Finding a supportive environment where young people can reach their potential is a concern for parents who discover that options with or without a diagnosis can be limited.
Parents have a tough job. Yes, that’s all parents. But parents of young adults and teenagers with additional needs can find themselves stretched to breaking point.
Alongside the usual parenting dilemmas; these parents may find themselves caring for a child who has been temporarily or permanently excluded from school.
Struggling at school
Children and teenagers with poor mental health struggle at school. This ‘struggle’ can begin quite early on in the child’s education. Perhaps the early days at nursery or preschool were difficult. Perhaps separation from Mum or Dad felt more uncomfortable than for most of the other children or siblings.
There may have been a behavioural concern raised in pre-school or alarm bells ringing at home.
Maybe there was an unusual amount of sibling or family conflict, or the child witnessed a volatile home setting, divorce or separation. A recent large scale British Study highlighted findings which indicated that there were several relatable factors identifiable at, or before, primary school age.
More research needs to be undertaken to understand this vulnerable group of young children.
However, upon clinical assessment, we are often able to see patterns emerging and advise parents accordingly.
Being excluded from a school usually follows a series of discussions with teachers and Principals. Sometimes it can be a one-off event, perhaps involving violence, drugs or alcohol.
For others, it may be the final step in a long line of misdemeanours.
However, it happened, educational guidance requires that exclusion is a last resort for the most severe or unmanageable behaviours and violations. It is usually the first major consequence that young people have had imposed by an authority outside of the family.
Parents may, for the first time, be exposed to the full extent of their teenager’s behaviour.
Parents may feel distressed, worried about the future and fearful that their child will be excluded from society at large.
Excluded children and teenagers can be labelled as ‘a problem’ and finding the solution can seem daunting even for the most resilient families.
Children and teenagers may have been described as impulsive, loud, disruptive, unruly, difficult to engage, reduced attention and concentration and lacking in motivation. They may have been involved in unsavoury behaviours, scuffles, theft, dealing or using in the school premises.
They may have a poor attendance record or they may have subjected others to harmful or unpleasant situations.
Parents describe the dilemma surrounding the disclosure of the issues when approaching new schools or Headteachers.
Leaving the educational system
Extensive research indicates that children with undiagnosed or poorly managed mental health, or behavioural health concerns, are more likely to leave school significantly earlier than their peers.
This can leave them falling out of the education system several years before their childhood friends.
Children with ADHD are more than 100 times more likely to be excluded from school than their non-ADHD friends. This is a very high number.
Parents of young people diagnosed with ADHD are more than 100 times more likely to have to place a child or teenagers in an education system where he or she has already been labelled as ‘a problem’.
Substance Use Disorder (SUD) or Drug and Alcohol misuse are 3 to 4 times more prevalent in young people with undiagnosed ADHD.
Young people are particularly susceptible to problematic substance use including; cannabis, synthetic cannabis (K2/Spice), cocaine, Ketamine, ice, codeine, and stimulants.
Approximately 15% of young people with ADHD will have a co-occurring Substance Use Disorder Diagnosis. Difficult to manage even for the most seasoned professionals to manage, it is incredibly challenging for parents at home and teachers in the classroom.
The good news is that teenagers appropriately medicated with well-managed ADHD are significantly less likely than their undiagnosed counterparts to run into difficulties with drugs and alcohol.
The social impact of exclusion
The social impact of school exclusion has also been extensively researched and documented.
Antisocial and Criminal behaviour is significantly more likely in groups of young adults who have been excluded from the school and education system.
44% of the male prison population was at one point excluded from school.
We are sure that school exclusion in adolescence is a predictor of long term mental health challenges.
For this reason and a host of others, it is important to work on inclusion at the first available opportunity.
Parents are faced with a series of decisions regarding education and treatment. Parental decisions following a severe misdemeanour or school exclusion need to made quickly. In some places, options need to be secured in as little as five days.
