The mental health of children and adolescents in Great Britain

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The mental health of children and adolescents in Great Britain The report of a survey carried out in 1999 by Social Survey Division of the Office for National Statistics on behalf of the Department of Health, the Scottish Health Executive and the National Assembly for Wales

Howard Meltzer Rebecca Gatward with Robert Goodman Tamsin Ford

London: The Stationery Office

About the Office for National Statistics The Office for National Statistics (ONS) is the Government Agency responsible for compiling, analysing and disseminating many of the United Kingdom’s economic, social and demographic statistics, including the retail prices index, trade figures and labour market data, as well as the periodic census of the population and health statistics. The Director of ONS is also Head of the Government Statistical Service (GSS) and Registrar-General in England and Wales and the agency carries out all statutory registration of births, marriages and deaths there.

Editorial policy statement The Office for National Statistics works in partnership with others in the Government Statistical Service to provide Parliament, government and the wider community with the statistical information, analysis and advice needed to improve decision-making, stimulate research and inform debate. It also registers key life events. It aims to provide an authoritative and impartial picture of society and a window on the work and performance of government, allowing the impact of government policies and actions to be assessed.

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© Crown copyright 2000. Published with the permission of the Office for National Statistics on behalf of the Controller of Her Majesty’s Stationery Office. If you wish to reproduce any items in this publication, contact the ONS Copyright Manager, Zone B1/09, 1 Drummond Gate, London, SW1V 2QQ. Tel 020 7533 5674 or fax 020 7533 5685 or e-mail [email protected] ISBN 0 11 621373 6

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Contents

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Page Authors’ acknowledgements List of tables List of figures Notes Summary of the report

v vi viii ix 1

Part 1: Prevalence of mental disorders 1

Background, aims and coverage of the survey 1.1 Background 1.2 Aims of the survey 1.3 Timetable 1.4 Coverage of the survey 1.5 Content of the survey 1.6 Coverage of the report 1.7 Access to the data

9 9 11 12 12 13 14 14

2

Concepts and methods used in assessing mental disorders 2.1 Introduction 2.2 Definitions of mental disorder 2.3 Concepts 2.4 Methods of assessing mental disorders 2.5 Single versus multiple informants 2.6 Case vignette assessment

16 16 16 16 17 19 20

3

Sampling and interviewing procedures 3.1 Introduction 3.2 Sample design 3.3 Survey procedures 3.4 Survey response rates 3.5 Interviewing procedures

22 22 22 23 23 24

4

Prevalence of mental disorders 4.1 Introduction 4.2 Prevalence of mental disorders by personal characteristics 4.3 Prevalence of mental disorders by family characteristics 4.4 Prevalence of mental disorders by household characteristics 4.5 Prevalence of mental disorders by areal characteristics 4.6 Odds Ratios of socio-demographic correlates of mental disorders

26 26 26 27 29 30 31

5

Characteristics of children with mental disorders 5.1 Introduction 5.2 Characteristics of children with any disorder 5.3 Emotional disorders 5.4 Conduct disorders 5.5 Hyperkinetic disorders 5.6 Less common disorders

62 62 62 63 63 64 64

iii

Page

Part 2: Children and adolescents with specific mental disorders 6

Mental disorders and physical complaints 6.1 Introduction 6.2 General health 6.3 Physical complaints 6.4 Life threatening illnesses 6.5 Accidents and injuries 6.6 Parent’s view of child’s mental health

73 73 73 73 74 75 75

7

Use of services 7.1 Introduction 7.2 Use of health services for any reason 7.3 Use of services for significant mental health problems 7.4 Use of professional and non-professional help 7.5 Socio-demographic correlates of service use 7.6 Trouble with the police

82 82 82 83 84 85 85

8

Scholastic achievement and education 8.1 Introduction 8.2 Special Educational Needs 8.3 Specific learning difficulties 8.4 Absenteeism from school 8.5 Truancy

91 91 91 92 93 93

9

Social functioning of the family 9.1 Introduction 9.2 Mental health of parent 9.3 Family functioning 9.4 Reward strategies and punishment regimes 9.5 Stressful life events 9.6 Social functioning correlates of mental disorders 9.7 Impact of the child’s mental disorder on the family

99 99 99 100 101 101 102 102

10

Children’s social functioning and lifestyle behaviours 10.1 Introduction 10.2 Friendships 10.3 Help-seeking behaviour 10.4 Smoking, drinking and drug use

119 119 119 120 121

Part 3: Appendices A B C D E F

iv

Sampling, weighting and adjustment procedures Statistical terms and their interpretation Sampling errors Follow-up findings Survey documents Glossary of terms used in the report

133 138 140 147 149 228

Authors’ acknowledgements We would like to thank everybody who contributed to the survey and the production of this report. We were supported by our specialist colleagues in ONS who contributed to the sampling, fieldwork and computing elements for the survey. A special thank you is extended to Robert Goodman from the Institute of Psychiatry, London, who designed the questionnaire for the assessment of the mental health of children, took on the task of making clinical ratings of over ten thousand completed interviews, gave sound advice on the preliminary analysis of the survey data and not least gave encouragement and support to the whole research team for the past five years. Great thanks are also due to the 300 interviewers who worked on the survey. The project was steered by a group comprising the following, to whom thanks are due for assistance and specialist advice at various stages of the survey:

Department for Education and Employment Mr N Remsbery Mr R McElheran

Expert advisors: Prof R Goodman (Institute of Psychiatry, London) Dr I Frampton (Royal Cornwall Hospital) Prof I Goodyer (University of Cambridge) Prof R Harrington (University of Manchester) Dr T Brugha (University of Leicester) Prof R Nichol (University of Leicester) Prof R Jenkins (Institute of Psychiatry, London) Professor G Lewis (University of Wales) Office for National Statistics Ms S Carey Ms R Gatward Dr H Meltzer Most importantly, we would like to thank all the parents, young people, and teachers for their cooperation.

Department of Health Mrs K Tyson (chair) Ms A Roberts Dr R Jezzard Miss H Jones Mr A Boucher Mr D Hird Mr M Rae Mr P Smith Dr P Baldry Mr J O’Shea (secretariat) Scottish Office Dr D Will Mr G Russell Welsh Office Dr S Watkins Mr J Sweeney

v

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List of tables Page

Page 5.4

3. Sampling and survey procedures 3.1 3.2 3.3

Response to initial CBC letter Response to interview Achieved interviews by type of informant

22 23

5.5

Family’s employment status, social class and income by type of mental disorder 69 Household and geographical characteristics by type of mental disorder 70

24

6. Mental disorders and physical complaints 6.1

4. Prevalence of mental disorders 4.1 4.2 4.3 4.4 4.5

4.6

4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16

Prevalence of mental disorders by age and sex Prevalence of mental disorders by ethnicity, age and sex Prevalence of mental disorders by family type, age and sex Prevalence of mental disorders by family structure, age and sex Prevalence of mental disorders by number of children in household, age and sex Prevalence of mental disorders by educational qualifications of parent, age and sex Prevalence of mental disorders by family’s employment, age and sex Prevalence of mental disorders by gross weekly household income, age and sex Prevalence of mental disorders by receipt of disability benefits, age and sex Prevalence of mental disorders by social class, age and sex Prevalence of mental disorders by tenure, age and sex Prevalence of mental disorders by type of accommodation, age and sex Prevalence of mental disorders by region, age and sex Prevalence of mental disorders by ACORN classification, age and sex Odds Ratios for socio-demographic correlates of mental disorders Odds Ratios for socio-demographic correlates of emotional disorders

33

6.2

34

6.3

36 6.4 38 6.5 40

6.6 6.7

42 6.8 44 46

6.9

48 50 52 7.2

56 7.3 58 7.4 60 7.5 61 7.6

5. Characteristics of the sample 5.1 5.2 5.3

vi

Number of children with each mental disorder by age and sex Child’s personal characteristics by type of mental disorder Family characteristics by type of mental disorder

67 67 68

76 77

78 79 79 80 80

81

81

7. Use of services 7.1

54

General health rating by type of mental disorder Type of physical complaint by type of mental disorder Odds Ratios for physical complaints & socio-demographic correlates of mental disorders Prevalence of mental disorders by type of physical complaint Experience of a life threatening illness by type of mental disorder Experience of accidents and injuries by type of mental disorder Prevalence of mental disorders by type of accident or injury Parental view of child’s mental health by clinical assessment of type of mental disorder Clinical assessment of type of mental disorder by parental view of child’s mental health

7.7

Use of health services in the past 12 months (for any reason) by type of mental disorder Use of services for significant mental health problems by type of mental disorder Use of professional and non-professional help by type of mental disorder Use of professional and non-professional help by number of mental disorders Odds Ratios for the socio-demographic correlates of service use In trouble with the police in the past 12 months by type of mental disorder, age and sex Ever been in trouble with the police by type of mental disorder

86

87 88 89 89

90 90

Page

8. Scholastic achievement and education 8.1

Officially recognised special educational needs by type of mental disorder 8.2 Level of officially recognised special educational needs by type of mental disorder 8.3 Prevalence of mental disorder by level of SEN 8.4 Odds Ratios for mental disorder & socio-demographic correlates of SEN 8.5 Specific learning difficulties by type of mental disorder 8.6 Prevalence of mental disorders by specific learning difficulties 8.7 Absenteeism from school by type of mental disorder 8.8 Truancy (parent interview) by type of mental disorder 8.9 Truancy (young person interview) by type of mental disorder 8.10 Truancy (teacher questionnaire) by type of mental disorder

95

95 96 96 97 97 97 98

9.13 Number of stressful life events by type of mental disorder 9.14 Prevalence of mental disorders by type of stressful life events 9.15 Prevalence of mental disorders by number of stressful life events 9.16 Odds Ratios for social functioning and socio-demographic correlates of mental disorder 9.17 Impact of child’s problems on family relationships by type of mental disorder 9.18 Impact of child’s problems on social life and stigma by type of mental disorder 9.19 Impact of child’s problems on parent’s health by type of mental disorder 9.20 Impact of child’s problems on parent’s health behaviour by type of mental disorder

