Emotional well-being Vs. mental health

Important to note. . . 

One important clarification to make early on in the life of this blog is that the aim of this blog is to help staff in special schools to support the emotional well-being of young people with autism rather than their mental health.

Although mental health is mentioned regularly as a significant related field, most school staff will not be appropriately trained to take the lead in treating medical conditions, we are not trained medical professionals.

Mental health is not necessarily even connected with emotional well-being. For instance people who report high levels of satisfaction and happiness can be susceptible to depression whilst those who suffer trauma and distress may never develop mental health problems.

There has been a wealth of work on how best to treat people with mental health problems but not all of these are useful for people with learning disabilities or autistic spectrum disorders. For example, talking therapies are usually seen as the best way to tackle problems relating to the stresses of life (Karim, Ali, O’Reilly, 2014). Cognitive Behaviour Therapy is a commonly used, highly researched, therapy used to treat a range of problems including treating factors that lead to depression, but there is no evidence that it is effective in helping young people with autism (White et al, 2009).

Having said all that; as I have made clear in other blogs, what we do to support our learners now may have long term beneficial effects on their mental health. What we can do is try to relieve symptoms and causes of anxiety amongst those learners whom we know well and care about with the aim of preparing them for adult life. We can and must promote emotional well-being.


Pets – emotional well-being and spiritual development with animals

There is no psychiatrist in the world like a dog licking your face! (Purkiss, Goodall and Nugent, 2016).

As we think supporting the emotional well-being of people with autistic spectrum conditions (ASC) we must remember that we are all spiritual beings. Other activities, some of which I have discussed on this site, can be useful in helping individuals to develop this aspect of their self through creative expression, experience, exploration of feelings and beliefs. However, there is little that is as important in developing our spiritual sides as expressing our personalities through relationships. Anyone who has ever described themselves as a ‘dog-person’ knows full well that this expression runs freely when interacting with a dog.

Many myths pervade our collective beliefs around autism, one is that people with autism cannot, or do not want to, form relationships. I have not found this to be true for even one of the individuals with ASC I have supported over the past 14 years.

Interaction with animals has been shown to bring a wide range of benefits, including emotional and psychological, to people with ASC, providing a sense of purpose and getting people active outside (Morrison, 2007). Having a pet is positive for mental health, effective in treating depression and anxiety. This could be because people with pets have lower blood pressure in stressful situations (Nepps, Stewart and Bruckno, 2014) and are better able to communicate and interact with others (Rossetti and King, 2010).

People with ASC may form positive relationships with animals, feeling closer to them than other humans in school. Pets could therefore be of great help to learners experiencing anxiety and stress by bringing love and attachment. This could reduce feelings of stress, isolation or loneliness (O’Haire, 2013) and provide opportunities for communication, a person with ASC may have an understanding of animals that other people lack (Nepps et al. 2014), and improve self-esteem through developing responsibility.

Therapy dogs can assist to increase empathy/compassion/self-esteem, support victims of bullying, decrease retaliatory violence, build social networks between learners, reduce stress and anxiety, reduce the impact of traumatic circumstances and contribute to the improvement of reading skills.

School staff may have to overcome certain hurdles in seeking to bring dogs into schools. Therefore it is important that implementing an animal therapy program is well planned. However, the benefits are worth it. The benefits from a well-run dog therapy program in a school far outweigh the initial efforts.

Potential issues could be legal Implications, supervising the dog, allergic reactions, potential harm to students, staff or the animal, maintenance costs and responsibility, hygiene and phobias of some learners.

In planning for these challenges a school ought to consider applying to be supported by a well experienced organization such as Pets as Therapy. Competent dog handlers are trained to watch for potential harm to either a child or their own dog and are primarily responsible to manage the animal. Check that dog handlers representing these organizations carry insurance coverage, meet cleanliness requirements to minimise allergic reactions and have regular veterinarian checks. Ensure that families provide signed consent forms to ensure full awareness of potential problems and to avoid unwanted contact with the dog, the learners are likely to overcome their fear as they gain confidence and respect of the dog. Consider where the dog can be kept safely, establish policies before the program starts, begin small with short visit.

Consider further research; below are some helpful sources of information.

Socio-Emotional Effects of a Dog in the Classroom. Andrea Beetz1, 2 1 University of Erlangen,

Erlangen, Germany. 2University of Rostock, Rostock, Germany.

  • Quantifying the Impact of Incorporating Therapy Dogs in an Afterschool Program: A Comparison of

Net Change in Reading Fluency. Jennifer Emmert1, Sue Gonzales2 1The San Francisco SPCA, San Francisco,

CA, USA. jemmert@sfspca.org 2E.R. Taylor Elementary School, San Francisco, CA, USA.

