8/14/2020 0 Comments
The Children's Society published a recent report based on data and statistics of young people's mental health and need during the Covid-19 pandemic. The main take home message from the report is that pre Covid-19 1 in 8 children were at risk of developing a mental health condition whereas currently the statistics show that this risk has risen to 1 in 5. The report covers many populations of children including; looked after children, vulnerable children, separated children and children at risk / experiencing abuse. However, after reading..and then re reading the report I was surprised to see that the SEN population has not been reported. How can this population of been overlooked? Of course, one could argue that the SEN population falls into the vulnerable and/or the at risk categories but I would have liked to have seen this demographic have its own category due to their own specific risks. So I thought I would develop my own.
To begin, lets explain the risk of psychopathology within the ASD population pre Covid. In the UK estimates of psychiatric comorbidity in children with ASD are reported to be as high as 70%–75% in community clinic studies (Simonoff et al., 2008), and 83% for psychiatrically referred youth with ASD (Joshi et al., 2010). More recently, data from 29 publicly funded mental health programs found 92% of children with ASD meeting criteria for at least one comorbid psychiatric condition (Brookman-Frazee, Stadnick, Chlebowski, Baker-Ericzén, & Ganger, 2018). Amongst the most commonly identified comorbid disorders have been anxiety disorders, communication disturbance, depression, obsessive compulsive and eating disorders, schizophrenia and psychosis (Brereton, Tonge & Einfeld, 2006; Gillberg & Billstedt, 2000). With the indication of high comorbidity between mental illness and autism, national statistics suggest this vulnerable population is at increased risk of suicide, with the NSPCA reporting suicide to be the second highest cause of death for adults with an ASD diagnosis (NSPCA, 2017). Research has also suggested that children with ASD are 28 times more likely to experience suicide ideation or attempt suicide than a typical developing child (Halberg et al., 2005). To summarise, the reported research which was undertaken between 2000 and 2019 highlights the SEN population to be at a significantly high risk of developing serious psychiatric conditions, so I wonder, based on the above why was this population not included within TCS report?
Covid-19 has changed our lives, our worlds and our day to day functioning. Routines have been disrupted, schools have closed and expectations and boundaries have developed and altered. For a lot of ASD children, initially the lockdown was a dream come true and many clients of TBR reported this. No school, no forced interactions, pressures removed. However as the weeks turned into months concerning behaviour patterns are being reported. Our isolated children have become even more isolated. The fear of Covid has instilled and reinforced health anxiety and OCD tendencies, the disruption to routines (even those that were welcomed) shift a sense of normality and security resulting in heightened emotion dysregulation, challenging behaviour and poor sleep patterns. These behaviours then cycle into low mood, depression and increased anxiety. And then we have the next stage of lockdown. The reintegration into society. Schools are reopening full time in September and our children are supposed to come out of isolation bewildered, confused and scared and thrust back into the pressures and triggering world that they sought solace from. But it will be different. The world is still not as it was. And this says to some of our children, that the world is still not safe. So how do we explain this move and changes to children already suffering with anxiety and fear who cannot distinguish or compute the changes?
Alongside the SEN populations presentation and increased risk we then have the problems covid has caused to our supporting services. Pre Covid, the current treatments for ASD individuals and co morbid MH disorders include pharmaceuticals, biomedical, alternative treatments and behavioural therapies (Vohra et al, 2013). The main psychological therapies utilized for this population included Applied Behavioural Analysis (ABA) and cognitive behavioural therapies ( Brookman – Frazee et al, 2010). Data suggests that in the past 10 years services providing ASD support including MH have increased by 600% (Mandell et al , 2005). The increase in the need for these services have reportedly added additional strain to the families attempting to access the support for comorbid MH (Bromley, Hare, Davidson & Emerson, 2004; Chiri & Warfield, 2012). For example, research by a leading UK autism charity, the National Autistic Society’s ‘You Need to Know’ campaign, parents with a child with ASD and MH condition stated that the main problem was the lack of appropriate support with professionals simply not having the right understanding of their child’s condition (NAS, 2010). Research indicates that 39.5% of General Practitioners within the UK report never having any formal training in ASD and furthermore report low levels of confidence in recognising mental health problems in ASD patients and little confidence in knowing the relevant services available for those of the spectrum (Unigwe et al, 2017). Additionally research highlights concerns of a national shortage of professionals with expertise in ASD with research stating training programmes offer a limited number of clinic hours for experience working with ASD (Kalb et al, 2017). Furthermore, research indicates that mental health professionals hold a number of inaccurate beliefs about ASD (Heidgerken et al, 2005; Brookman-Frazee et al, 2010). In addition to the reported lack of informed professionals working within this population there is limited research and evidence to review the practices and implementation of therapies within the MH services with ASD individuals (Brookman-Frazee, 2010).
Many young adults with ASD have reported being unable to access services themselves, either due to their symptoms not deemed severe enough, or only gaining access once crisis points had occurred (Crane et al., 2018). Parents of ASD children often reported unmet needs in relation to MH services (Chiri & Warfield, 2012; Vohra et al, 2013; Thomas et al , 2007). So now, in the midst of a pandemic where does this leave our children in accessing MH support? Services have moved online, or in some places needed to pause all together. Waiting lists may increase, or treatment times may reduce.
The research above paints a bleak picture. Before the pandemic our children were already at increased risk of developing MH conditions, and our MH services were hard to access and even when they were, professionals were not adequately trained and those that are, are far and few between. The pandemic has increased isolation, health concerns and trauma. So, The Children's Society I bring this question to you. Why was this population not included in your report??