113 113 114

114 115 116 117

118

98

10. Children’s social functioning and lifestyle behaviours

98

10.1 Friendship behaviour by type of mental disorder 10.2 Friendship score by type of mental disorder 10.3 People asked for help by type of mental disorder 10.4 Type of help sought by type of mental disorder 10.5 Potential helpers by type of mental disorder 10.6 Type of potential help by type of mental disorder 10.7 Smoking behaviour by age, survey source and sex 10.8 Drinking behaviour by age, survey source and sex 10.9 Drug taking by survey source 10.10 Prevalence of mental disorders by smoking behaviour 10.11 Prevalence of mental disorders by drinking behaviour 10.12 Prevalence of mental disorders by use of cannabis

9. Social functioning of the family 9.1

Page

Distribution of parent’s GHQ-12 scores by type of mental disorder 105 9.2 Distribution of parent’s GHQ-12 scores by number of mental disorders 105 9.3 Prevalence of mental disorders by parent’s GHQ-12 score 105 9.4 Prevalence of mental disorders by parent’s GHQ-12 score (grouped) 106 9.5 Distribution of family functioning scores by type of mental disorder 106 9.6 Distribution of family functioning scores by number of mental disorders 107 9.7 Prevalence of mental disorders by family functioning score 107 9.8 Reward strategies by type of mental disorder 108 9.9 Punishment regimes by type of mental disorder 109 9.10 Prevalence of mental disorders by type of non-physical, parental punishment 110 9.11 Prevalence of mental disorders by type of physical, parental punishment 111 9.12 Stressful life events by type of mental disorder 112

123 124 124 125 125 126 126 127 128 128 129 129

vii

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List of figures Page

Page

1. Background aims and coverage of the survey

6. Mental disorders and physical complaints

1.1

6.1

Timetable for survey

12

Percentage of children with a mental disorder by type of physical complaint

74

4. Prevalence of mental disorders 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14

Prevalence of any mental disorder by age and sex Prevalence of any mental disorder by ethnicity Prevalence of any mental disorder by family type Prevalence of any mental disorder by family structure Prevalence of any mental disorder by number of children in household Prevalence of any mental disorder by educational qualifications of parent Prevalence of any mental disorder by family’s employment Prevalence of any mental disorder by gross weekly household income Prevalence of any mental disorder by receipt of disability benefits Prevalence of any mental disorder by social class Prevalence of any mental disorder by tenure Prevalence of any mental disorder by type of accommodation Prevalence of any mental disorder by country/region Prevalence of any mental disorder by ACORN classification

7. Use of services 33

7.1

35

7.2

37

7.3

39 41

8.1 8.2 45

51 53 55 57 59

5.2 5.3 5.4 5.5

viii

Sex distribution by type of mental disorder Family’s employment situation by type of mental disorder Gross weekly household income by type of mental disorder Tenure by type of mental disorder ACORN classification by type of mental disorder

64 65 65 66 66

Officially recognised SEN by type of mental disorder Prevalence of mental disorder by level of SEN

91 92

9. Social functioning of the family 9.1

49

5. Characteristics of the sample 5.1

8. Scholastic achievement and education

43

47

Use of services (for any reason) by type of mental disorder 83 Contact with primary & secondary health services by type of mental disorder 84 Use of professional and non-professional help by type of mental disorder 84

Prevalence of mental disorders by parent’s GHQ-12 score

100

10. Children’s social functioning and lifestyle behaviours 10.1 Distribution of friendship scores by type of mental disorder 10.2 Help seeking behaviour by type of mental disorder

120 121

Notes 1 Tables showing percentages The row or column percentages may add to 99% or 101% because of rounding. The varying positions of the percentage signs and bases in the tables denote the presentation of different types of information. Where there is a percentage sign at the head of a column and the base at the foot, the whole distribution is presented and the individual percentages add to between 99% and 101%. Where there is no percentage sign in the table and a note above the figures, the figures refer to the proportion of people who had the attribute being discussed, and the complementary proportion, to add to 100%, is not shown in the table.

3 Significant differences The bases for some sub-groups presented in the tables were small such that the standard errors around estimates for these groups are biased. Confidence intervals which take account of these biased standard errors were calculated and, although they are not presented in the tables, they were used in testing for statistically significant differences. Statistical significance is explained in Appendix B to this Report.

The following conventions have been used within tables showing percentages: no cases 0 values less than 0.5% 2 Small bases Very small bases have been avoided wherever possible because of the relatively high sampling errors that attach to small numbers. Often where the numbers are not large enough to justify the use of all categories, classifications have been condensed. However, an item within a classification is occasionally shown separately, even though the base is small, because to combine it with another large category would detract from the value of the larger category. In general, percentage distributions are shown if the base is 30 or more. Where the base is lower, actual numbers are shown in square brackets.

ix

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Summary of main findings

Summary of main findings

Summary of main findings

The findings described in this report and summarised here focus on the prevalence of mental disorders among 5-15 year olds and on the associations between the presence of a mental disorder and biographic, socio-demographic, socio-economic and social functioning characteristics of the child and the family. Causal relationships should not be assumed for any of the results presented in this report.

Background, aims and coverage (Chapter 1) ●

The primary purpose of the survey was to produce prevalence rates of three main categories of mental disorder: conduct disorders, emotional disorders and hypekinetic disorders based on ICD-10 (International Classification of Diseases, tenth revision) and DSM-IV (Diagnostic and Statistical Manual, fourth revision) criteria.



The second aim of the survey was to determine the impact or burden of children’s mental health. Impact covers the consequences for the child, burden reflects the consequences for others.



The third main purpose of the survey was to examine the use of health, social, educational and voluntary services among children with mental disorders.



The surveyed population comprised children and adolescents, aged 5-15, living in private households in England, Scotland and Wales.



Fieldwork for the survey took place between January and May 1999.

Concepts and methods (Chapter 2) ●

This report uses the term, mental disorders, as defined by the ICD-10, to imply a clinically recognisable set of symptoms or behaviour associated in most cases with considerable distress and substantial interference with personal functions.



The methodological strategy for the survey was a one-stage design with all children eligible for a full interview, i.e., without a screening stage.



The measures designed for the present study incorporated structured interviewing supplemented by open-ended questions. When definite symptoms were identified by the structured questions, interviewers used open-ended questions and supplementary prompts to get informants to describe the problems in their own words.



Data collection included information gathered from parents, teachers, and the children themselves (if aged 11-15).



A case vignette approach was used for analysing the survey data - using clinicians to review the responses to the precoded questions and the transcripts of informants’ comments, particularly those which asked about the child’s significant problems.

Mental Health of children and adolescents in Great Britain

1

Summary of main findings

Summary - continued Sampling and survey procedures (Chapter 3) ●

The sample was drawn from Child Benefit Records held by the Child Benefit Centre (CBC).



14,250 opt out letters were despatched by the Child Benefit Centre on behalf of ONS: 30 letters for each of the 475 postal sectors selected for the survey.



After subtracting those addresses that opted out or were ineligible, 12,529 addresses were allocated to the ONS interviewers.



Information was collected on 83% of the children eligible for interview from up to three sources resulting in 10,438 achieved interviews.



Among the co-operating families, almost all the parents and most of the children took part. Four out of five teachers also returned their questionnaires.

Prevalence of mental disorders (Chapter 4) ●

All the rates presented below are based on the diagnostic criteria for research using the ICD-10 Classification of Mental and Behavioural Disorders with strict impairment criteria - the disorder causing distress to the child or having a considerable impact on the child’s day to day life.



10% of children aged 5 -15 years had a mental disorder: 5% had clinically significant conduct disorders; 4% were assessed as having emotional disorders - anxiety and depression - and 1% were rated as hyperactive.



As their name suggests, the less common disorders (autistic disorders, tics and eating disorders) were attributed to half a percent of the sampled population.



Among 5-10 year olds, 10% of boys and 6% of girls had a mental disorder. In the older age group, the 11-15 year olds, the proportions of children with any mental disorder were 13% for boys and 10% for girls.



2

The prevalence rates of mental disorders were greater among children: ● in lone parent compared with two parent families (16% compared with 8%) ● in reconstituted families rather than those with no step-children (15% compared with 9%) ● in families with five or more children compared with two-children (18% compared with 8%) ● if interviewed parent had no educational qualifications compared with a degree level or equivalent qualification (15% compared with 6%) ● in families with neither parent working compared with both parents at work (20% compared with 8%) ● in families with a gross weekly household income of less than £200 compared with £500 or more (16% compared with 6%) ● in families of social class V compared with social class I (14% compared with 5%) ● whose parents are social sector tenants compared with owner occupiers (17% compared with 6%) ● in household with a striving rather than a thriving geo-demographic classification (13% compared with 5%)

Mental health of children and adolescents in Great Britain

Summary of main findings

Summary - continued Characteristics of children with mental disorders (Chapter 5) ●

Children with a mental disorder compared with other children were more likely to be boys, living in a lower income household, in social sector housing and with a lone parent. They were less likely to be living with married parents or in social class I or II households.

Mental disorders and physical complaints (Chapter 6) ●

The overall proportion of children with a fair, bad or very bad general health rating was 7%, the corresponding proportion among children with a mental disorder was 20% compared with 6% of those without a disorder.



The physical illness or health conditions which showed the greatest disparity in prevalence rates between children with a mental disorder and those with no disorder were: bedwetting (12% compared with 4%), speech or language problems (12% compared with 3%), co-ordination difficulties (8% compared with 2%), and soiling pants (4% compared with 1%).



Among children who had a life-threatening illness, about 1 in 6 were found to have a mental disorder.



25% of children who had accidental poisoning had a mental disorder, whereas the corresponding rate among children who had a broken bone was 12%, just above the national average.

Use of services (Chapter 7) ●

Almost a half of the children with a mental disorder had been in contact with a GP in the past 12 months for any reason compared with just over a third of children with no disorder.



Children with a disorder were more likely to have been taken to an Accident and Emergency department than those without a disorder (26% compared with 17%) and on more than one occasion (7% compared with 4%).



Inpatient stays were slightly more common among children with a disorder than those with no disorder (9% compared with 5%).



Children with a mental disorder were more likely than other children to have visited an Outpatient Department in the past year (29% compared with 18%.)



One half of the children with mental disorders had seen someone from the educational services, about one quarter had used the specialist health care services and one fifth had contact with the social services.



Two thirds of children assessed as having a mental disorder had seen a secondary level service provider in the last year.



Parents of children with an emotional disorder were the group most likely to have asked family or friends for advice (23%) and the least likely to have sought professional services (63%).



