Report of Child Mental Health ZOOM seminar entitled
“Understanding Child Behaviour – a Research Perspective”
28th Sept. 2020
Presented by Richard Shircore M.Sc. FRSPH
Facilitated by Rev. Sue Lepp
Introduction: The following questions and comments come from a ZOOM seminar presentation by Richard Shircore, on Monday 28th September 2020. The presentation explored the challenge of understanding child behaviour and emotional (affective) states using an Assessment Pathway approach.
The presentation began with an assessment and review of treatment for child and adolescent mental health. It is characterised by a reliance on psychiatry and psychology. Indeed the narrative around child mental health rarely, if ever, indicates an alternative approach to understanding. Richard reported on a review of the House of Commons Select Committee report of November 2014 which looked at the state of Child and Adolescent Mental Health Services (CAMHS) in England.[1] The Report stated that CAMHS was failing to provide early intervention, operated reduced services and reported that parents had to fight “battles” to get assessment and treatment for their children.
The core of the Authors concern was that child mental health services failed to follow the path of physical medical practice by starting with basic and fundamental checks of capacity and capability before moving to a set of “default” psychological or psychiatric interventions.
The Author stated they was a professional failing to empirically assess a child’s basic competency and capacity to “engage with and comprehend the child’s environment”. This reflects a key element in successful personal life, in that there is a constant need for each of us to accurately “encode” messages and information for others and to reciprocate by “decoding” their responses. Without this basic communication and awareness capacity life is confusing, challenging and difficult.
The Author reported on the number and range of physiological and biological conditions that significantly impact on a child or persons ability to “decode” what is going on and to accurately “encode” a coherent response.
Much of this encoding and decoding is enabled (or frustrated by) the level of “sensory integration” of the child. He gave an example of Irlen syndrome as an example.[2]
Video clips were shown of a child acting with an apparent obstructive behaviour. Later the child was shown exhibiting distress saying such things as, “I hate my life”. This example led into describing an “Early Assessment Pathway” approach to assessment which was described in detail. The Pathway starts with a history taking covering health, social, educational and housing information. It includes the child’s preferences and dislikes. The second phase is a check on the basic requirements of life, food, sleep and security. The third stage focuses on Sensory Integration. Subsequent stages looked at specific areas of capability and capacity required for “engaging and comprehending the child’s environment”.
Richard stated his view that the use of such an Assessment Pathway would forestall a great number of referrals to CAMHS and allow a faster more targeted response to early intervention.
The following comments and questions were recorded on screen and addressed at the event. Below are the issues raised and the Author gives a fuller response than was possible on the night due to time constraints.
Comments and Questions – Richards’s responses in italics
1 How much do you ‘blame the Parents’? “Short answer ‘Never’, with the Pathway we are starting to assess the child not the parents. The concept of ‘blame’ not helpful in this process and at this time”.
2 The child commented that there are too many people. Maybe not able to deal with larger crowds other than those close to him? “Not being able to deal with crowds I would see as a possible symptom not a cause issue. Treating symptoms detracts from helping/understanding ‘what we are looking at?’ which is the key question to answer. If I refer back to the concept of “engagement and comprehension”, not being able to deal with crowds, is an interesting observation. So what might it mean in respect to cause?”
3 Perhaps bullying? “Again I would state that to begin with we need to see bullying behaviour as a symptom. Also check whether what we are seeing as “bullying” is bullying in a general sense. By how far is the person seen as a bully “engaging and comprehending” what is going on? Do they comprehend the consequence of their behaviour? We need to check their behaviour is not a clumsy attempt at being sociable.
4 Perhaps this might be leading to behaviour issues at school which might make him feel worthless? “With what we know now this sense of ‘worthlessness and also hopelessness’ may well be correct. We learnt later via assessment of “capacity to engage with comprehend” that he was not ‘engaging nor comprehending! He had significant visual issues – double vision and hearing issues which significantly impacted on his comprehension” ability.
5 How many specialists like you are there in our area and how do you get in contact with them? “I regret to say very few. As I said at the start of this presentation we have a fragmented and chaotic service approach to child mental health assessment.
For example opticians can check for visual acuity in each eye but rarely check for visual comprehension by the brain. Audiologists check hearing in each ear as defined by physiological response but not auditory comprehension overall when measured by “perception” of sound. Other European countries are much more aware of the need for and importance of ‘sensory integration’ than we in the UK. We are behind the curve.
We are obsessed with viewing child mental health through the lens of “grief, attachment or trauma theory”. All very valid but it is a ‘top down’ approach based on assumptions which may turn out not to be true. The assessment process I have outlined is an empirical one – starting with the basics and moving forward to more complex issues as the evidence indicates”.