  • Studying for Exams Just Got More Relaxing—Animal-Assisted Activities at the University of Connecticut

Library. Reynolds, Jo Ann; Rabschutz, Laurel. College & Undergraduate Libraries. 2011 Oct; 18(4): 359-367.

  • Adolescent Social Work Journal. 2011 Jun; 28(3): 243-256.Kids, Dogs, and the Occupation of Literacy.

Scott, Keri; Haseman, Jean; Hammetter, Rona OT Practice, 2005 Feb 21; 10(3): 16-20.

  • Active Open Learner Models as Animal Companions: Motivating Children to Learn Through Interacting

with My-Pet and Our-Pet. Chen, Zhi-Hong; Chou, Chih-Yueh; Deng, Yi-Chan; Chan, Tak-Wai. International

Journal of Artificial Intelligence in Education, 2007; 17(2): 145-167


Rambling Club – Emotional well-being through nature and exercise

“Walking is man’s best medicine” – Hippocrates

Getting outside is great for the mind and if it involves getting a little out of puff that’s all the better, rambling is superb for just about anyone and very helpful when thinking about well-being.

Aerobic exercise such as walking has been found to improves the physical fitness of people with ASC; Pitetti, Rendoff, Grover, and Beets (2007) showed that a walking programme improved the physical condition and BMI index of ten adolescents with ASC. Importantly for schools it can also improve difficult behaviour (Elliot, Dobbin, Rose, & Soper, 1994; Yilmaz et al., 2004), social behaviour, communication, academic engagement and sensory skills (Sowa, Meulenbroek, 2011).

Walking is an amazing activity for many of our learners, helping them improve their health and their spiritual well-being. It can be grounding for those with proprioceptive difficulties, it involves a range of sensory experiences, it is low risk (as long as you choose your route sensibly), affordable, accessible, local (you can go from your front door and free!

Movement difficulties are very common in people with ASC possibly due to difficulties with posture, coordination and motor planning. However, walking has been shown to be a useful exercise in improving fitness in people with Rett syndrome (Lotan, Isakov, & Merrick, 2004) and autism (Pitelli and Rendoff, 2007).

On top of the physical, health benefits walking in a group can help build friendships boost our restorative ‘sense of connection’ with nature and participants get a ‘feel good factor’, all of which helps support positive mental health and spiritual well-being.

Walking also has potential benefits for managing anxiety; challenging behaviours can restrict opportunities for people with ASC, some of this behaviour can be attributed to physiological arousal. McDonnella, et al. (2011) recommend the inclusion of activity that lowers the arousal of learners in managing the challenging behaviours of individuals with ASC.

I lead the school Rambling Club; we meet on Friday mornings when we go out for about 45 minutes. Most of us walk, some are in wheel chairs, the group is inclusive for anyone in school who may want to come along – all they need is a risk assessment.

Schools will want to make walks inclusive for people with a learning disability so that all learners have an equal opportunity to take part. When planning walking group considerations will depend upon the setting but important areas of preparation may be:

Routes: consider having a circular route so you do not have to turn around. I have found this to be useful with learners who have ASC in the past, one learner in particular became very anxious if asked to turn around or change direction, fortunately a local supermarket has a path the whole way around the car park so we could walk there, walk around the path and head back to school without ever turning around.

Map the route out in preparation. Consider the length; for slow walkers a 1 mile walk is probably a good starting distance, for more accomplished walkers 2 or more miles may be more satisfactory.

For young people in wheelchairs consider the temperature, they may get colder more quickly than others who are walking.

Consider how your learners may be able to learn to navigate the route with increased independence; perhaps using a chalk line to follow, arrows pre-marked on the pavement using chalk or impermanent paint, a list of stimuli landmarks such as obviously visible items e.g. post-box, a neon sign, places that make noise e.g. a bus depot, a river, places that smell e.g. a farm, bakery, or taste e.g. McDonalds, photographs of landmark to head towards, written instructions for any who can read and follow instructions, a map to read for those capable.

Clothing – encourage learners to bring sensible clothing and footwear; soggy feet and sticky clothes put anyone off walking, the effect could be worse for people with sensory difficulties, or they may like it!

Staff may be advised to wear high-viz jackets, these model road safety to the learners and help them to keep an eye on you.

Warm weather – take a drink.

Paper work

Ensure all emergency contact details for walkers are up to date, you have risk assessed the route, you have permission from famililes.

Risk assessment – make sure that you have considered the risks that may be along the route, how to minimise the risk and what to do in case of emergency. You may have to consider open water, roads, animals, barbed wire, styles (trip hazard), narrow pavements where walking side by side is difficult, electric fences, uneven ground, slippery ground, risk to/from the public – and don’t forget the risk of going past enticing shops, avoiding some of our learners from running into an open shop door may be a challenge.