25% of 11-15 year olds reported that at one point in their lives they had been in trouble with the police, which included 43% of children with a disorder and 21% of children with no disorder.

Mental Health of children and adolescents in Great Britain

3

Summary of main findings

Summary - continued Scholastic achievement and education (Chapter 8) ●

1 in 5 children had officially recognised special educational needs - those with a disorder were about three times more likely than other children to have special needs: 49% compared with 15%.



Among children with officially recognised special educational needs, 28% of those with a disorder and 13% without a disorder had been issued with a statement of SEN by the local authority (Stage 5).



The prevalence rate of mental disorders ranged from 6% among children who did not have special educational needs to 40% among children who were at Stage 5.



Given that the rate of specific learning difficulties (SpLD) was set at 5%, children with a mental disorder were three times more likely than those with no disorder to have SpLD: 12% compared with 4%.



25% of children with emotional disorders had been absent from school for 11 days or more in the past term compared with 21% of children with conduct disorders and 14% with hyperkinetic disorders.



According to young people’s own reports, those with a disorder were about four times more likely than other children to have played truant: 33% compared with 9%. Children with conduct disorders had the highest rate of truancy at 44%.

Social functioning of the family (Chapter 9)

4



47% of children assessed as having a mental disorder had a parent who scored 3 or more on the GHQ12 (the twelve-item General Health Questionnaire), approximately twice the proportion of the sample of children with no disorder, 23%.



The proportion of children with GHQ12 screen-positive parents rose from 23% of the no-disorder group to 44% of children with one disorder to 50% of those with two disorders and to 68% of children with three disorders.



Children with a mental disorder were twice as likely to live in families rated as having unhealthy functioning compared with children with no disorder: 35% and 17% respectively.



Children with mental disorders were far more likely to be frequently punished than children with no mental disorder: 18% compared with 8% were frequently sent to their rooms; 17% compared with 5% were frequently grounded, and 42% compared with 26% were frequently shouted at.



50% of children with a mental disorder had at one time seen the separation of their parents, compared with 29% of the sample with no disorder. The corresponding figures for problems with the police were 15% and 5% and for a parent or sibling dying - 6% compared with 3%.



Two factors associated with the highest prevalence rates of mental disorders were: children (aged 13-15) who had split with a boyfriend or girlfriend (24%) and children whose parents had been in trouble with the police (22%).



About 1 in 3 of their parents said the child’s problem made their relationship more strained.

Mental health of children and adolescents in Great Britain

Summary of main findings

Summary - continued ●

20% of parents with no partner in the household reported that the child’s problem was a contributory factor to a previous relationship breaking up.



One quarter of parents said their children’s problems caused difficulties with other family members.



Eighty seven per cent of parents said their child’s problems made them worried and 58% felt that their child’s problems caused them to be depressed.

Social functioning of the child (Chapter 10) ●

Among 11-15 year olds, 6% had a severe lack of friendship: 9% of those with mental disorders and 5% with no disorder.



One quarter of young people had felt so unhappy or worried that they asked people for help. Children with a disorder were almost twice as likely, than those without a disorder, to have sought help and advice: 41% compared with 23%.



41% of 11-15 year olds who regularly smoked were assessed as having a mental disorder (28% had a conduct disorder, 20% had an emotional disorder and 4% were rated as having a hyperkinetic disorder) compared with the overall rate of 11%.



24% of young people who drank alcohol more than once a week had a mental disorder, three times the proportion among the group who had never drunk any alcohol.



About one half of the 11-15 year olds who frequently used cannabis, i.e., more than once a week, had a mental disorder compared with one fifth of the less than once a month users and one tenth of those who had never used cannabis.

Mental Health of children and adolescents in Great Britain

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Summary of main findings

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Mental health of children and adolescents in Great Britain

Background, aims and coverage of the survey

1

Part 1: Prevalence of mental disorders

Mental health of children and adolescents in Great Britain

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Mental health of children and adolescents in Great Britain

1 1.1

Background, aims and coverage of the survey

Background

The survey of the mental health of children and adolescents in Great Britain is the sixth major survey of psychiatric morbidity to be carried out by ONS (formerly OPCS) commissioned by the Department of Health, Scottish Health Executive and National Assembly for Wales. All the previous five surveys covered adults aged 16-64 but were distinct in terms of the respondents’ place of residence or particular psychiatric problems: • adults living in private households (Meltzer et al. 1995 a, b, c) • residents of institutions specifically catering for people with mental health problems: hospitals, nursing homes, residential care homes, hostels, group homes and supported accommodation (Meltzer et al. 1996 a, b, c) • homeless adults living in hostels, nightshelters, private sector leased accommodation or roofless people using day centres (Gill et al., 1996) • adults known to have a psychotic disorder (Foster et al., 1996) • prisoners (Singleton et al., 1998) The rationale put forward for a national survey of psychiatric morbidity among children and adolescents is exactly the same as for the survey of adults. “In order to plan mental health services effectively, it is necessary to know how many severely ill people there are, what their diagnoses are, and how far their needs for treatment are being met. The extent of the morbid population in the community needs to be known so that the resources and planning can effectively take this into account.”

Official statistics on the mental health of children in Great Britain Maughan (1995) summarised the official statistics collected on child health problems and the limitations with their interpretation. These included

• Data on psychiatric service use • Consultations with GPs and others • Trends in specific problem areas (e.g. substance abuse, delinquency and suicide) She commented that data on the use of psychiatric services are the most problematic as indicators of prevalence rates of mental health problems among young people because the great majority of psychiatric problems go untreated. This has long been recognised in relation to adult disorders and epidemiological studies suggest that it is also true in childhood. Rutter (1970) found that only about 10% of children in the community with disorders were in contact with specialist services at any one time. A second difficulty with official statistics is that when children do receive help for psychiatric problems it may come from a range of services: paediatric, education and social services as well as psychiatric services. Many of the professionals (outside of the psychiatric services) who treat children with mental health problems may not use psychiatric classification systems in their practice. Those within the psychiatric service may use different classification systems. Thus, official statistics on service use give little indication of the extent of childhood psychiatric disorders.

Review of previous research Epidemiological surveys in Great Britain which have focused on psychiatric morbidity among children have concentrated on: • Specific disorders - hyperactivity (Taylor et al., 1991), anorexia nervosa (Crisp et al., 1996), autism (Wing and Gould, 1978) • Particular age ranges - adolescents (Kashani et al., 1987) ten year olds (Vikan, 1985) • Comprehensive studies in particular localities - Isle of Wight (Rutter, 1976; Rutter, 1989), Edinburgh and Oxford (Platt et al., 1988) and Inner cities (Rutter, 1975).

Mental health of children and adolescents in Great Britain

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1

Background, aims and coverage of the survey

Brandenberg et al (1990) reviewed the published reports from eight prevalence surveys of childhood and adolescent disorders carried out in the 1980s in Australia, Canada, Holland, New Zealand, Norway and the USA. She highlighted how the surveys differed in focus (psychiatric disorders), coverage (age, place of residence), sample design (number of stages, sample size, number and type of informants) and instrumentation. Prevalence rates varied from 5% (Vikan, 1985) to 26% (Verhulst et al., 1985) among 8 to 11 year olds. A more recent review by Bird (1996) also demonstrated that different studies with different methodologies arrive at very varied prevalence estimates, with much higher rates being reported by studies that judge disorders just from symptoms without taking account of resultant social impairment.

Lessons from previous epidemiological surveys Defining psychiatric disorder solely in terms of psychiatric symptoms can result in implausibly high rates. For example, Bird et al. (1988) estimated from their epidemiological study that about 50% of Puerto Rican children aged between 4 and 16 years met criteria for at least one DSMIII diagnosis. As Bird et al. (1990) noted, many of the children who were eligible for DSM-III diagnoses were not significantly socially impaired by their symptoms, did not seem in need of treatment, and did not correspond to what clinicians would normally recognise as “cases”. This underlines the importance of defining psychiatric disorders not only in terms of symptom constellations, but also in terms of significant impact. Including impact criteria can dramatically alter prevalence estimates. For example, in the Virginia Twin Study, the population prevalence of DSM-III-R disorder was 42% as judged by symptoms alone, falling to 11% when impairment criteria were included (Simonoff et al., 1997). In DSM-IV (American Psychiatric Association, 1994), most of the common child psychiatric disorders are now defined in terms of impact as well as symptoms; operational criteria stipulate that symptoms must result either in substantial distress for the child or in significant impairment in the child’s ability to fulfil normal role expectations in

10

Mental health of children and adolescents in Great Britain

everyday life. This same requirement for impact, in terms of significant distress or social incapacity, characterises the diagnostic criteria employed in the research version of ICD-10 (World Health Organization, 1994). These findings emphasise the need to use measures of psychiatric disorder that consider not only symptoms but also resultant distress and social incapacity. Failure to do so will result in unrealistically high prevalence rates and will mislead service planners by labelling many children with relatively innocuous symptoms as having psychiatric disorders. While previous surveys have often used measures of psychiatric disorder that inappropriately included children with many symptoms but little resultant impairment, these same surveys have inappropriately failed to diagnose another group of children who do make considerable and appropriate use of child and adolescent mental health services. Despite having psychiatric symptoms that result in distress and social impairment, these children do not meet the full criteria for an operationalised diagnosis such as hyperkinesis, separation anxiety disorder or oppositional defiant disorder. With clinical judgement, these children can be assigned nonoperationalised diagnoses, e.g. anxiety disorder, Not Otherwise Specified (NOS); disruptive behaviour disorder, NOS. A substantial minority of children with psychiatric disorders seem to “fall between the cracks” of the operationalised diagnostic categories because they have partial of undifferentiated syndromes (Goodman et al, 1996; Angold et al, 1999). This emphasises the need to incorporate clinical judgement into measures of psychiatric disorder so as not to miss children who are severely distressed or impaired by symptoms that do not meet current operationalised diagnostic criteria. Does it matter if previous surveys have used measures of psychiatric disorder that are simultaneously over-inclusive and under-inclusive? As far as estimating prevalence is concerned, the problems or over-inclusiveness and underinclusiveness will cancel out to some extent, though the number of children with symptoms but not much impact is substantially larger than the number with impact but relatively few symptoms.

Background, aims and coverage of the survey

As far as examining the appropriateness of current service provision is concerned, the two types of error add rather than cancel out. Diagnosing children who have symptoms without much impact will make it look as if services are failing to see these children. At the same time, failing to diagnose children who fall between the cracks of the current diagnostic system will make it look as if services are inappropriately (rather than correctly) seeing these children.

