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Children and Young People with Learning Disabilities - Understanding their Mental Health

ContentsIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Mental health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a. Good mental healthb. Resiliencec. Five ways to wellbeingd. Children and resilience2. Introduction to mental health problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a. Children and young peopleb. People with learning disabilitiesc. Mental illnessesi. Depressionii. Anxietyiii. Serious mental illnessesd. Treatment and support3. Learning disabilities and mental health problems . . . . . . . . . . . . . . . . . . . . . . 11a. Autismb. Foetal Alcohol Syndrome4. Identifying mental health problems in children with learning disabilities. . . 14a. What is usual?b. Causes of changec. Context, duration, intensity and frequency of your concernsd.Symptoms of mental health problemsi. Depression and learning disabilitiesii. Anxiety and learning disabilitiesiii. Obsessive behaviour and learning disabilitiesiv. Serious mental illness and learning disabilitiesChildren and Young People with Learning Disabilities - Understanding their Mental Health

5. What to do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21a. Recording your concernsb. Who to talk toi. Sharing your concernsii. Talking to parentsc. What you can doi. In schoolii. CAMHSd. In a crisisi. Panic attacksii. Self-harmiii. Suicidal behaviouriv. Aggressive behaviour6. Further support and information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307. Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31a. Making Sense of Mental Health – National Association of Special Schoolsb. Mental Health First Aid for Intellectual Disabilities – Mental Health First Aid Australiac. Person Centred Plan – Foundation for People with Learning Disabilitiesd. Friends for Life – Foundation for People with Learning Disabilitiese. Resilience and Results – Children and Young People’s Mental Health Coalitionf.Resilience-based approaches to working with children and young people withcomplex needs – Professor Angie Hart, Boing Boingg. Children with special needs and their grief – Child Bereavement UKh. Moving On – Foundation for People with Learning Disabilitiesi.Standards and Audit Tool for Whole School Mental Health (Wellbeing)– Marnie Astonj.Six Relaxation Sessions for Children – Lin Hunt, Sherbrook Primary Schoolk. Zippy’s Friends for Children with SEN – Partnership for ChildrenChildren and Young People with Learning Disabilities - Understanding their Mental Health

INTRODUCTIONThis information pack is intended to provide a basic introduction to mental wellbeingand mental health problems before considering mental health problems in childrenand young people with learning disabilities in more depth.This introduction to the subject is supported by a range of different resources thatmay be useful for all those working with children and young people with learningdisabilities, including details of different programmes that support mental health, aswell as practical resources that can be used to support children.This is a BOND publication led by BOND partner organisation the Mental HealthFoundation. For more information please contact Barbara McIntosh or 020 7803 1100.1Children and Young People with Learning Disabilities - Understanding their Mental Health

1MENTAL HEALTHWe all have mental health. Mentalhealth relates to how we think, feel,behave and interact with other people.includes having positive relationships andsocial connections, as well as feeling incontrol of your life and having a sense ofpurpose.Good mental health and wellbeingMental wellbeing does not mean beinghappy all the time and it does not meanyou won’t experience negative or painfulemotions such as grief, loss, or failure,which are a normal part of life. Peoplewith high levels of wellbeing will stillexperience these feelings, but are likely tobe better able to cope with them without ithaving a significant impact on their mentalhealth.At its simplest, good mental healthis the absence of a mental disorder ormental health problem. Adults, childrenand young people with good mentalhealth are likely to have high levels ofmental wellbeing. The World HealthOrganisation has defined mentalwellbeing as‘a state of mind in whichan individual is able torealise his or her ownabilities, can cope with thenormal stresses of life,can work productively,and is able to make acontribution to his or hercommunity.’ 1It can be helpful to understand wellbeingas being made up of two key elements1. Feeling good2. Functioning wellFeeling good means experiencingpositive emotions like happiness,contentment and enjoyment. Italso includes feelings like curiosity,engagement and safety.Functioning well is about how a personis able to function in the world. This2Good mental wellbeing is closely linked togood mental health, but they are not quitethe same thing. Someone who has beendiagnosed with a mental health problemmay experience high levels of wellbeingfor some of the time, but would bemore likely to experience periods of lowwellbeing than someone without a mentalhealth problem. Equally, supportingpeople who have low levels of wellbeingcan help to prevent the developmentof mental health problems, particularlydepression, stress and anxiety, andsupporting the wellbeing of people withmental health problems can supportrecovery and improve health outcomes.Our mental health and wellbeing arestrongly influenced not only by ourindividual attributes, such as age,personality, gender or genetics, but alsoby the circumstances in which we findourselves and the environment in whichwe live.ResiliencePeople are more likely to maintainhigh levels of wellbeing and protecttheir mental health if they are resilient.Resilience is the ability to cope with life’schallenges and to recover from, or adaptto, adversity.Children and Young People with Learning Disabilities - Understanding their Mental Health