Road safety – consider doing some road safety work with your learners before leaving. Try these resources http://think.direct.gov.uk/education/early-years-and-primary/ or http://www.brake.org.uk/info-and-resources/resources/guide-to-teaching-road-safety

Emotional well-being and physical exercise

“Lack of activity destroys the good condition of every human being, while movement and methodiical physical exercise save it and preserve it”


This truth is pertinent to the learners who have ASC with whom we work, we must consider physical activity whilst thinking about well-being.

Physical exercise not only improves the physical condition but also reduces the maladaptive behavioural patterns of people with ASD (Lancioni & O’Reilly, 1998).

Sports, exercise, and other physical activities can be a useful adjunct to traditional behavioral interventions, leading to improvement in symptoms, behaviors, and quality of life for individuals with autism” (Dawson, Rosanoff, 2009).  For the school aiming to improve the well-being of learners with ASC and profound learning disabilities there are physical activities that may help develop a pupil’s activity in school (Brown, 2012); this is useful for learners with ASC as they seek to develop their personalities and spiritual self as the better they feel the better they can engage with the world.

People with ASC are more susceptible to stress (Prior & Ozonoff 1998; Groden et al. 2005), a primary cause of anxiety and poor mental health in people with ASC (Groden et al. 2006). Exercise and enjoyable physical activity help to reduce stress, including in people with learning difficulties (Hutchinson et al. 2003). They also help with spiritual well-being which has been shown to improve an individual’s resilience to mental illness (Koenig, 2010).

Exercise and active leisure pursuits do wonders for the well-being of our learners (García-Villamisar, Dattilo, 2010) and providing them with coping mechanisms (Iwasaki et al. 2006). Exercise is powerful in improving success in education; pre-lesson exercise improves the academic response of young and older children with ASC (Oriel, George, Peckus, Semon, 2011). Dupuis & Smale (1995) showed that hobbies including swimming is associated with better psychological well-being and lower levels of depression. Increased aerobic exercise can significantly decrease the frequency of behaviors that challenge while not decreasing other positive behaviors (Rosenthal-Malek & Mitchell, 1997). Strenuous exercise is associated with decreases in stereotypic behaviors, hyperactivity, aggression, self-injury, and destructiveness (Elliott, Dobbin, Rose, Soper, 1994). And it increases production of ‘feel-good’ hormones, endorphins and serotonin (Chaouloff, 1997), distracts the mind from anxious thinking, improves sleep and raises energy levels (Mayo, 2010). It helps with motor skills, an area that people with ASC often need to work on (Elliott, 1994).

The potential benefits of physical activity for a person’s self, if successfully implemented into education for people with ASC are huge. It could help learners to overcome behavioural, physiological and emotional challenges – improving the spiritual well-being across school.

Despite the benefits, most people with ASC are not meeting the recommended exercise requirements (Pan, Frey, 2006) and are likely to have more screen time than their neuro-typical peers (Busst, 2015). Children, adolescents, and adults with developmental disabilities typically have physical fitness levels inferior to their non-disabled peers, similar to people who have a sedentary lifestyle (Fernhall & Pitetti, 2001), this includes people with autism (Pitetti et al., 1999).

Even in school, where we usually have the required resources and funds to help, some teachers report a lack of confidence in planning exercise sessions for people with ASC and learning disabilities due to the difficulties faced by our learners in joining in team sports.

This need not impede the provision of opportunities for exercise however. Although group exercise is shown to be more beneficial for social interaction (Sowa, Meulenbroek, 2012) individual exercise provides wide reaching benefits.

In planning exercise sessions for people with ASC teachers make various considerations such as how to make the activity accessible. The exercise activity needs to be tailored to the specific needs of the individuals with ASC in school. Complicated rules or difficult motor activities can be a de-motivating (Busst, 2015), especially for people with limited motor functioning, motivating for someone who has difficulty with fine or gross motor-planning and self-monitoring and accessibly for someone with sensory processing needs (Dawson, Rosanoff, 2009).

The decision over the variety of physical activities to implement will depend on the setting an individuals. There is no agreement over which form of exercise may be best (Busst, 2015).

As with all activities in school, we must consider how to make the activity enjoyable – As Gina Davies from Attention Autism has said; children should be laughing hundreds of times a day – a typically developing child laughs 200 times per day. How often do our children laugh? The more challenging a child is the more anxious and uptight the people around them become. Laughter relaxes everyone and keeps children mentally happy and healthy.”

To raise the chances of positive engagement it is helpful to choose activities in which the learner is interested; examples may include swimming, dance, tricycling, gym (e.g. rowing machine, carrying weights, steps), jogging, group athletics or exer-gaming (video games that involve physical exertion. List Hilton, effects of exer-gaming on executive function and motor skills in children with autism spectrum disorder. 2014. American Journal of Occupational Therapy.)