1.2

Aims of the survey

Prevalence The primary purpose of the survey was to produce prevalence rates of three main categories of mental disorder: conduct disorder, hyperactivity and emotional disorders (and their comorbidity), based on ICD-10 and DSM-IV criteria. Where there were sufficient numbers, the survey also aimed to provide prevalence rates of type of problem (e.g., separation anxiety, social phobia etc.) and to investigate the comorbidity or co-occurrence of disorders.

Impact and burden The second aim of the survey was to determine the impact and burden of children’s mental health problems in terms of social impairment and adverse consequences for others. The measurement of burden and impact are essential parts of the survey as they fulfil several functions: forming an integral part of diagnostic assessment, acting as measures of severity of the disorder, and helping to describe the problem in its social context. Social impairment is measured by the extent to which each particular mental problem interferes with relations with other family members, forming and keeping friendships, participation in leisure activities, and scholastic achievement. More broadly, impact reflects distress to the child or disruption to others as well as social impairment. The burden of the child’s problem is a measure of the consequences of the symptoms in terms of whether they cause distress to the family by making the parents worried, depressed, tired or physically ill. Whereas impact covers the consequences for the child, burden reflects the consequences for others.

1

Services The third main purpose of the survey was to examine service provision. The examination of service use requires the measurement of contextual factors (stressful life events, lifestyle behaviours and risk factors). These factors are alluded to in The Health of the Nation: Key Area Handbook for Mental Illness in describing children’s use of and need for services (Sections 3.27, 3.12 and 3.13). “Particular attention should be paid to identifying the current provision of services dedicated to the needs of children and adolescents.” (Section 3.27) “The needs of children and adolescents are different from those of adults. Psycho-social factors which affect parents can also have distinct and separate effects on their children. In assessing needs, purchasers and providers will need to consider the child and the family, the school or college and the child’s general social network.” (Section 3.12) “Some particular issues to consider when assessing the need for services for children and adolescents are: the rate and effect of changes in family circumstances such as separation, divorce or death of a parent; the level of homelessness and poor living conditions; and drug addiction and alcohol misuse in both children/adolescents and their parents.” (Section 3.13) Emotional and behavioural problems which resolve rapidly and spontaneously are far less relevant for service planning than problems that persist unless help is provided. While it is possible for a cross-sectional survey to ask informants to recall how long symptoms (and resultant impairments) have been present, there are well known biases associated with this sort of retrospective enquiry. The survey aimed to determine the prevalence of persistent disorders by asking a sample of informants about symptoms and resultant impairments on two separate occasions. Therefore, the main survey and its follow up component measure current psychopathology and examine whether help has been provided already, or whether help is provided over the course of the subsequent six months.

Mental health of children and adolescents in Great Britain

11

1

Background, aims and coverage of the survey

1.3

Timetable

Carrying out a national survey of the development and well-being of children and adolescents for the first time in Great Britain required a considerable amount of feasibility and pilot work. The general strategy was to look at various sampling strategies at the same time as designing and developing the interview schedules and interviewer procedures, and to carry out tests on children from the private household population as well as those known to have mental health problems. Comments were sought from experts in child psychiatric epidemiology, as well as those involved in service policy and practice. Figure 1.1 summarises the timetable for the whole programme of research.

1.4

Coverage of the survey

age of 5 were excluded primarily because the assessment instruments for these children are different and not so well developed as those for older children. The feasibility study which took place in January to March 1997 included a questionnaire for parents of 3 and 4 year olds. The questions were based on the Richman questionnaire revised by Nichol for a study of pre-school children (Nichol et al., 1987). Fifty seven families of 3-4 year olds were interviewed. The data were presented in terms of case studies which highlighted the areas where parents expressed concern about their children: eating habits, potty training, bedtime, indoor play etc. Discussions of the report on the feasibility study by an expert group recommended that 3 and 4 year olds should not be included in the main survey because of the problems in finding an appropriately sensitive instrument.

Region Childhood psychopathology The surveyed population comprised children and adolescents living in private households in England, Scotland (including the Highlands and Islands) and Wales.

Age The survey focused on the prevalence of mental health problems among young people aged 5-15. Teenagers, aged 16 and above, were included in the previous adult surveys. Children under the

Though children and teenagers can be affected by many different mental health problems, most of these are rare. The survey concentrated on the three common groups of disorders: emotional disorders such as anxiety, depression and obsessions; hyperactivity disorders involving inattention and overactivity; and conduct disorders characterised by awkward, troublesome, aggressive and antisocial behaviours.

Figure 1.1 Timetable for survey

12

From

To

Activity

Sep.1994

Dec. 1995

Preliminary discussions between ONS and DH

Jan. 1995

Mar. 1995

Review of the literature, looking at the practicalities and logistics of carrying out a national survey, and evaluating the suitability of published assessment instruments

Jan. 1996

Mar. 1996

Reviewing options for a feasibility study

Apr.1996

Dec. 1996

Designing sample and questionnaires for feasibility study

Jan. 1997

Mar. 1997

Fieldwork for feasibility study

Apr. 1997

Dec. 1997

Analysis, interpretation and report writing of feasibility study and design of pilot survey

Jan. 1998

Mar. 1998

Fieldwork for pilot study

Apr. 1998

Dec. 1998

Analysis, interpretation and report writing of pilot study and design of main stage survey. Carrying out a mini-pilot in October 1998 to finalise survey documents

Jan. 1999

May. 1999

Main stage fieldwork

Apr. 1999

Aug. 1999

Clinical assessment of survey data

Jun. 1999

Jul. 1999

Six month, postal follow-up of respondents in fieldwork during January and February 1999.

Aug. 1999

Mar. 2000

Analysis, interpretation and report writing of main survey.

Mental health of children and adolescents in Great Britain

Background, aims and coverage of the survey

1.5

Content of the survey

A brief summary of the sections of the questionnaire is shown below, subsumed under the headings of questionnaire content for parents, children and teachers. The rationale behind using three sources of information is described in Chapter 2.

Questionnaire content for parents This interview schedule for parents was asked of a parent of all selected children. It included the following sections: • Background characteristics • General Health • Strengths and Difficulties Questionnaire(SDQ) • Post Traumatic Stress Disorder (PTSD) • Separation anxiety • Specific Phobias • Social Phobia • Panic attacks and agoraphobia • Compulsions and Obsessions • Generalised Anxiety • Depression • Attention and activity • Awkward and troublesome behaviour • Less Common Disorders • Impact • Significant problems • Use of services for significant problems • Stressful Life Events • Use of all types of services • Strengths • Education and Employment (parent and partner) • State Benefits (parent and partner) • Self completion: GHQ12 and Family Functioning

Questionnaire content for children and adolescents Questions for children aged 11-15, by face to face interview, included the following topics: • Friendship • Strengths and Difficulties Questionnaire (SDQ)

• • • • • • • • • • • • •

1

Separation anxiety Specific Phobias Social Phobia Panic attacks and agoraphobia Post Traumatic Stress Disorder (PTSD) Compulsions and Obsessions Generalised Anxiety Depression Attention and activity Awkward and troublesome behaviour Less Common Disorders Significant problems Strengths

The self-completion element for the 11 to 15-yearolds included: • • • • • • •

Chronic fatigue syndrome (M.E.) Awkward and troublesome behaviour Moods and feelings Help from others Smoking cigarettes Use of alcohol Experience with drugs

All children, aged 5-15 were assessed for dyslexia by means of the British Picture Vocabulary Scale (BPVS-II) and the reading and spelling elements of the British Abilities Scale (BAS-II). The rationale behind the choice of instruments and their administration are described in Chapter 8.

Questionnaire content for teachers A postal questionnaire was sent to teachers covering scholastic achievement as well as assessments of behaviour and emotional well-being: • Scholastic achievement and special needs • Strengths and Difficulties Questionnaire (SDQ) • Emotions • Attention, activity and impulsiveness • Awkward and troublesome behaviour • Other concerns • Help from school

Mental health of children and adolescents in Great Britain

13

1

Background, aims and coverage of the survey

1.6

Coverage of the report

One of the main purposes of this report is to present prevalence rates for mental disorders among children and adolescents aged 5-15 in England, Scotland and Wales during the first half of 1999. These are presented in Chapter 4. In order to interpret these results, it is important to have an understanding of the concepts and methods adopted for this study; these are described in Chapter 2. Chapter 3 describes the sampling and interview procedures. Part 2 of the report contains 6 chapters on specific topics (e.g. physical illness, services or social functioning) for children with all disorders as distinct from chapters on particular disorders. The final part of the Report contains the technical appendices and has six sections. The first gives details of the sampling design and shows how the data were weighted. The second section describes the statistical terms used in the report and their interpretation. The third section gives examples of standard errors from the prevalence tables. Section 4 presents the results of a 6 month follow up study of a subsample of survey respondents. The last two sections comprise the survey documents and a glossary of terms.

