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Exclusion in school may lead to poorer mental health in children

Tamsin Ford

Exclusion in school, which was more common in boys, secondary school students and socioeconomically disadvantaged children, was associated with higher psychological distress, according to secondary survey analysis results.

“The influence of children’s mental health on their ability to cope at school was a prioritized question from the experience of local pediatricians and child psychiatrists,” Tamsin Ford, PhD, study researcher with the University of Exeter, England, told Healio.com/Psychiatry. “We thought we could demonstrate problems in the identification of the mental health condition so that better training and advice might be a solution, and we anticipated that being excluded has an impact on children’s mental health.”

To assess associations between exclusion from school and psychopathology, Ford and colleagues conducted secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007. Parents reported exclusion from school and sociodemographic characteristics. Researchers assessed psychopathology with the Strengths and Difficulties Questionnaire and determined psychiatric disorders with the DSM-4 criteria and the Development and Well-Being Assessment.

Results revealed that exclusion from school was more common among boys, secondary school students and participants living in socioeconomically deprived areas.

Poor general health and learning disability in children and poor parental mental health were associated with exclusion.

At baseline and follow-up, participants who experienced exclusion exhibited consistently high levels of psychological distress.

“Children spend a lot of time at school, so no assessment of a child is complete without some communication with the teacher. Understanding the strengths and weaknesses of this social situation and how the child copes with them is as much a part of understanding a child’s difficulties as understanding the family,” Ford told Healio.com/Psychiatry.

Schools can serve as a resource for support, but can also be a stressor to children and families, according to Ford.

“While ADHD and [autism spectrum condition] clearly present challenges to coping with school, depression and anxiety can sometimes undermine concentration and attainment, and can lead to a vicious circle of teacher disapproval feeding into the emotional problems, resulting in worsened concentration and increased disapproval,” Ford said. “Children who are anxious or depressed can be irritable and withdraw from peers and school. Communication about a child’s difficulties, with the agreement of both the child and his or her parents, can increase support and turn a child who is a problem into a child who has a problem by making sense of behavior that can be misunderstood as willful disobedience and disruption.” – by Amanda Oldt

Disclosures: The researchers report no relevant financial disclosures.