It is likely to be more motivating if staff join the learners in the activity and consider how to motivate that individual such as through use of rewards.

Mindfulness – developing a knowledge of self to build emotional well-being

All people, including learners in our schools, who may experience very severe symptoms of autism, are spiritual beings to the extent that we have individual personalities, desires, emotions and experiences. Our learners may need extra support in developing their spiritual selves. While traditional RE lessons may not be appropriate it may be possible to help them to develop spiritually through helpful practices. Personal development may be enjoyable and calming so useful in supporting learners’ emotional well-being.

Mindfulness can be successful in reducing stress (Nepps et al. 2014). It is an attempt to be aware of one’s present experience – the here and now. This is helpful in recognising that the present experience is temporary. When we are not being mindful of our experiences and feelings our thoughts tend to slip into an unhelpful patterns of worry about the future and dwelling on the past – this is a common route to depression (Hassad, 2011).

Mindfulness has been shown to help people manage aggressive instincts (Singh, 2011), increase compassion and reduce anxiety (Hassad, 2011).  It may be useful in helping learners to realise that they have a choice in each situation, to react appropriately and therefore to reduce stress (Shadi et al. 2016). In the area of learning disability mindfulness has been successful in reducing aggression, improving mental health, and reducing the use of physical restraints (Barber, 2013). And in people with high-functioning ASC mindfulness training has reduced anxiety, depression and rumination (Cachia, Anderson, Moore, 2016).

Various traditions have utilised regular mindfulness to effectively address stress and anxiety (Kabat-Zinn et al. 1992), to increase awareness of experience and promote self-regulation and caring for others. These very factors are important to learning and to developing supportive relationships for people with ASC (Hwang, Kearney, Klieve, Lang and Roberts, 2015).

Recently, as mindfulness has grown in popularity in schools, attempts have been made to modify it for the benefit of high-functioning individuals with autism. The aim is to reduce co-morbid symptoms in autism and alleviate distress. Recent studies show some success, especially for symptoms of anxiety and depression (Weiss & Lunsky, 2010). Mindfullness encourages thinking about the present so the individual is distracted from ruminating on negative thoughts, as this is a form of reflection on the personal experience it does not require a theory of mind.

When beginning the introduction of mindfulness as an activity for learners with autism and learning difficulties it is likely that, as with all activities, you will need to search for resources and tailor them to the needs of your class.

I have recently come across this website with a range of resources, these ‘20 relaxation/calming activities for children’ in particular could be useful for our learners. However, each of our classes are different and you will have to consider how best to introduce mindfulness for yours.

Consider whether to try mindfulness while sitting on the ground, walking, lying down or on chairs. The sessions could last anything from 30 seconds to 20 minutes depending upon the ability of the learners to concentrate and their enthusiasm for the mindfulness. There are many types of mindfulness that can be used, it will be important to choose a style that suits the needs and preferences of your group.

Then, as usual, ensure that support staff know the expectations and point of the exercise so that they can help the learners to get as much from each session as possible, importantly by modelling expected behaviour.

Consider the environment – your classroom is probably set up to be calm anyway, but it is always worth remembering to work on a low-stimulation environment. When expecting our learners to concentrate we must minimise distractions around the room. Consider; is the room tidy? Is stuff ordered and un-confusing? Is the environment simple with space to walk around and clear surfaces.

Mindfulness activities could support learners who are working towards achieving a level of relaxation; this will have to be assessed through written observation notes by staff who know the learner well.

Learners may also work on being able to choose which activities they prefer, whom they would like to sit with, staff or peer and how to follow routines to set up the room using lighting, seating, table cloths etc.

Development of self – iPad app for mindfulness

Blurb from the maker:

Calm is an iPad app and website that allows users to meditate, relax, and collect their thoughts. The layout and functionality is straightforward — as it should be for a calming app. It’s important to find time in the day to unwind and relax, and Calm provides the ideal setting to do so. A serene visual gently moves in the background while soothing soundscapes provide users with a way to escape from stress and the outside world. Calm offers voice-guided, timed meditation sessions in addition to the music track, allowing for a more focused and directed experience. There is a section for nature sounds as well as a meditation guide that lays out the “7 steps of calm.” Users can visit Calm.com to get started or download the app on iTunes. Calm’s ease of use, simple concept, and soothing content make it suitable for all ages. We recommended Calm for children ages 9 and up, although younger users may find it just as relaxing and meaningful.