1.7

Access to the data

Anonymised data from the survey will be lodged with the ESRC Data Archive, University of Essex, within 3 months of the publication of this report. Independent researchers who wish to carry out their own analyses should apply to the Archive for access. For further information about archived data, please contact: ESRC Data Archive University of Essex Wivenhoe Park Colchester Essex CO4 3SQ Tel: (UK) 01206 872323 FAX: (UK) 01206 872003 Email: [email protected]

14

Mental health of children and adolescents in Great Britain

References American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC: American Psychiatric Association. Angold, A., Costello, E. J., Farmer, E. M. Z., Burns, B. J & Erkanli, A. (1999) Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129-137. Bird, H. R. (1996) Epidemiology of childhood disorders in a cross-cultural context. Journal of Child Psychology and Psychiatry, 37, 35-49. Bird, H. B., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., Woodbury, M., Huertas-Goldman, S., Pagan, A., Sanchez-Lacay, A. & Moscosco, M. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of General Psychiatry, 45, 1120-1126. Bird, H. B., Yager, T. J., Staghezza, B., Gould, M. S., Canino, G. & Rubio-Stipec, M. (1990). Impairment in the epidemiological measurement of childhood psychopathology in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 796-803. Brandenburg, N.A., Friedman, R.M., Silver, S.E., (1990) “The epidemiology of child psychiatric disorder: prevalence findings from recent studies” Journal of the American Academy of Child and Adolescent Psychiatry, 29:76-83 Crisp, A.H., Palmer, R.L., Kalucy, R.S., (1976) How common is anorexia nervosa? A prevalence study”, British Journal of Psychiatry ,128:549-54 Department of Health, (1995) The Health of the Nation Handbook on Child and Adolescent Mental Health Foster K, Meltzer H, Gill B and Hinds K. (1996) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 8: Adults with a psychotic disorder living in the community HMSO: London Gill B, Meltzer H, Hinds K and Petticrew, M., (1996) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 7: Psychiatric morbidity among homeless people, HMSO: London. Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581-586. Goodman, R. (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791-801. Goodman, R., Meltzer, H., & Bailey V. (1998) The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child and Adolescent Psychiatry, 7, 125-130. Goodman, R. & Scott, S. (1999) Comparing the Strengths and Difficulties Questionnaire and the Child Behaviour Checklist: Is small beautiful? Journal of Abnormal Child Psychology, 27, 17-24. Goodman, R., Yude, C., Richards, H. & Taylor, E. (1996) Rating child psychiatric caseness from detailed case histories. Journal of Child Psychology and Psychiatry, 37, 369-379. Kashani, J.H., Beck, N.C., Hoeper, E.W. et al (1987) Psychiatric Disorders in a community sample of adolescents. Am. J. Psychiatry 144: 584-589 Maughan, B., (1995) Mental Health in (ed.) B. Botting The Health of Our Children, London: HMSO

Background, aims and coverage of the survey

Meltzer H, Gill B, Petticrew M and Hinds, K. (1995a) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 1: the prevalence of psychiatric morbidity among adults living in private households. HMSO: London Meltzer H, Gill B, Petticrew M and Hinds, K.(1995b) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 2: Physical complaints, service use and treatment of adults with psychiatric disorders. HMSO: London Meltzer H, Gill B, Petticrew, M and Hinds K. (1995c) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 3: Economic activity and social functioning of adults with psychiatric disorders. HMSO: London Meltzer H, Gill B, Hinds K and Petticrew M. (1996a) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 4 The prevalence of psychiatric morbidity among adults living in institutions, HMSO: London Meltzer H, Gill B, Hinds K and Petticrew M. (1996b) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 5: Physical complaints, service use and treatment of residents with psychiatric disorders. HMSO: London Meltzer H, Gill B, Hinds K and Petticrew M. (1996c) OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 6: Economic activity and social functioning of residents with psychiatric disorders. HMSO: London Nicol, A.R., Stretch, D.D., Fundundis, T., Smith, I and Davidson, I., (1987) The nature of mother and toddler problems - I Development of a multiple criterion screen. J. Child Psychol. Psychiatry, 28:739-754 Platt, S., Hawton, K., Kreitman, N., Fagg, J., Foster, J., (1988) Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities Psychological Medicine 18:405-18 Rutter, M., Tizard, J., and, Whitmore, K., (1970) Education, health and behaviour, Longmans, London

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Rutter, M., Cox, A., Tupling, C., Berger, M., Yule, W., (1975), “Attainment and adjustment in two geographical areas I. The prevalence of psychiatric disorder” Br. J. Psychiatry 126, 493-509 Rutter, M., Tizard, J., Yule, W., Graham, P., Whitmore, K., (1976) Research report: The Isle of Wight Studies 1964-1974 Psychological Medicine 6:313-32 Rutter, M., (1989) Isle of Wight Revisited: Twenty five years of Child Psychiatric Epidemiology American Academy of Child and Adolescent Psychiatry. Simonoff, E., Pickles, A., Meyer, J. M., Silberg, J., Maes, H. H., Loeber, R., Rutter, M., Hewitt, J. K. & Eaves, L. J. (1997). The Virginia twin study of adolescent behavioral development: influences of age, gender and impairment on rates of disorder. Archives of General Psychiatry, 54, 801-808. Singleton, N., Meltzer, H., Gatward, R., Coid, J., and Deasey, D. (1998) Psychiatric morbidity among prisoners in England and Wales HMSO: London Taylor, E., Sandberg, S., Thorley, G., Giles, S., (1991) “The epidemiology of childhood hyperactivity”, Oxford, Oxford University Press Verhulst, F.C., Berden, G.F.M.G., Sanders-Woudstra, J.A.R., (1985), Mental health in Dutch children: (II) the prevalence of psychiatric disorder and relationship between measures Acta Psychiatr. Scand. Suppl. 324, 1-45 Vikan, A., (1985) Psychiatric epidemiology in a sample of 1510 tentear-old children, I. J. Child Psychol. Psychiatry, 26: 55-75 Wing, L., Gould, J., (1978), Systematic recording of behaviours and skills of retarded and psychotic children J. Autism Child. Schizophr. 8, 79-97 World Health Organisation (1993) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organisation: Geneva

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2

Concepts and methods used in assessing mental disorders

2 2.1

Concepts and methods used in assessing mental disorders

This chapter is divided into five sections. In the first of them, the use of the term, mental disorder, in relation to young people is discussed and the definitions of the terms used in this report are outlined. The second section aims to define concepts related to prevalence. This is followed by a discussion of methods of assessment, in particular the choice between one- and two-stage sampling designs and the selection of assessment instruments. The penultimate section examines the advantages of gathering information from multiple informants (parent, teacher and child) and the chapter ends with a description of how a clinical input was added to the interpretation of the survey data. Estimates of the prevalence of psychiatric morbidity among young people depend on the choice of concepts as well as how they are operationalised. These, in turn, depend on the particular purposes and aims of the study. This point needs emphasising because it means that estimates from this survey will not necessarily be comparable with those obtained from other studies using different concepts and methods or using samples which may not be representative of the total population of children and adolescents aged 5-15.

2.2

Definitions of mental disorder

Although this survey report uses the term, mental disorder, in relation to children, there is a recognition that this terminology can cause concern. (NHS Health Advisory Service, 1995) “First such terms can be stigmatising, and mark the child as being different. However, unless children with mental health problems are recognised, and some attempt is made to understand and classify their problems, in the context of their social, educational and health needs, it is very difficult to organise helpful interventions for them. The second concern is that the term mental disorder may be taken to indicate that the problem is entirely within the

16

child. In reality, disorders may arise for a variety of reasons, often interacting. In certain circumstances, a mental or psychiatric disorder, which describes a constellation or syndrome of features, may indicate the reactions of a child or adolescent to external circumstances, which, if changed, could largely resolve the problem.”

Introduction

Mental health of children and adolescents in Great Britain

“It is important to define terms relating to the mental health of children and adolescents because experience shows that lack of terminological clarity leads to confusion and uncertainty about the suffering involved, the treatability of problems and disorders and the need to allocate resources.” Because the questionnaires used in this survey were based on ICD-10 and DSM-IV diagnostic research criteria, this report uses the terms mental disorders as defined by the ICD-10: to imply a clinically recognisable set of symptoms or behaviour associated in most cases with considerable distress and substantial interference with personal functions.

2.3

Concepts

Period prevalence This survey aims to establish the prevalence of mental disorders during a particular period prior to interview. This time period is not the same for each disorder and is subject to various criteria: • • • •

Criteria imposed by the measurement instrument Criteria chosen by the research team Criteria contingent on the nature of the disorder itself Criteria imposed by the nature of the sample

Co-occurrence of disorders Instruments used for clinical assessments of psychiatric disorders often allow for several possible diagnoses to be made. Although it would be possible to impose a hierarchy among different disorders, the

Concepts and menthods used in assessing mental disorders

prevalence rates presented in subsequent chapters of this report do not have a hierarchy imposed on them. Thus, individuals with multiple diagnoses can be represented in several parts of a table. However, Chapter 4 of this report does present data on the cooccurrence of disorders.

2.4

Methods of assessing mental disorders

Two key decisions had to be made in deciding how to measure the prevalence of mental disorders of children and adolescents. The first related to whether to adopt a one- or two-stage design, i.e. ask all questions of all respondents or start off with a short screening instrument applicable to all children followed up with a detailed assessment with all screen positives and a sample of screen negatives. The second crucial question was whether to use or adapt an existing instrument or create a new one afresh from first principles. We decided on adopting a one-stage design with a questionnaire created anew based on ICD-10 and DSM-IV diagnostic research criteria. The strengths and weaknesses of the options considered are described below.

One- versus two-stage designs About half of the national surveys that have been carried out in other countries have used the multimethod-multistage approach of Rutter et al. (1970) to ascertain potential cases. In this approach, rating scales completed by children above a certain age and/or parents and/or teachers are used as first stage screening instruments. Subjects with scores above the cut-off score are identified as potential cases and further evaluated. A small sample of individuals with scores below the cut-off threshold are also selected for interview to assess the frequency of false negatives, i.e., those who have problems but whose rating scale scores were below the cut-off score. In the second stage, children with scores above the cut-off score and a sample of those with scores below this value are interviewed using semi-structured or structured psychiatric interview instruments. At this stage categorical diagnoses are made. The overall prevalence of disorder is determined at the conclusion of this two-stage process.

2

The other method does not base caseness upon the multimethod-multistage approach. All children and adolescents identified through the initial sampling procedure are eligible for diagnostic assessment. There are many advantages of such an approach: • Detailed information is collected on all children. A sample distribution can be produced on all subscales even though only those with above-threshold score will have psychopathology. • Because the survey aims to investigate service use, social disabilities, stressful life events, risk factors and the use of tobacco, alcohol and drugs, it is also important to have this information for all children from which a control sample can be selected. • With the possibility of a longitudinal element in the survey, there is a large pool of children from which to select controls who could be matched on several characteristics to the children who exhibit significant psychiatric symptoms during the first stage interview. • A one-stage design is likely to increase the overall response rate compared with a twostage (screening plus clinical assessment) design. • A one-stage design reduces the burden put on respondents. Ideally, a two-stage design would require a screening questionnaire to be asked of a parent, a teacher as well as the child, followed up with an assessment interview administered to the child and the parent. A one-stage design only requires an interview with the parent and child and, if possible, the administration of a teacher questionnaire. • One of the advantages of a one-stage over a two-stage design is that its implementation is cheaper and can be carried out in a far shorter timescale.

