When we talk about mental health in schools, most of us picture a teenager.

When we discuss delays to child and adolescent mental health services (CAMHS) and share stories of mental health challenges, again its not younger children who are usually the focus. And even the government seems to have decided that secondary is where mental health is the biggest challenge: its mental health first aid pledge is applicable to secondary schools only. 

Could all this mean children in primary schools with mental health challenges are being missed and are not getting the support they need? That’s what we are discussing on this week’s Tes Podagogy (listen below).

Dr Wendy Sims-Schouten, associate professor in childhood studies at the University of Portsmouth and head of the mental health in childhood and education research group, argues we certainly need to be more aware of mental health in the 2- to 11-year-old age bracket. 

“When it comes to mental health issues and problems, we know that when young people are diagnosed, it is more likely to be when they are teenagers, most commonly at the age of 14,” she explains. “[But] that is not to say there are no signs of mental health issues earlier in life.

“There are signs and symptoms of specific mental health issues at primary school and earlier on, even when children are in EYFS [the early years foundation stage]. And if we get involved early on with the right interventions, we can try to ensure those signs do not turn into diagnosable mental health issues.”

Identifying mental health challenges

Spotting signs of potential mental health challenges in this age group is, she admits, very tricky. 

“Traditionally, we try to be very careful when diagnosing younger children,” she explains. “There are different developmental pathways and milestones. We need to acknowledge that children are developing.

“But you are looking for the extremes. If a child is occasionally a bit off and throws a tantrum, that is what you would expect. But if a child is coming in day in, day out and they are not functioning, there are behavioural issues, they are withdrawn, or they are not concentrating - if it is a pattern that is abnormal for that individual child, [then we need to take notice].”

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While teenagers may be able to articulate their feelings, younger children often cannot, and sometimes they do not really understand what they are feeling, Sims-Schouten adds. 

“With a younger child, it is more likely they will say they have a stomach ache or they are not feeling well,” she explains. “But there are some really interesting books that teachers can use to open up discussions around emotions and wellbeing.”

She advises that asking “How are you feeling? What is going on?” is far too direct. Instead, you can present, say, the story of a snail who has poor self-esteem, or a train that is being bullied and does not know what to do.

Behavioural issues

If we fail to give children a method of expression, the issue tends to manifest as behavioural problems, Sims-Schouten explains. And when that happens, she believes we too often hand out punishments and fail to take a step back to work out if there is more going on. 

“There is a tendency to meet any behaviour with punishments,” she says. “But really, we need to be actively looking first at reasons for the behaviour. It is really important for the adults around the child to step back and talk to the child. We need to do social buffering - having chats with the child to find out how they are in an indirect way. It is about opening up discussions.”

The most common diagnosable problems in this age group are, she says, conduct disorder and anxiety disorder. 

“Conduct disorder is when child is showing extreme violent behaviour, to the point they are harming animals and being destructive. the evidence we have suggests this is caused by a mix of nature and nurture,” she explains. “Anxiety disorder can be a sign of underlying attachment issues, or attachment disorder, it could be associated with mental health problems in parents or problems at school.”

Vulnerable groups

The statistics suggest that children from black and ethnic minority (BAME) backgrounds are less likely to be diagnosed. Sims-Schouten believes this may not be about a lower occurrence in those communities, but rather a failure to identify potential issues these children may have. 

“The official data says they are less likely to have mental health issues compared with white British children, but you could argue that is because some of the signs and symptoms are not recognised in these children. We need to do far more in this area,” she says.

What teachers cannot do, she argues, is try to diagnose mental health problems or attempt to “fix” them. Even though access to trained support in the form of CAMHS or educational psychologists may be delayed, she advises against getting into discussions about specific disorders, particularly with parents. She stresses, however, that communication about any concerns with parents is essential. 

Parental input

“I don’t think a teacher should ever label a child or use mental health language,” Sims-Schouten says. “They are not qualified to do that. All they should do is try and spot the early signs and, if they do discuss those issues with parents, form that conversation around discussions of wellbeing. If you start talking about mental health issues, you are assuming there is a proper diagnosable disorder and teachers are not in a position to be able to do that.

“I have spent a lot of time talking to parents about their experiences. What I consistently hear from them is that they appreciate when a teacher talks to them and also when a teacher listens”

In the podcast, Sims-Schouten talks at length about what may cause mental health issues for young children, and why child involvement in any transition information is crucial. She also shares her views on whether testing is a contributory factor. 

“I think we are doing too much testing and it is causing stress, but I do think it is as much about how we approach the testing,” she says. 

You can listen to the podcast on the player above, or type “Tes - the education podcast” into your podcast platform (including Spotify).