Available at http://learningworksforkids.com/apps/calm/


Special Schools – why we must support emotional well-being

Given the high levels of stress and anxiety leading to depression recorded in the population of learners with ASC (Gillott, Furniss, & Walter, 2001; Van Steensel, Bögels, & Perrin, 2011), and the associated effects on mental-health, behaviour and achievement, it is of paramount importance that schools supporting learners with ASC consider their needs in this area. The Review of Special Educational Needs Provision Cornwall, 2016 which lists Social Emotional and Mental Health and Autistic Spectrum Disorders, as two of its five priorities (Cornwall County Council, 2016).

What can special schools do?

We must promote curricula, activities and general practices that improve learners’ mental state, this can be described as well-being (Mind, 2016). By guarding positive mental health, through trying to limit the degree of stress and anxiety experienced by learners, we can hope to instil greater resilience against mental illness. Watson (2014) states that ‘wellbeing is a massive issue – not just for us, but for everyone who cares about education.’

When thinking about reducing stress and anxiety, education professionals should think about how to improve well-being in our learners and the community as a whole; the best interventions promote positive mental health for all, as well as targeting individuals (Weare, 2011). We need to be in the business of improving the well-being of whole school communities by reducing the experience of stress. In fact, the United Nations Convention on the Rights of the Child states that all who have responsibility for children have a duty of care to promote the fundamental right of every child to well-being.

Well-being has been identified as a weakness of UK schools; it is damaging our youth (Hagell, 2004).  Psychologists are actively debating what may be behind the poor state of mental well-being in young people for instance Collishaw (2015) and Greig, MacKay, Roffey and William (2016).

Positive well-being is linked to a longer life expectancy (Diener & Chan, 2011), speedy recovery from illness (Cohen, Doyle, Turner, Alper & Skoner, 2003), improved well-being of those around us (Schwarze, J. 2004) and positive outcomes in life (ONS, 2013).  Significantly for educators, well-being, as identified by White, (2008), has a direct relation to success rates in schools. The public Health England report on the link between health, wellbeing and attainment states that pupils with better health and wellbeing are likely to achieve better academically (public health England, 2014.

In contrast, poor emotional well- being can lead to detrimental effects on physical health, income, work, social and family relationships and work and educational outcomes (Layard, Clark and Senik, 2012).

Although research by the Office for National Statistics suggests that some aspects of well-being are improving in the UK (The UK is above average for life satisfaction (18th of 36 in the OECD Your Better Life Index (2013), meaning in life (9th of 27 in the European Quality of Life Survey (2012), happiness (10th of 27 also in the European Quality of Life Survey (2012), self-reported health (10th of 36 in the OECD Your Better Life Index (2013) and child life satisfaction (14th of 29 in the UNICEF Innocenti Report Cards 7 & 11), there remains a concerning trend of poor levels of overall emotional well-being, the UK came 20th of 27 in the European Quality of Life Survey (2012).  This may be related to the stubbornly high rate of mental illness amongst our population as evidenced by our (depressingly) high level of depression.

Importantly, there is no evidence that poor well-being leads directly to depression; it is not uncommon for people with a poor standard of well-being to avoid depression, equally there are people with a high standard of well-being who do get depression. However, stress and anxiety, especially if they are prolonged, can lead to depression and these are states that are common in people with autism.

Mind, the mental health charity, describe positive well-being as  having positive self-esteem, the ability to express emotions, build and maintain good relationships, feel engaged with the world and work productively. This could be summarised as feeling good, functioning well and minimising negative feelings such as anxiety (ONS 2013). Each of these can be a challenge for people with ASC due to struggles with language and communication, social understanding and relationships, flexible thinking and social imagination, sensory development, poor generalisation, attention, memory, understanding how others think and feel, getting the gist of a situation (Smith, 2015).


Supporting our learners to experience joyful emotions, to minimise negative feelings and to feel that they are functioning/succeeding is a challenge as they are likely to experience difficulties with language and communication, social understanding, relationships, flexible thinking, imagination, sensory development, generalisation, attention, memory and theory of mind (Smith, C. 2015).


However, although some work has been conducted in special schools to facilitate the implementation of stimulating, relevant curricula there are few resources specifically for our settings; so we have the constant challenge of tailoring our provision to meet the needs of individual learners.


For the population as a whole The New Economics Foundation sets out five evidence-based suggestions to improve our wellbeing and resilience. To socialise, be active, appreciate the world around us, to learn by developing an interest or completing, giving to others by helping those around us. Applying this to schools, The Department for Education report , Mental health and behaviour in schools, identifies that children are protected from mental health problems if they attend schools that offer clear policies on behaviour and bullying, an ‘Open door’ policy for children to raise problems, a whole-school approach to promoting good mental health, positive classroom management, a sense of belonging. They recommend that a schools should have a senior management team committed to valuing all pupils, foster a sense of belonging, set high expectations of attainment, work with families, provide professional development for staff that promotes good mental health and clear systems and processes to help staff who identify mental health problems.