Screening instruments Two rating scales have commonly been used for the first-stage, screening process in community-based studies of children: the Rutter Scales: A and B

Mental health of children and adolescents in Great Britain

17

2

Concepts and methods used in assessing mental disorders

(Rutter et al., 1970), the Child Behaviour Checklist (Achenbach and Edelbrock, 1983). The Rutter Child Scale A and Rutter Child Scale B cover aspects of behavioural and emotional functioning within the past year. These scales were used as first-stage screening instruments in their entirety (Connell et al., 1982), or in an abridged form (Vikan, 1985). The Rutter scales, along with additional items assessing attention deficit disorder and affective disorder, were used to gather supplementary information in the New Zealand study (Anderson et al., 1987). The Child Behaviour Checklist (CBCL) describes symptoms of emotional and behavioural disturbance over the past 6 months. It is a 138-item scale for use with 4 to 16 year-olds and assesses a wide range of pathological behaviours (118 items) and the child’s social competence (20 items). Parent and teacher forms were used to screen subjects in the Netherlands (Verhulst et al., 1985) and Puerto Rico (Bird et al., 1988). However, the CBCL has often criticised as being unnecessarily long, as having a negative perspective and may not be better than the more quicklyadministered instrument like the Rutter scales.

The Strengths and Difficulties Questionnaire Another brief alternative to the CBCL is the Strengths and Difficulties Questionnaire (SDQ), which is a brief behavioural screening questionnaire that can be administered to the parents and teachers of 4-16 year olds and also to 11-16 year olds themselves. It covers common areas of emotional and behavioural difficulties, also enquiring whether the informant thinks that the child has a problem in these areas, and if so, asking about resultant distress and social impairment. It has been shown to be of acceptable reliability and validity, performing at least as well as the CBCL and Rutter questionnaires (Goodman, 1997; Goodman et al., 1998; Goodman & Scott, 1999; Goodman, 1999). Though originally published in English, it is currently available in over 40 languages, including Welsh, Gaelic and the languages spoken by the main immigrant communities in Britain. The SDQ was used in the 1997 Health Survey for England. (McMann et al., 1996)

18

Mental health of children and adolescents in Great Britain

Diagnostic instruments In his review of diagnostic instruments, Angold (1989) makes the distinction between fullystructured and semi-structured diagnostic interviews. The semi-structured interviews which were reviewed either can not be undertaken by lay interviewers without extensive additional training or do not cover the desired age range: K-SADS (Schedule for Affective Disorders and Schizophrenia) requires considerable clinical judgement. It is intended for administration by clinically sophisticated interviewers. ISC (Interview Schedule for Children) requires extensive clinical experience and interview-specific training. The final diagnosis is arrived at in a group conference. CAS (Child Assessment Schedule) has been used by lay interviewers but is only suitable for children aged 7 to 12. CAPA (Child and Adolescent Psychiatric Assessment) requires substantial training to produce sufficient familiarity with the instrument especially for those who are clinically inexperienced. It applies to children aged 8-16. One of the advantages that it has over the previous three instruments is that it can produce ICD-10 diagnoses (as well as DSM-III-R). The two, fully-structured, interview schedules reviewed by Angold (1989) were the DISC (Diagnostic Interview Schedule for Children) and the DICA (Diagnostic Interview for Children and Adolescents). The DISC is applicable for children aged 6 and above. An interview with the child takes 40-60 minutes and the parent version about 60-70 minutes. Non-clinically trained interviewers require about 2-3 days training. It generates DSMIII-R diagnoses. Diagnostic algorithms for scoring the results of the interview are available The DICA is applicable to children aged 6 and above. It takes about 40-45 minutes to complete and exists for administration to parents or children. Only a short period of interviewing training is necessary,

Concepts and menthods used in assessing mental disorders

and interviewers do not need to have had clinical experience. It is can be scored for ICD diagnoses. Hodges (1993) has also reviewed structured interviews for assessing psychiatric morbidity among children: CAPA, CAS, DICA, DISC, ISC, KSADS. She looks at what lessons have been learnt from their use and reliability and validity data. Unfortunately, prevalence studies are not covered in the scope of her review.

Constructing a new instrument The measures designed for the present study were intended to combine some of the best features of structured and semi-structured measures. Using existing semi-structured measures for a large national survey would have been impractical and prohibitively expensive since it would have required recruiting a team of several hundred clinically trained interviewers or providing prolonged additional training and supervision to lay interviewers. Given the practical and financial imperative to use lay interviewers with relatively little additional training, it was clear that the main interviewing would need to be fully structured. The disadvantage of relying entirely upon existing structured interviews is that the results are far less clinically convincing than the results of surveys based on semi-structured interviewing. When informants answer fully structured interviews, they often over-report rare symptoms and syndromes because they have not really understood the questions. (Brugha et al., 1999) To circumvent this problem, the new measures use structured interviewing supplemented by open-ended questions. When definite symptoms are identified by the structured questions, interviewers use openended questions and supplementary prompts to get parents to describe the problems in their own words. The specfic prompts used were: Description of the problem Specific examples What happened the last time? What sorts of things does s/he worry about? How often does the problem occur? Is it many times a day, most weeks, or just once or twice? Is it still a problem?

2

How severe is the problem at it’s worst? How long has it been going on for? Is the problem interfering with the child’s quality of life? If so, how? Where appropriate, what does the family/child think the problem is do to and what have they done about it? Answers to these questions and any other information given are transcribed verbatim by the interviewers but are not rated by them. Interviewers are also given the opportunity to make additional comments, where appropriate, on the respondents’ understanding and motivation. A small team of experienced clinicians review the transcripts and interviewers’ comments to ensure that the answers to structured questions are not misleading. The same clinical reviewers can also consider clashes of information between different informants, deciding which account to prioritise. Furthermore, children with clinically relevant problems that do not quite meet the operationalised diagnostic criteria can be assigned suitable diagnoses by the clinical raters. There are no existing diagnostic tools that combine the advantages of structured and semi-structured assessments in this sort of way, which is why a new set of measures were specifically designed for this survey. The new measures and their validity are described in more detail elsewhere. (Goodman et al., 2000)

2.5

Single versus multiple informants

While single-informant investigation characterised nearly all of the early epidemiological studies, more recent studies (within the multi-method multistage approach) have broadened data collection to include information gathered from parents, teachers, and the subjects themselves. Hodges (1993) has pointed out that children and adolescents can respond to direct questions aimed at enquiring about their mental status and that there is no indication that asking these direct questions has any morbidity or mortality risks. A well-established fact is that information from many sources is a better predictor of disorder than just one source. Many experienced clinicians and researchers in child psychiatry believe that information

Mental health of children and adolescents in Great Britain

19

2

Concepts and methods used in assessing mental disorders

gleaned from multiple informants facilitates the best estimate of diagnosis in the individual case (Young et al., 1987). At the population level, information from multiple informants enhance the specificity of prevalence estimates. Angold (1989) states: “In general, parents often seem to have a limited knowledge of children’s internal mental states and to report less in the way of depressive and anxiety symptoms than their children would report. On the other hand adults seem to be better informants about externalised or conduct disorder items such as fighting and disobedience. Teachers are good informants about school behaviour and performance, whilst parents are informative about home life.” Hodges (1993) comments that agreement between child and parent has varied depending on type of pathology: “There appears to be more agreement for behavioural symptoms, moderate agreement for depressive symptoms, and poor agreement for anxiety.” One of the problems of collecting information from various sources is finding the best way to integrate the information which may show a lack of agreement. One method has been to accept a diagnosis irrespective of its source (Bird et al., 1992). Others have promoted “case vignette” assessments where clinical judgements are made on detailed case histories from several sources. (Goodman et al., 1996)

2.6

Case vignette assessment

This case vignette approach for analysing survey data uses clinician ratings based on a review of all the information of each subject. This information includes not only the questionnaires and structured interviews but also any additional comments made by the interviewers, and the transcripts of informants’ comments to openended questions particularly those which ask about the child’s significant problems. The case vignette approach was extensively tested among community and clinical samples in the pre-pilot and pilot phases of the survey.

20

Mental health of children and adolescents in Great Britain

The clinical raters perform four major tasks. Firstly, they use the transcripts to check whether respondents appear to have understood the fully structured questions. This is particularly valuable for relatively unusual symptoms such as obsessions and compulsions - even when parents or young people say “yes” to items about such symptoms, their own description of the problem often makes it clear that they are not describing what a clinician would consider to be an obsession or compulsion. Secondly, the clinical raters consider how to interpret conflicts of evidence between informants. Reviewing the transcripts and interviewers’ comments often helps decide whose account to prioritise. Reviewing all of the evidence, it may be clear that one respondent gives a convincing account of symptoms, whereas the other respondent minimises all symptoms in a defensive way. Conversely, one respondent may clearly be exaggerating. Thirdly, the clinical raters aim to catch those emotional, conduct and hyperactivity disorders that slip through the ‘operationalised’ net. When the child has a clinically significant problem that does not meet operationalised diagnostic criteria, the clinician can assign a ‘not otherwise specified’ diagnosis such as ‘anxiety disorder, NOS’ or ‘disruptive behaviour disorder, NOS.’ Finally, the clinical raters rely primarily on the transcripts to diagnose less common disorders such as anorexia nervosa, Tourette syndrome, autistic disorders, agoraphobia or schizophrenia. The relevant symptoms are so distinctive that respondents’ descriptions are often unmistakable. The following three case vignettes from the pilot study provide illustrative examples of subjects where the clinical rating altered the diagnosis. In each case the “computer-generated diagnosis” is the diagnosis arrived at by a computer algorithm based exclusively on the answers to fully structured questions. In these three illustrative instances, the computer-generated diagnoses were changed by the clinical raters. Subject 1: overturning a computer-generated diagnosis. A 13 year-old boy was given a computer diagnosis of a specific phobia because he had a fear that resulted in significant distress and avoidance. In his open-ended description of the fear, he explained that boys from another school had threatened him

Concepts and menthods used in assessing mental disorders

on his way home on several occasions. Since then, he had been afraid of this gang and had taken a considerably longer route home every day in order to avoid them. The clinical rater judged his fear and avoidance to be appropriate responses to a realistic danger and not a phobia. Subject 2: including a diagnosis not made by the computer. A 7-year-old girl fell just short of the computer algorithm’s threshold for a diagnosis of ADHD because the teacher reported that the problems with restlessness and inattentiveness resulted in very little impairment in learning and peer relationships at school. A review of all the evidence showed that the girl had officially recognised special educational needs as a result of hyperactivity problems, could not concentrate in class for more than 2 minutes at a time even on activities she enjoyed, and had been offered a trial of medication. The clinician concluded that the teacher’s report of minimal impairment was an understatement, allowing a clinical diagnosis of ADHD to be made. Subject 3: both adding to and subtracting from computer generated diagnoses. A 14-year-old girl received computer-generated diagnoses of simple phobia, major depression and oppositional-defiant disorder. The transcripts of the open-ended comments provided by the girl and her mother included convincing descriptions not only of a depressive disorder but also of anorexia nervosa of one year’s duration. The supposed phobia was an anorexic fear of food, and the oppositionality had only been present for a year and was primarily related to battles over food intake. Consequently, the clinical rater made the additional diagnosis of anorexia nervosa and overturned the diagnoses of simple phobia and oppositional-defiant disorder.

