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

J.HEBRON@LEEDSTRINITY.AC.UK

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