Families need education, and they are increasingly aware of the same situation arising if they are not able to find adequate therapeutic and psychiatric provision for their children.
Furthermore, fixed-term or permanent exclusions would compound the issues, making a return to education increasingly unlikely.
Searches for therapeutic boarding schools can lead to disappointing few results outside of the USA. Costs can also be prohibitive when considering long term care.
Fractured educational records can have a long term impact. Parents are often concerned that a break in the teenager’s education may adversely affect further education and university applications, peer groups and social interactions.
Research indicated that the stabilisation of the underlying behavioural concerns or mental health challenges should be addressed as the priority.
Without stability, any school applications are likely to fail or fall into dangerous territory very quickly. All schools approached need to be in possession of all of the relevant information.
This helps them to make a decision that benefits both the young person and the family. In the long run, withholding information on past difficulties does not help the young person or the family.
Some schools may be reluctant to commit to providing the level of support that is required. It is important to know this at the outset.
Schools are best placed to know whether a particular set of needs can feasibly be met within their environment. It can be hard for parents and young people to accept that not all schools will be available to them; however, it is very much better to find a supportive, boundaries and nurturing fit.
Residential treatment options are often a ‘bridge’ back into education. They are providing support during the transition period for both the young person and the family while addressing the underlying psychological or psychiatric concerns.
Treatment centres specialising in young people will have access to child and adolescent specialists together with family therapists. The routine, support and access to medical care is invaluable at this time.
Pharmacological interventions may be appropriate. There may have been periods of non-compliance with previous medication regimes that had preceded the events that led up to the exclusion or difficulties at home.
The family system is often exhausted, following months of chaos and benefits from the intensive therapeutic interventions available with residential treatment options. It is imperative that the cycle is broken and that a new cohesive family dynamic can be achieved.
Schools are often receptive and supportive of young people who have completed a residential treatment episode. Some schools will be open to conducting admission interviews and tests, while the young person is in treatment. This is an excellent option to support any anxiety or fear of failure. It also provides an opportunity for the therapy team to understand the school setting and give valuable insight into the specific challenges and needs for the young person. Families often feel more able to deal with future problems, with skill and insight gained in family therapy. All feel confident when a plan can be formulated.
When a young person is ready to leave treatment, they will have a detailed recovery plan that includes the school and the family, where possible. The treatment team will be able to plan and put various levels of support in place for the young person; including psychiatrists, therapists and educational support.
If there are specific requirements, such as random drug testing or attendance in online meetings, these can be planned.
Schools, families and the young person all feel settled and confident in knowing that their is a plan.
Psychotherapists specialising in educational settings are an invaluable resource during the decision making and planning process. They have inside knowledge and understanding of the levels of support that every school can provide and have often worked with the school and young people in similar circumstances.
The Wave regularly calls upon Practitioners with this level of experience to help place young people either in their home countries or overseas. Our families have access to specialist advice throughout the treatment period. They can work with the external therapist to support their education goals and direction.
Inclusion is so essential to teenagers and young people. They want to and need to belong. They also need to feel secure and be able to feel hope. Difficulties in education that resulted in fixed term exclusion or expulsion are a Red Flag Warning. Children and Teenagers often do not have the words or the ability to accurately explain their thoughts and difficulties.
Whilst parents may be concerned about the future, there is also the present and the past to deal with.
Our advice is to slow down, take stock of the situation and take time to evaluate the needs of the teenager. Education is always going to be there. It may be a longer and less direct pathway. However, the mental health of young people is all too often ignored in order to meet pre-set milestones that are always designed for those in the middle-ground.
Some kids need a different approach and even a different route.
Fiona Yassin is the Clinical Director at The Wave Clinic in Kuala Lumpur. Fiona has been helping international families and young people with additional needs for 15 years.
A Fellow of ACPPH and a member of FDAP, Adolescent and Family Trauma Professional and advocate of combining mental health treatment and education, Fiona has helped many young people achieve their learning goals in vocational and academic subjects while accessing mental health care.