2

References Achenbach, T.M., & Edelbrock, C.S., (1983), “Manual for the Child Behaviour Checklist and Revised Child Behaviour Profile”, Burlington, Vermont, University of Vermont, Department of Psychiatry. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC: American Psychiatric Association. Angold, A. (1989) Structured assessments of psychopathology in children and adolescents in (ed) C. Thompson, The Instruments of Psychiatric Research, John Wiley & Sons Ltd. Anderson, J.C., Williams, S., McGee, R. & Silva, P.A. (1987) DSM-III disorders in preadolescent children, Arch. Gen. Psychiatry, 44: 69-76 Bird, H.R., et al, (1988), Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico, Arch. Gen. Psychiatry, 45: 1120-1126 Bird, H.R., Gould, M.S. and Staghezza, B. (1992) Aggregating data from multiple informants in child psychiatry epidemiological research. J. Am. Acad. Child Adol. Psychiatry 31, 78-85 Brugha, T.S., Bebbington, P.E., and Jenkins R. (1999) A difference that matters: comparisons of structured and semi-structured psychiatric disgnostic interviews in the general population. Psychological Medicine, 29. 1013-1020 Connell, H.M., Irvine, L., & Rodney, J. (1982) Psychiatric Disorder in Queensland primary schoolchildren. Aust. Paediatr. J., 18: 177-180 Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581-586. Goodman, R. (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791-801. Goodman, R., Meltzer, H., & Bailey V. (1998) The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child and Adolescent Psychiatry, 7, 125-130. Goodman, R. & Scott, S. (1999) Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is small beautiful? Journal of Abnormal Child Psychology, 27, 17-24. Goodman, R., Yude, C., Richards, H. & Taylor, E. (1996) Rating child psychiatric caseness from detailed case histories. Journal of Child Psychology and Psychiatry, 37, 369-379. Hodges, K., Structured Interviews for Assessing Children (1993) J. Child Psychol. Psychiatry 34: 49-68 Rutter, M., Tizard, J., and, Whitmore, K., (1970) Education, health and behaviour, Longmans, London Verhulst, F.C., Berden, G.F.M.G., Sanders-Woudstra, J.A.R., (1985), “Mental health in Dutch children: (II) the prevalence of psychiatric disorder and relationship between measures” in Acta Psychiatr. Scand. Suppl. 324, 1-45 Vikan, A., (1985) Psychiatric epidemiology in a sample of 1510 ten-tear-old children, I. J. Child Psychol. Psychiatry, 26: 55-75 World Health Organisation (1993) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organisation: Geneva Young, J.G., O’Brien, J.D., Gutterman, E.M. & Cohen, P., (1987) Research on the clinical interview. J. Am. Acad. Child Adol. Psychiatry 26, 5: 613-620

Mental health of children and adolescents in Great Britain

21

3 3.1

Sampling and survey procedures

Introduction

This chapter covers three main topics: the sampling design, the organisation of the survey and survey response.

3.2

Sample design

The sampling design for the survey was different from and many other surveys carried out by ONS in that the Postcode Address File was not used as the sampling frame. Instead the sample was drawn from Child Benefit Records held by the Child Benefit Centre (CBC). Using centralised records as a sampling frame was preferred to carrying out a postal sift of over 100,000 addresses and to sampling through schools. The postal sift would have been time consuming and expensive. We did not want to sample through schools because we wanted our initial contact to be parents who then would give signed consent to approach the child’s teacher. We were aware that 90% of child benefit records have postcodes attributed to addresses. The Child Benefit Centre had no evidence that records with postcodes were different from those without. The addresses with missing postcodes probably represent a mixture of people who did not know their postcode at the time of applying for child benefit or simply forgot to enter the details on the form. If there are other factors which differentiate between households with and without postcoded addresses, the key question is to what extent these factors are related to the mental health of children. As these factors are not known, we do not know what biases have been introduced into the survey by omitting the non-postcoded addresses. We also excluded from the original sampling frame those cases where “action” was being invoked. Examples of such action are: the death of the child and a change of address. They are simply administrative actions as distinct from some legal process concerning the child and hence should not bias the sample in any way.

22

Another consequence of sampling from child benefit records rather than the Postcode Address File was having less control over the proximity of addresses. In order to exert some control over this we asked the CBC to list records by postcode (e.g. AB1 2AA, AB1 2AB ......... AB1 2ZY, AB1 2ZZ) and than stratify by age and sex within postcode.

Mental health of children and adolescents in Great Britain

In order to keep within data protection guidelines, we had to go through several steps to get our sample. First, we supplied the Child Benefit Centre with the list of 475 postal sectors we wanted covered. We then gave them details of how to calculate the sampling fraction to apply to their records in each postal sector in order to select 30 children whose parents received child benefit. We then asked them to send out a letter on our behalf telling them about our survey and giving parents an opportunity to opt-out. To manage this process, the sectors were grouped into three waves. Table 3.1 shows that 14,250 letters were despatched by the Child Benefit Centre on behalf of ONS: 30 letters for each of the 475 postal sectors. Nine hundred and thirty one of the sampled addresses (6.5%) contacted ONS via a free phone number to opt out and a further 790 addresses (5.5%) were found to be ineligible. The main reason for ineligibility was that the family had moved and could not be traced. This accounted for 629 of the 790 ineligibles - 4.4% overall. Other reasons for ineligibility were that the child was deceased, in foster care, outside the age criteria, 5-15, or the family had emigrated. Therefore, just over twelve and a half thousand addresses were allocated to around 300 interviewers. (Table 3.1) Table 3.1

Response to initial CBC letter

Sampled children Opt outs Ineligibles Children eligible for interview

Wave1

Wave 2

Wave 3

All

4183

4394

5673

14250

267 196

276 257

388 337

931 790

3720

3861

4948

12529

Sampling and survey procedures

3.3

Survey procedures

Checking CBC information When the interviewer went to the address of the sampled child, her first task was to find out if the family still lived there and if the name was correct. Experience from the pilot survey indicated that many of the addresses from the CBC were out of date. The families had changed address and not informed the CBC. Because the survey had a national coverage, attempts were made to trace the movers, and the family reallocated to another interviewer working in the vicinity of the new address.

When the parent and child interviews were completed, parents were asked for written consent to contact the child’s teacher. Parents were asked to nominate the teacher who they felt knew the child best. If the child had been expelled or excluded from school within the last few months, contact names for teachers were still sought. Before the teachers’ questionnaire was posted out, various steps were taken to maximise response: • A paragraph describing the survey was inserted into a journal which goes to all teachers. • Chief Education Officers were notified of the plans for the survey and the extent of teachers’ involvement. • A week before any postal questionnaires were sent off to teachers, the head teachers in all schools of the sampled children were notified that some of their teachers would be sent a questionnaire to fill in. • The sample design with 475 postal sectors and the stratification of the CBC list were intended to reduce the burden on teachers so that most would not have to fill in more than two questionnaires.

Interviewers also found that, in many cases, the names of both the selected child and the mother had changed owing to new relationships: remarriage, change of partner, etc. In this regard, the interviewers also checked that they had the right address.

Order of interview The first stage of the interview was the completion of the face to face interview with the parent including a five minute self-completion element (GHQ12 and Family Functioning Scale). If the parent had difficulties with the English language a special two page self-completion questionnaire available in 40 languages was available as a replacement.

3.4

After the parent interview, permission was sought to ask questions of the sampled child. Children aged 11-15 had a face to face interview and entered details of their smoking, drinking and drug-taking experiences via a self-completion questionnaire on laptop. All children, from 5 to 15 years, were administered reading and spelling tests.

3

Survey response rates

Information was collected on 83% of the 12,529 children eligible for interview from up to three sources resulting in 10,438 achieved interviews. (Table 3.2) Among the co-operating families, almost all the parents and most of the children took part. Four out of five teachers also returned their questionnaires, based on an initial mail out and one reminder letter. (Table 3.3)

Table 3.2 Response to interview Wave1 All interviews Refusals Non-contacts

3100 545 76

Base=set sample

3721

(83%) (15%) (2%)

Wave 2

Wave 3

All

3191 (83%) 543 (14%) 127 (3%)

4147 (85%) 686 (13%) 114 (2%)

10438 1774 317

3861

4947

12529

(83%) (15%) (2%)

Mental health of children and adolescents in Great Britain

23

3

Sampling and survey procedures

Table 3.3

Achieved interviews by type of informant Number

%

Parent interviews Child interviews/assessments Teacher questionnaire

10405 9347 8382

(99.7%) (95.3%) (80.3%)

Base= achieved interviews

10438

3.5

problems of excluding the rest of the family from the living room for a considerable period of time. Some parents were initially taken aback that the interviewer needed to see the child on his/her own, though the great majority were happy with the explanations given. A technique successfully used by interviewers when parents refused to leave the room was to sit side by side with the child, reading out the questions but then asking the child to key in their own answers into the laptop computer.

Interviewing procedures

Choice of parent to interview

Use of laptop computers

In most interviews, over 95%, the interview with the parent was carried out with the mothers as they tended to be more available when the interviewer called. In the cases where the father was interviewed, the mother did not speak sufficient English to cope with the interview. The remainder were cases of lone fathers or fathers who were at home by themselves most of the time.