There has been limited research into how these principles may be applied, especially in the specific context of a special school for children with profound autism. The next stage of this blog is to think about what these might look like for teenagers with ASC in a special school.

Special schools must address poor mental health in pupils with autism

In order to best serve our learners with ASC and profound learning difficulties in preparing them for adulthood, it is essential that staff in special schools consider what can be done to support the resilience of learners to mental health problems.

Research by the National Institute for Health and Care Excellence (Nice) suggests that children and teenagers are in the grip of a mental-health crisis resulting from deficiencies in well-being. Like depression, this is particularly significant among people who have learning difficulties. Huntington and Bender (1993), demonstrate that emotional well-being is not positive in people with learning disabilities who have an increased risk for depression and suicide. Rather than well-being, being well, the experience of many people with ASC is stressful; many unwanted behaviours associated with ASC (e.g. aggression, self-injury, tantrums and property destruction) are related in some way to this stress (Prior & Ozonoff 1998; Groden et al. 2005). Baron et al. (2006) concluded that ‘. . . the connection between stress and ASD is a contributor to the physiological, psychological, and overt behavioral manifestations . . .’ of ASD (p. 5) and that it plays an extremely important role in mediating many of the inappropriate behaviors of individuals with autism and their delays in learning’ (p. 6).

Hence improving well-being, quality of life, is critical in the rehabilitation of people with developmental disabilities (Renwick & Friefeld 1996),

A school vision statement from the past, a statement of intent or guiding principle, contained just three words: Aspiration, Confidence and Independence. The message was that as staff in that school we would work hard and pull together to overcome barriers so that our learners can achieve the best outcomes possible.

The risk of mental illness is a serious barrier to an independent adult life; but there is little research into what special schools can do to develop resilience against mental health problems. However, school staff, although caring, concerned for and invested in the well-being of learners, are not medical professionals. We don’t have expertise or authority in treating mental illness. We need to play a part in a team approach to tackling the issue (Dossetor, White & Whatson, 2011).

Haracz and Roberts (2016) explain that resilience training helps workers’ in wellbeing outcomes such as stress, depression, anxiety and negative mood. It is for us to attempt similar outcomes for learners in our schools.

What is profound/severe/classic/low-functioning/Kanner’s autism?

Autism is a condition, sometimes known as autistic spectrum condition (ASC) or autistic spectrum disorder is a developmental condition that affects how a person communicates with and relates to other people, and how they see, hear and feel the world around them. It is a lifelong condition that is a fundamental part of a person’s make up, not an illness that can be cured (National Autistic Society (NAS), 2016).

Having an ASC is relatively common; in the UK there are around 700,000 people living with autism – more than 1% of our population. Worldwide autism affects individuals from all nationalities and cultures, although it is more often diagnosed in males (NAS, 2016).

Autism is a spectrum condition, it is made up of certain traits that can make the experience of life in our society difficult, but being autistic affects people in different ways, meaning people need different levels of support. People most severely affected by autism need a great deal of support. It is not unusual for a person with severe autism to require 24/7 support. There is no universal grading system for the severity of impact that a person with ASC experiences but the people most affected are sometimes described as having severe or profound autism, this is also known as classic autism or Kanner’s autism. These terms refer to people with the most significant symptoms on the autism spectrum disorders who may need regular or constant support. The aspects of autism that may cause someone with ASC to require regular support may be being entirely unable to use spoken language or take notice of other people, low IQ’s, sensory dysfunction (they’re too sensitive or not sensitive enough to light, sound, touch, taste or smell, experiences most people take for granted such as going outside can be overwhelming), repetitive behaviours others may find difficult which can include self-injury, eloping, aggressive behaviours, faecal smearing, door banging, etc. They may also have health issues such as sleeplessness, epilepsy, mood disorders and gastrointestinal issues (Rudy, 2016).

People with ASC are more likely to experience anxiety as the particular traits of their autism can lead to a high degree of challenge in navigating the world and our communities; this increases the chances of experiencing stress across a range of everyday situations. This is especially likely to relate to forming relationships with other people, taking part in social activities such as spending time with people at school or in the family, communicating and coping with unexpected events or changes (Rudy, 2016).

Why Our Learners Suffer From Mental Health Problems and Poor Emotional Well-Being

Causes of mental health issues in the general population

With depression and other mental illnesses having a devastating effect on learners with profound ASC in special schools it is important to understand what might be driving this crisis.