We are not born with a fixed capacityfor resilience. Resilience is somethingthat can be learned and improved, aswell as eroded or worn down by difficultcircumstances, so a person’s resiliencemay change over their lifetime.Resilience is important because it canhelp to protect against the development ofmental health problems. People with highresilience are more likely to cope withdifficult experiences whilst maintaininghigh levels of wellbeing. And good levelsof resilience can help people to recovermore quickly if they do experience mentalhealth problems.Five ways to wellbeingThe New Economics Foundation hasidentified and set out five evidence-basedthings that we can all do to improve ourwellbeing and resilience. These are:Connect With the people around you. With family, friends, colleagues and neighbours. Athome, work, school or in your local community. Think of these as the cornerstonesof your life and invest time in developing them. Building these connections willsupport and enrich you every day.Be active Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercisingmakes you feel good. Most importantly, discover a physical activity you enjoy andthat suits your level of mobility and fitness.Take notice Be curious. Catch sight of the beautiful. Remark on the unusual. Notice thechanging seasons. Savour the moment, whether you are walking to work, eatinglunch or talking to friends. Be aware of the world around you and what you arefeeling. Reflecting on your experiences will help you appreciate what matters toyou.Keep learning Try something new. Rediscover an old interest. Sign up for that course. Take ona different responsibility at work. Fix a bike. Learn to play an instrument or how tocook your favourite food. Set a challenge you will enjoy achieving. Learning newthings will make you more confident as well as being fun.Give Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteeryour time. Join a community group. Look out, as well as in. Seeing yourself, andyour happiness, linked to the wider community can be incredibly rewarding andcreates connections with the people around you.New Economics Foundation 2008 23Children and Young People with Learning Disabilities - Understanding their Mental Health

These are not just things that we shoulddo by ourselves. Community groups,schools, services, and facilities alsoplay a role in promoting the five ways towellbeing to those they come in contactwith and supporting people to take part inthem.Children and resilienceThings that can help keep children andyoung people mentally well include: eing in good physical health, eating ba balanced diet and getting regularexercise aving time and the freedom to play, hindoors and outdoors eing part of a family that gets along bwell most of the time oing to a school that looks after the gwell-being of all its pupils t aking part in local activities for youngpeople.Research has suggested that effectiveresilience strategies for adolescence andearly adulthood include strong socialsupport networks, the presence of aleast one supportive parent, a committedmentor, positive school experiences,a sense of mastery and autonomy,participation in extra-curricular activities,the capacity to re-frame adversitiesso that the beneficial is recognised,the ability to help others and ‘makea difference’, and not to be shelteredfrom challenging situations3. For 10 –20 year olds school is one of the keyenvironments in which mental healthproblems can be identified and mentalhealth support can be provided.Other factors are also important,including: f eeling loved, trusted, understood,valued and safe eing interested in life and having bopportunities to enjoy themselves eing hopeful and optimistic b b eing able to learn and havingopportunities to succeed ccepting who they are and recognising awhat they are good at aving a sense of belonging in their hfamily, school and community f eeling they have some control over theirown life aving the strength to cope when hsomething is wrong (resilience) and theability to solve problems.4Children and Young People with Learning Disabilities - Understanding their Mental Health