6 There are all sorts of assessments in schools. This would seem to be a fundamental way of looking at child development which could be included in a normal school assessment programme perhaps? “I would hope this could be made a reality but we are dealing with a lot of vested interests. We need to change the curriculum in respect to child health in professional development and training in Universities for teaching, social services, medicine and nursing, also shift the narrative around how child mental health is presented in all the media.
7 Would this type of assessment work for teenagers and young adults too? Sometimes these things have not been properly picked up in childhood. “Correct, it is bewildering to me how adults can fail to learn to read or write (for example) and people not be curious as to why? “Why can’t they read? We have too many default positions to hand such as professionals saying ‘they don’t want to learn, their parents do not care about education, or, they (the child) is rebellious’, all maybe true or not. The only way to know is by a proper empirical assessment. Then we shall know what we are talking about!”
8 During early development checks, i.e. milestones, do they not check hearing and eyesight? “We do have a limited number of child development checks. However they are primarily based of physical or biological functioning not comprehension of the senses in the brain. Put another way and using a computer analogy – there may be nothing wrong with the child’s hardware but there is a problem with the software. Even more important if there is a software issue it can usually be rectified with the appropriate exercises.
9 Your case studies are really interesting. “Thank you. Remember what I have spoken about all took time and help from colleagues to sort out. I have had to unlearn a great deal to get to this point”.
10 Thanks Richard the session has changed my perspective of secondary school children. “I hope it has been of help. I think we have too many school exclusions because we are focusing on the control of “symptoms” i.e. aggression, bullying, disruptive behaviours, depression etc. and not on casual issues that impact on the child’s ability to “engage with and comprehend their environment. And by environment I also mean the people around them”.
11 Thank you, I have found this very interesting and helpful as a primary school teacher. I would welcome further information on your research. “I am happy to make the Power Point available and to answer any questions and help with implementation. There is much to do”.
12 I went to the Youth in Mind conference in Oxford back in February and one of the speakers in the workshops said that lots of children are labelled as ADHD when there are often underlying mental health issues. “I would put the response the other way round. The observed behaviour of that which is called ADHD is an expression of a more profound developmental issues which need to be investigated. This is not to say ADHD does not exist. It may in a particular child. But……we need to prove it is ADHD empirically rather than assume we know what we are looking at”.
13 Thank you very much, very interesting. Thank you for your feedback”.
14 We need a lot more courses like this. There are over 160 different kinds of Dyslexia and still counting. “I was not aware that there were so many! However I would reiterate what I said earlier, Dyslexia, ADHD, Oppositional Defiant Disorder are labels we attach to things. These labels have no diagnostic value whatsoever. We must first check the child’s capacity to ‘engage with and comprehend their environment’. So much behaviour and emotional states is about difficulties with basic engagement and comprehension, encoding and decoding – making sense of their world”.
15 Very useful for me working as a social worker in adult care, coming across young men at times with possible multiple diagnoses and behaviours. It is often very difficult to get suitable support for them. “This is a good point with regard to multiple or dual diagnosis. Nothing I have said would detract from the chance of a “dual diagnosis” for any individual. What I would say is that as a Pathway there is logic in starting with the most basic issues around the individual’s capacity to ‘engage and comprehend’ and their ability to ‘encode and decode’. For without this all else is difficult for that person, if not impossible”.
16 Thank you Richard I could listen all night. “Thank you”.
17 How soon can we change the current system to one more like your proposals?
“I regret to say I think it will be a very long time. As I stated earlier we have a raft of vested interests in keeping the status quo. We need parents and carers to demand a change. It will not come from professional agencies who hold their own niche positions. Commissioning bodies will not shift away from the familiar. Moreover it will need a change in how we view children, adolescents and their behaviour.
The current narrative (how the media and other opinion formers) treat child and adolescent mental health only serve to reinforce accepted positions. There is little critical comment around the current content of assessment and therapy. There is criticism around ‘service provision’.
18 Thank you, sorry have to leave now, very interesting.
19 Thanks Sue most refreshing means to expand Education for other or similar subjects!
20 Thank you very much indeed
21 Thank you very much, Richard
End.
Richard Shircore would be pleased to discuss any aspect of the issues raised by this seminar.
Contact: Shircore@healthpromotion.uk.com Mobile 07943 404 388
[1] Children’s and Adolescents Mental health and CAMHS. https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/342.pdf Accessed 5/10/2020
[2] Irlen Syndrome: Irlen Syndrome (also referred to at times as Meares-Irlen Syndrome, Scotopic Sensitivity Syndrome, and Visual Stress) is a perceptual processing disorder. It is not an optical problem. It is a problem with the brain’s ability to process visual information. This problem tends to run in families and is not currently identified by other standardized educational or medical tests. See https://irlen.com/what-is-irlen-syndrome/ accessed 03/10/2020
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