It is unlikely that any single factor is likely to cause depression. Sufferers often talk about a spiral affect (NHS, 2016) with one difficult event leading to another, each affecting their mood, until they develop depression. However, some people are more likely to suffer depression than others (Janowsky, Morter, Hong, 2002) unhelpful factors that may worsen a person’s mental health problems include loneliness, drug use (including alcohol), hormonal and physical changes along with changes to lifestyle and sleep resulting from childbirth, illness, head injuries or an underactive thyroid (hypothyroidism). (NHS, 2016).

To some extent, depression may be hereditary; a person’s genes can make them more likely to suffer depression. The incidence of depression in a close relative, perhaps a parent or sibling, makes it more likely, but not inevitable (Levinson, Nichols, 2012).This is a predictable observation, given the links between genetics and personality (Tellegen, Lykken; Bouchard, Wilcox, Segal, Rich, 1988). The traits of a person’s personality have a direct influence on an individual’s vulnerability to depression, such as poor self-esteem (NHS 2016, Krueger & Johnson 2008, Watson et al. 2006).

Depression may also extend from lived experiences. The risk of depression is increased by traumatic, challenging situations, prolonged feelings of anxiety or stress have been linked to depression (Thurston RC, Kubzansky LD, Kawachi I, Berkman LF. 2006). People who are regularly under stress are at a higher risk of a range of problems from headaches to depression and even high blood pressure (Barton, 2010). Stress increases production of the stress hormone, cortisol, and reduce the reward hormones, serotonin and dopamine, this can trigger depression (Martin, 2011). This is especially likely if the stressful event triggers unhelpful changes in lifestyle such as reduced time outdoors, exercise, work, social time with family and friends or increased drinking or drug use. The experience of tragic events early in life may also lead to an increased risk of depression in the future (NHS, 2016). This is illustrated by the very high rate, 45%, of children in care having a mental health disorder (Ford, 2007).

Causes of mental health issues in learners with ASC in special schools

Variation in individual life experiences, genetics and personality make it impossible to definitively identify causes of depression in an individual with ASC. In fact there is little understood about the factors that place those with ASC at risk of co-occurring mental health disorders (Ghaziuddin et al. 2002).

  • Triad of impairment

ASC is a complex spectrum of disorders (Joshi, Petty and Wozniak, 2010) often defined as a condition with a particular presentation. This presentation is described as a triad of impairments, manifesting as difficulty in three areas; social interaction, flexibility of thought and communication research suggests social and emotional skill deficits are risk factors for mental health issues (Humphrey et al. 2007); It is likely, therefore, that a combination of factors relating to these areas of impairment can make functioning in every-day situations stressful and lead to high levels of anxiety. Difficulty in communication, socialisation, sensory processing and executive functioning lead to behavioural deficits that may result in people with ASD being vulnerable to stressors (Groden et al. 1994, 2006).

Living with regular stress increases the susceptibility of a person with ASC to depression (Galanopoulos, Robertson, Spain, Murphy, 2014). Nick Dublin reports in The Autism Spectrum and Depression (2014) that for people with ASC, the stresses of coping with a world that seems alien can lead to depression.

This is especially concerning for a person with ASC and associated learning difficulties in a special school where they might experience stressful situations frequently due to the behaviour, emotional disorders and methods of communication of learners around them.

‘For many the busy nature of our schools is a stressful and at times worrying experience’ (Carpenter, 2016).

Add to this limited access to outdoor environments, exercise, success in work, social engagement with friends and family disruptions to routines and the stress of regularly trying new activities and it is not a surprise that mental health is a concern amongst our learners. This may help explain why individuals with ASD commonly present clinically significant problem behaviours (Bearss et al. 2013)

  • Sense of success

In order to sustain positive well-being The World Health Organisation (2010) explains a person must feel that they are able to function in the world, including having positive social connections, a sense of purpose and feeling in control. These are far more difficult for someone with ASC (Association AP. Diagnostic and statistical manual of mental disorders; 2000). This struggle to achieve well-being due to a difficulty in functioning can lead to increased anxiety (National Autistic Society, 2010) and could have a long term negative impact on a person’s mental health.

  • Medical experience

Someone with autism may be affected by medical drug use in relation to co-occurring conditions such as epilepsy (Carol et. al., 2005), and could have experienced separation from parental care givers through hospitalisation early in life, factors listed by the NHS as possible causes of depression.

People with ASC are also more likely to be overweight; this increases the risk for many illnesses, including depression. In the U.S., 16% of children ages 2-19 are overweight, whereas the prevalence among children with ASC is 19% with a further 36% being at risk of being overweight (Carol et. al., 2005).

  • Sensory processing

An aspect of ASC about which understanding is still developing is a difficulty with sensory processing. This refers to difficulty processing sensations common among people with autism. Any of the senses could be over- or under-sensitive and can make perception of the world difficult. The stimulating sensory input of school environments could cause heightened anxiety in a pupil with sensory processing difficulties (Higashida, 2014).