2MENTAL HEALTH PROBLEMSJust as we can develop problems with ourphysical health, mental health problemswill be experienced by many of us overthe course of our lives. Mental healthproblems range from the worries we allexperience as a part of our everyday life,to serious long term conditions that canbe very difficult to manage and have ahuge impact on people’s lives.“Mental disorders comprise a broadrange of problems, with differentsymptoms. However, they are generallycharacterized by some combination ofabnormal thoughts, emotions, behaviourand relationships with others. Examplesare schizophrenia, depression anddisorders due to drug abuse. Most ofthese disorders can be successfullytreated.”4It is estimated that one person in fourwill be affected by a mental healthproblem each year: Anxiety and depression are the mostcommon problems, with about 1 in10 people affected at any given time5.Anxiety and depression can be severeand long-lasting and have a big impacton people’s ability to lead their daily life. etween 1 and 2 in every 100 people Bwill experience a serious mental healthproblem such as bipolar disorder,psychosis or schizophrenia6. Peopleaffected may hear voices, see thingsno one else sees, hold unusual beliefsthat are not in line with what is generallyaccepted as real, feel unrealisticallypowerful or feel worthless, with a loss ofinterest in daily life.5Children and young peopleOne in ten children and young people inthe UK aged between 5 and 16 have adiagnosable mental health problem, andone in five of these have more than oneof the main types of mental disorder7. Upto one in six young adults aged between16 and 24 will be experiencing anxietyand depression at any one time8, andone in 15 young people aged 15 to 25are thought to self-harm9. The averageage for the onset of psychosis and forschizophrenia is around 22, and threequarters of all mental health disorderswill be evident by the mid-20s10. Childrenand adolescents with learning disabilitiesare over six times more likely to have adiagnosable psychiatric disorder thantheir peers who do not have learningdisabilities (see ‘Learning Disabilities andMental Health’ below).Mostly things that happen to childrendon’t lead to mental health problems ontheir own, but traumatic events can triggerproblems for children and young peoplewho are already vulnerable. Changesoften act as triggers: moving home orschool or the birth of a new brother orsister, for example. Some children startschool feel excited about making newfriends and doing new activities, but theremay also be some who feel anxiousabout entering a new environment.Teenagers often experience emotionalturmoil as their minds and bodiesdevelop. An important part of growing upis working out and accepting who youare. Some young people find it hard tomake this transition to adulthood and mayexperiment with alcohol, drugs or othersubstances that can affect mental health.Children and Young People with Learning Disabilities - Understanding their Mental Health

People with learning disabilitiesResearch demonstrates that anestimated 25-40% of people with learningdisabilities have mental health problems.Evidence compiled by the Public HealthObservatory for Learning Disability showsthe following: A prevalence rate of 3% forschizophrenia amongst people withlearning disabilities (three times greaterthan for the general population), withhigher rates for people of South Asianorigin evels of anxiety and depression are Lsimilar to those of the general population(though higher in people with Down’ssyndrome). The prevalence rate of a diagnosablepsychiatric disorder is 36% in childrenand adolescents with learningdisabilities, as opposed to 8% in thosewho do not have a learning members who are best-placed toidentify such changes.Some key factors that often contribute toa change in emotional well-being includephysical health, loss and bereavement(this could be a change of support orbus driver who takes the child to school,as well as the loss of a family member),change and transition to adulthood.Mental illnessesDepressionDepression affects more children andyoung people today than in the last fewdecades, but it is still more commonin adults. Teenagers are more likelyto experience depression than youngchildren.Depression is a common mental disorderthat causes people to experienceMental health problems may bedepressed mood, loss of interest orworsened for those with greater supportpleasure, feelings of guilt or low selfneeds, particularly if they are unableworth, disturbed sleep or appetite,to communicate about their feelings orlow energy, and poor concentration.communicate their distress (it may resultDepression is different from feelingin this behaviour mistakenly being seen to down or sad. Unhappiness is somethingbe challenging). As a result, changes inwhich everyone feels at one time oremotional wellbeing in children and adults another, usually due to a particular cause.with high support needs may easily beA person suffering from depressionoverlooked by those who care for them,will experience intense emotions ofparticularly if they have high levels ofanxiety, hopelessness, negativity andmedical needs.helplessness, and the feelings stay withthem instead of going away.Research by the Foundation for Peoplewith Learning Disabilities clearly identified Younger children experiencing depressionthat people with profound and multiplemay show symptoms in a different waylearning disabilities do experience mental to adults or teenagers. For example, theyhealth problems, often for reasons similar might lose interest in school or in play,to those of the general population11.refuse to go to school, become moretearful, withdrawn, irritable or moodyHowever, identifying the signs andthan usual. They may also become moresymptoms that indicate changes in thedisruptive at school, or have violent oremotional and mental wellbeing of people aggressive outbursts.with profound and multiple learningdisabilities takes longer, and it is often6Children and Young People with Learning Disabilities - Understanding their Mental Health

