and egg’ dilemma …
What can we do?
Consider findings from school bullying research
While generally positive, the effectiveness of many bullying
interventions has been questioned (e.g. Merrell, Gueldner,
Ross, & Isava, 2008)
Approach needs to be holistic:
Bullies, victims, and bystanders
At multiple levels (e.g. peer, class, school, community)
Look at ways of reducing risk and/or levels of risk …
School connectedness
Social bonds and connections to others are a fundamental
human need (Baumeister & Leary, 1995).
“The extent to which students feel personally accepted,
respected, included, and supported by others in the school social
environment” (Goodenow, 1993)
Found to be a protective factor against future mental health
problems (Shochet, Dadds, Ham, & Montague, 2006).
Also associated with: greater academic motivation and
engagement, reduced health-risk behaviour, and higher levels of
self-esteem (references available).
Very little research in this area!
School connectedness across
primary-secondary transition
4
4.1
4.2
4.3
4.4
4.5
4.6
4.7
Time 1* Time 2* Time 3 Time 4
Psychological sense of school membership
ASC group Comparison group
Reproduced from Hebron, J. (2017). The Transition from Primary to Secondary School for Students with Autism
Spectrum Disorders (p. 90). In Little, C. (Ed.), Supporting Social Inclusion for Students with Autism Spectrum
Disorders. London: Routledge.
School connectedness
As differences exist from before the transition to secondary
school, SC needs to be recognised and addressed during
primary years.
e.g. Mandy et al. (2015)
May protect against future short- and long-term issues,
such as mental health problems, social inclusion, and
bullying
More research needed in this area to inform school
strategies and interventions
Why do these differences exist?
What can we do to address them?
Conclusions
Mental health issues disproportionately high, especially
anxiety and depression
Young people with ASC appear extremely vulnerable to
bullying from peers
Early intervention is likely to be effective
at several levels, including peer and school
School connectedness is a potentially important area to
target
Long-term benefits of having a positive sense of school
membership/connectedness
Selected references
Goodenow, C. (1993). The psychological sense of school membership among adolescents: Scale development and educational correlates. Psychology in the Schools, 30(1), 79-90. doi:10.1002/1520-6807(199301)30:1<79::AID-PITS2310300113>3.0.CO;2-X
Green, H., McGinnity, Á., Meltzer, H., Ford, T., & Goodman, R. (2005). Mental health of children and young people in Great Britain, 2004.
Hebron, J. (2017). The Transition from Primary to Secondary School for Students with Autism Spectrum Disorders. In C. Little (Ed.), Supporting Social Inclusion for Students with Autism Spectrum Disorders. London: Routledge.
Hebron, J., & Humphrey, N. (2014). Mental health difficulties among young people with autistic spectrum disorders in mainstream secondary schools: a comparative study. Journal of Research in Special Educational Needs, 14(1), 22-32. doi:10.1111/j.1471-3802.2012.01246.x
Hebron, J., Oldfield, J., & Humphrey, N. (2016). Cumulative risk effects in the bullying of children and young people with autism spectrum conditions. Autism: The International Journal of Research and Practice. doi: 10.1177/1362361316636761
Mandy, W., Murin, M., Baykaner, O., Staunton, S., Hellriegel, J., Anderson, S., & Skuse, D. (2016). The transition from primary to secondary school in mainstream education for children with autism spectrum disorder. Autism, 20(1), 5-13. doi:1362361314562616.
Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: a global public-health challenge. The Lancet, 369(9569), 1302-1313
Shochet, I. M., Dadds, M. R., Ham, D., & Montague, R. (2006). School Connectedness Is an Underemphasized Parameter in Adolescent Mental Health: Results of a Community Prediction Study. Journal of Clinical Child & Adolescent Psychology, 35(2), 170-179. doi:10.1207/s15374424jccp3502_1
Sofronoff, K., Dark, E., & Stone, V. (2011). Social vulnerability and bullying in children with asperger syndrome. Autism, 15(3), 355-372. doi:10.1177/1362361310365070