  • Genetic influences

The genes genes of an individual that increase their chances of having have autism are also linked to depression (Smoller, 2013). About 1 in every 10 people with ASC will experience another mental health problem, this does note include anxiety which nearly every person with ASC will experience although it may go undiagnosed (Purkiss, Goodall and Nugent, 2016).

  • Late / limited response

A person with autism can also struggle to respond to poor well-being. A diagnosis of depression is less likely (Hirvikoski, Mittendorfer-Rutz E, Boman M, et al, 2016). Diagnosis may be more difficult in a person who has autism because of difficulties in self-reporting of information (Baron-Cohen S, Leslie AM, Frith U, 1985). It may be more difficult for a person with ASC, being wary of change to access help, anxiety and depression can cause people to be extra introverted, or describe their symptoms, experiencing difficulty sharing their thoughts and feelings (Galanopoulos, et al, 2014). Symptoms of depression in ASC

One of the reasons depression is hard to spot is that some of the symptoms are similar to traits of ASC such as an increased difficulty with routine change, difficulty sleeping and an increase in sensitivity to sensory stimuli (Ghaziuddin et al., 2002).

With raised anxiety and difficulty functioning it is not surprising that learners with ASC in a special school are at an increased risk of developing depression (Galanoppuos, et al, 2014).

The result is an epidemic of mental illness among learners with profound autism in special schools.  According to research reported in the Journal of the American Academy suggests that up to 70% of autistic individuals are likely to have one mental health disorder such as anxiety or depression, and 40% have two or more mental health problems (Simonoff, E. et al. 2008).

Importantly, being predisposed to a higher likelihood of having depression does not mean that developing it is guaranteed. However, due to the higher chance than someone in the neuro-typical population it is important that special schools consider how to go about improving the resilience of their learners.


Concern for the well-being of those with autism in special schools

Depression is a major issue that affects people across culture, age, sex and background. In Australia, on average, 1 in 5 women and 1 in 8 men experience some level of depression over a lifetime (ABS, 2008). Closer to home, in the UK, The Health and Social Care Information Centre report that approximately 3% of the population experience depression at any given time (2009). The NHS Mental Health Taskforce reports one in four adults experience at least one diagnosable mental health problem in any given year. The World Mental Health Survey conducted in 17 countries found that on average 1 in 20 people reported having an episode of depression in the previous year. Depression is the leading cause of disability worldwide and in the UK (Marcus, Taghi Yasamy, Van Ommerson, Chisholm, Saxena, 2012).

A sad truth is that mental health affects people in all walks of, and at any point of life. Recent media reports have highlighted the worryingly high incidence of depression amongst young people.  Geraldine Bedell in The Independent newspaper reports Teenage mental-health crisis: Rates of depression have soared in past 25 years. Rates of depression and anxiety among teenagers have increased by 70 per cent in 25 years.

A 2004 survey by the Office for National Statistics reports that up to 80,000 children in the UK are estimated to suffer from severe depression, including 8,000 below the age of 10. This is associated with decreased functioning in adulthood, recurrence and an increased risk of suicide (Williams et al. 2009).

Mental health problems are affecting the autistic community particularly acutely (Farmer, Dyer, 2016). Whilst the high rate of depression amongst the population as a whole is concerning (Marcus, et al.2012), the inflated incidence amongst the ASC community is alarming.

A recent Daily Mail headline read; People with autism die 16 years early: epilepsy and suicide are leading to premature deaths. People with high functioning autism are 9 times more likely to commit suicide than neuro-typical people of the same age and sex. After heart disease, suicide is the leading cause of early death in adults with autism (Hirvikoski, T. et al. 2015). People with autism are particularly prone to depression and other mental health problems (Stewart ME, Barnard L, Pearson J, Hasan R, O’Brien G. 2006).

The rate of diagnosis of depression is especially concerning amongst teenagers with ASC. In the USA the rate of major clinical depression with an increased risk for suicidal tendencies is reported to be 37% in adolescents with ASD, this is more common than the 5% of adolescents in the general population. This affect is also seen in wider families, studies rate parental depression among parents with autistic children as high as 50% (Hedges, S.,White, T., & Smith, L. 2014)

This high rate of mental illness is having a massive effect on our schools. It effects behaviour and achievement of the individuals effected and on those around them. Hence, it is important for us in special schools to consider the causes of these issues and how to support our learners to become more resilient.

The question for us as educators is, what, if anything, can we do to minimise the impact on the learners in our settings? Do keep reading to find what the research suggests.

For more detailed findings visit http://www.specialneedsweek.co.uk/index.php/the-ticking-time-bomb