There are a range of anxiety and depressive disorders. Michael Farrell examines what schools can do, including therapy and support options
The range of anxiety disorders and depressive disorders
The Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000) defines depressive disorder and a range of anxiety disorders including: generalised anxiety disorder; obsessive-compulsive disorder; specific phobia and social phobia; separation anxiety disorder and selective mutism. About a third of children with one anxiety disorder also meet the criteria for at least one other anxiety disorder and a round a third also experience major depression. There are different implications for provision for these different disorders. For example, effective provision for childhood obsessive-compulsive disorder appears to be a combination of medication (selective serotonin reuptake inhibitors/SSRIs) and cognitive behavioural therapy (See also Farrell, 2008). The remainder of this article looks more broadly at provision for children and young people with anxiety disorders and depressive disorders.
Aspects of the curriculum encouraging open communication are valuable, including personal and social education sessions, discussions, art, drama, dance, and play. Encouraging emotional literacy includes developing the language of feelings, encouraging reflection on them, and engaging in dialogue about thoughts and feelings (Antidote, 2003, pp. 33-56).
Also important are opportunities for the child to communicate any worries with staff trained to listen and respond helpfully. This may include counselling as well as an ethos emphasising pupil participation, consultation and communication.
Group work can offer opportunities to share problems and experiences and build up mutual support, as in the ‘Coping in Schools programme’, which included reintegration groups developed in special schools (McSherry, 2001, pp. 34-44). Circle time can focus on sharing perceptions and seeking to deal with any problems as a group. Peer counselling may involve trained and supervised students carrying out ‘interpersonal helping tasks’ (Hornby, Hall and Hall, 2003, p.71).
The SENCO and teachers will be aware of any psychotherapy the child is receiving and be supportive of it. For example, where usual school provision is likely to bring the child into contact with an item or situation about which he experiences phobia, teachers will need to work with therapeutic staff to determine the best approach. The SENCO may wish to consider the basic knowledge and skills staff are likely to need. A rolling programme of training involving other professionals as necessary can then be devised and monitored. Supervision and support is important in less structured times such as breaks and lunchtimes and the staff mainly responsible for these periods may require special awareness training. In some schools the treatment may take place on the school campus and specially trained education staff contribute to aspects of psychotherapeutic interventions.
Provision of therapy is an important contribution and the SENCO, other teachers and therapists need to liase well.
Cognitive behavioural therapy is used for separation anxiety; obsessive-compulsive disorder, and (with family work) for anxiety disorders. For phobia, behavioural methods, social learning (modelling) and cognitive behavioural therapy are employed. For mild depression in adolescents therapy may comprise: cognitive behavioural therapy with treatment of any concurrent maternal depression; interpersonal therapy adapted for adolescents (Mufson et al, 1999); or SSRIs. Medication such as SSRIs may be administered for obsessive-compulsive disorder. Staff need to be aware of any medication taken by children, its likely effects, and its possible side effects, necessitating liaison between education and health personnel.
A calm and reassuring school ethos is important, with teachers being supportive without being over protective and routines being well understood by the child. Many schools have transition arrangements for pupils starting school, coming from another school or area, or returning to school after a long absence. This might involve initial visits with parents, ensuring the new pupil has other pupils to help him settle in, and procedures to help ensure the pupil knows what is expected, or where to go at different times of the day. Special transition arrangements may be made perhaps involving the pupil first attending a unit on the school campus then gradually reintegrating into the rest of the school. Separation anxiety may lead to the child being extremely reluctant to attend school. The school might arrange to provide shorter sessions for part of the day and part of the week to gradually return the child to school. Support for parents also experiencing anxiety can help.
Where family management is provided relating to child anxiety disorders or where the mother of a depressed adolescent is herself depressed, the school will want to do all it can in support. Where schools have facilities for therapy on site this can encourage parents to seek support themselves. Parents who feel harassed by persistent requests from a child with obsessive-compulsive disorder, may require particular understanding and support.
- American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington DC: APA
- Farrell, M (2008) Educating Special Children: An Introduction to Provision for Pupils with Disabilities and Disorders, London: Routledge
- Antidote (2003) The Emotional Literacy Handbook, London: David Fulton Publishers.
- Hornby, G et al (2003) Counselling Pupils in Schools: Skills and Strategies for Teachers, London: Routledge Falmer
- McSherry, J (2001) Challenging Behaviours in Mainstream Schools: Practical Strategies for Effective Intervention and Reintegration, London: David Fulton Publishers
- Mufson, L et al (1999) ‘Efficacy of Interpersonal Psychotherapy for Depressed Adolescents,’ Archives of General Psychiatry 56, 573-579
Dr Michael Farrell