AnxietyPsychosisAnyone can have feelings of anxiety,including children and young people.Anxious feelings often occur in responseto a stressful situation and include:feeling scared or panicky, feeling irritable,having negative thoughts or worries,feeling shaky, dizzy or sick, breathingfast, sweating, having tense muscles orpalpitations. Sometimes these feelingscan be helpful, for example, by increasinga person’s ability to perform in a race orexam. These feelings are normal.Psychosis describes the distortion ofa person’s perception of reality, oftenaccompanied by delusions (irrational andunfounded beliefs) and/or hallucinations(seeing, hearing, smelling, sensingthings that other people can’t). Peopleexperiencing psychosis can also havemuddled or blocked thinking (thoughtdisorder), can at times seem unusuallyexcited or withdrawn and avoid contactwith people, and might not realise thatthere is anything wrong with themselves(lack of insight). People often experiencetheir first episode of psychosis in their lateteens or in their early 20s.However, anxiety can become a problemwhen the symptoms are more intenseor long-lasting and begin to interferewith a person’s concentration andability to do routine tasks. People may:avoid situations that could provokefeelings of anxiety, feel embarrassed orashamed a lot of the time, not have theconfidence to face new challenges, orhave problems eating and sleeping. Thisinterference with daily living, as much asthe symptoms themselves, may lead aperson to seek help.Anxiety disorders come in various forms,and include generalised anxiety disorder(GAD), social anxiety disorder, phobias,panic attacks, obsessive compulsivedisorder and post-traumatic stressdisorder (PTSD).Serious mental illnessesSerious mental illnesses such aspsychosis, schizophrenia and bipolardisorder are rarely diagnosed in childrenand young people before the age of14. However, many young people willexperience their first episode of a seriousmental illness in their late teens or early20s. The average age for the onsetof psychosis and for schizophrenia isaround 2212.7Psychosis is a symptom of some of themore severe forms of mental healthproblems, such as bi-polar disorder,schizophrenia, substance abuse or someforms of personality disorder.SchizophreniaSchizophrenia is a serious mentalillness characterised by disturbancesin a person’s thoughts, perceptions,emotions and behaviour. Schizophreniais an umbrella diagnosis used to describea wide range of symptoms. During anepisode of schizophrenia, a personmay lose touch with reality, see or hearthings that are not there, hold irrationalor unfounded beliefs, and appear to actstrangely because they are respondingto these delusions and hallucinations.An episode of schizoph

Children with special needs and their grief – Child Bereavement UK h. Moving On – Foundation for People with Learning Disabilities i. Standards and Audit Tool for Whole School Mental Health (Wellbeing) – Marnie Aston j. Six Relaxation Sessions for Children – Lin Hunt, Sherbrook Primary School k. Zippy’s Friends for Children with SEN – Partnership for Children. 1 Y nderstanding .

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