The use of laptop computers to ask sensitive questions - awkward and troublesome behaviour and smoking, drinking and drug taking - of children aged 11-15 worked successfully. However, the reporting of all types of substance use and abuse were under-reported compared with the national surveys of smoking and drinking carried out by group administration in school settings (Goddard and Higgins, 1999a; Goddard and Higgins, 1999b)

Logistics of arranging interviews Language difficulties The unpredictable length of the interview meant that interviewers had to make appointments when mothers would have a clear 90-120 minutes. This was often difficult for those mothers who had several children with different ‘pick-up’ times from school and nursery, and mothers with full or part time jobs. In some areas, this meant that the interviewer could arrange an interview in the morning, but could not start again until children were back from school and parents, if employed, were back from work. Interviewers reported that some of the children had even busier ‘social calendars’ than their parents and a lot of flexibility (on the interviewer’s part) was needed to complete both the parent and the child interview.

Privacy The need for privacy in the interviews (for both parent and child) also affected the logistics of appointment making. It was obviously easier for the mother if none of her children were around (not just the selected child). This was clearly difficult if the mother worked during the day. Children’s interviews, by definition, had to be done when the children were home from school, leading to the

24

Mental health of children and adolescents in Great Britain

In some circumstances, neither parent had a sufficient grasp of English to be interviewed, especially as some of the questions on the mental health of children, e.g., obsessions and compulsions were quite difficult to formulate in English. To overcome this difficulty, the two-page, Strengths and Difficulties Questionnaire was made available in approximately 40 languages. This was used, in a self-completion format, instead of the face-to-face parent interview.

Incentive payments During the pilot stages of the survey, the need for incentive payments was investigated. Most teenagers agreed to be interviewed without an incentive payment. The lack of an incentive payment did not appear to affect response in the main stage of the survey, as shown by the high response rate by all children, 96% of co-operating families. One or two young people may have agreed to an interview with an incentive payment but this was not sufficiently widespread to recommend the universal use of incentive payments.

Sampling and survey procedures

3

References Goddard, E., and Higgins, V. (1999a) Smoking, drinking and drug use among teenagers, Volume 1, England London: The Stationary Office. Goddard, E., and Higgins, V. (1999b) Smoking, drinking and drug use among teenagers, Volume 2, Scotland London: The Stationary Office.

Mental health of children and adolescents in Great Britain

25

4 4.1

Prevalence of mental disorders

Introduction

The prevalence of mental disorders among children and adolescents was based on a clinical evaluation of parent, teacher and child data collected by lay, ONS interviewers from questionnaires designed by the Department of Child and Adolescent Psychiatry, Institute of Psychiatry in London. Chapter 2 of this report describes the assessment process in some detail and the questionnaire is reproduced in Appendix E. Four broad categories of mental disorders were identified and specific disorders were subsumed under these three headings.

Emotional disorders Anxiety disorders Separation anxiety Specific phobia Social phobia Panic Agoraphobia Post Traumatic Stress Disorder (PTSD) Obsessive-Compulsive Disorder (OCD) Generalised Anxiety Disorder (GAD) Other anxiety Depression Depressive episode Other depressive episode

Conduct disorders Oppositional defiant disorder Conduct disorder (family context) Unsocialised conduct disorder Socialised conduct disorder Other conduct disorder

Hyperkinetic disorder Hyperkinesis Other hyperkinetic disorder

26

Mental health of children and adolescents in Great Britain

Less common disorders Pervasive developmental disorder Psychotic disorder Tic disorders Eating disorders Other psychiatric disorders Prevalence rates for all disorders are shown in the tables as percentages to one decimal point. Therefore, rates per thousand of the population can be calculated by multiplying the percentages by ten. The percentages in the text and figures which refer to the numbers in the tables are rounded to the nearest integer. Sampling errors around these estimates are shown in Appendix C. The figures in the tables in this chapter are weighted to take account of differential sampling, non-response by age, sex and region and adjusted to take account of missing teacher data. The weighting and adjustment strategies are fully described in Appendix A.

4.2

Prevalence of mental disorders by personal characteristics

Among children aged 5 -15 years, 5% had clinically significant conduct disorders; 4% were assessed as having emotional disorders – anxiety and depression – and 1% were rated as hyperactive. As their name suggests, the less common disorders (autistic disorders, tics and eating disorders) were attributed to half a percent of the sampled population. The overall rate of 10% includes some children who had more than one type of disorder. (Table 4.1) These rates are based on the diagnostic criteria for research using the ICD-10 Classification of Mental and Behavioural Disorders with strict impairment criteria - the disorder causes distress to the child or has a considerable impact on the child’s day to day life.

Prevalence of mental disorders

Sex and age The proportion of children and adolescents with any mental disorder was greater among boys than girls: 11% compared with 8%. This disparity was evident in both younger and older children. Among 5-10 year olds, 10% of boys and 6% of girls had a mental disorder. In the older age group, the 11-15 year olds, the proportions of children with any mental disorder were 13% for boys and 10% for girls. (Figure 4.1) Whereas the rates of emotional disorders were similar for boys and girls, the prevalence of conduct disorders was found to be approximately twice as common among boys than girls and for hyperkinetic disorders the ratio was even greater: 2% among boys of all ages compared with about half a percent of girls. (Table 4.1) Age and sex differences of this magnitude have been found in other national surveys on the mental health of children and adolescents. (Zubrick et al., 1995) Owing to these age and sex differences, all the subsequent tables showing the prevalence rates by child, family and household characteristics, are presented by age and sex. Table 4.1 also shows the prevalence rates of specific mental disorders (e.g. social phobia, oppositionaldefiant disorder, hyperkinesis etc.) by age and sex. These data have been presented for reference purposes. Owing to the relatively low rates of the specific disorders, all the remaining tables in this chapter focus on the broad groups of disorder.

Ethnicity Nearly 10% of white children and 12% of black children were assessed as having a mental health problem whereas the prevalence rates among Asian children were 8% of the Pakistani and Bangladeshi and 4% of the Indian samples. (Figure 4.2) Despite the large number of interviews achieved in this survey, over ten thousand, ethnic differences are difficult to interpret because of the small numbers in the sample who regarded themselves as belonging to particular ethnic groups. When the ethnic groups are categorised by age and by sex the bases are smaller still and make the differences between distributions correspondingly more

4

difficult to interpret. Nevertheless, Indian children, particularly girls seem to have far lower rates of mental disorder than both white or black children. (Table 4.2)

4.3

Prevalence of mental health disorders by family characteristics

Family type and marital status Two questions were asked to obtain the marital status of the interviewed parent. The first asked: “Are you single, that is never married, married and living with your husband/wife, married and separated from your husband/wife, divorced or widowed?”. The second question asked of everyone except those married and living with husband/wife was, “May I just check, are you living with someone else as a couple?”. As neither the stability of the relationship nor the length of the period of cohabitation was assessed, it is not possible to draw conclusions about cohabitation per se. Children of lone parents were about twice as likely to have a mental health problem than those living with married or cohabiting couples: 16% compared with 8%. This relationship was also found in the Western Australian survey of 14,100 children. (Zubrick et al., 1995) “Children from single parent families were more likely (odds ratio 2:1) to have a mental health morbidity than those in two-parent families” Within the GB sample of children of lone parents, the prevalence of mental disorders did not differ markedly by whether the lone parent was single or widowed, divorced or separated. (Figure 4.3) However, children living with cohabiting as distinct from married couples were more likely to have a mental health problem, in particular, conduct disorders: 8% compared with 4%. (Table 4.3) There were also sex differences in the family type relationship. Nearly 1 in 5 of boys of lone parents had a mental health problem, with most of them having a conduct disorder. Among the girls in lone parent families, about 1 in 8 had a mental disorder, equally distributed among conduct and emotional disorders. (Table 4.3)

Mental health of children and adolescents in Great Britain

27

4

Prevalence of mental disorders

In an attempt to explain the relationship between family type and the mental health of children, Fombonne (1995) comments: “On the whole, secular changes in patterns of family life expose children and adolescents to more frequent and earlier challenges: marital discord, parental breakdown and divorce, remarriage or cohabitation, and single parent families, which have all been shown to be associated with negative outcomes in young people, with boys and girls being affected in different ways…… It is possible that secular changes in patterns of family life have led to an increase in the conditions of family functioning that lead to depression.. among adolescents” Zubrick (1995) also explains that family type differences are not simply due to the structure of the family but represent a multiplicative interaction of factors: “In view of the fact that rates of child mental health morbidity can vary according to a family’s social, economic and financial circumstances, family structure alone would not provide a satisfactory backdrop against which to assess rates of child mental health morbidity. Two additional factors that modify the initial finding (on family structure) were considered parental income and quality of the parents’ relationships.” This cautionary note is amply demonstrated in the GB survey which shows large differences in the socio-economic and social functioning of lone and two parent families. Married

Cohabiting

Lone parent

Percentage of families with each characteristic Interviewed parent was economically inactive

25%

31%

46%

1%

3%

21%

Social sector tenants

15%

38%

56%

Interviewed parent had GHQ-12 score of 4+

16%

20%

30%

17%

21%

24%

Household gross weekly income was less than £100

“Unhealthy” family functioning

28

Mental health of children and adolescents in Great Britain

As social and family functioning are regarded as key risk factors for childhood psychopathology, a whole chapter in this report looks at these relationships – see Chapter 9.

Reconstituted families The relationships between family member in the household were examined to see if any of the children were step-sons or step-daughters. This search was carried out for all children in the family not just the sampled child. Thus, a family was regarded as reconstituted if step-children were present. Overall, about 9% of the surveyed children lived in reconstituted families. Mental disorders were more prevalent among children of reconstituted families than those without step children: 15% compared with 9%. The ratio of the prevalence rates of child mental disorders by this measure of family structure was similar across all age and sex categories: 19% compared with 12% for 11-15 year old boys and 11% compared with 5% for 5-10 year old girls. The disparity in prevalence rates between the reconstituted and other families was mainly due to the differences in the proportions of children with conduct or hyperkinetic disorders rather than emotional disorders. (Table 4.4)

Number of children in household A child living in a family with one other child, i.e. two children households, represent the group least likely to have been assessed as having a mental health problem. If the number of children in the household are put in ascending order of the likelihood of having a mental health problem, the order would be 2-3-1-4-5. However, the only statistically significant differences were between those in two-children households (8%) and those who were part of four- and five-children households, 13% and 18% respectively. (Figure 4.5) Whereas this trend was evident for emotional and conduct disorders, there was a different pattern for hyperactivity. The prevalence of hyperkinetic disorders was highest among lone children: nearly 5% of 5-10 year old boys. (Table 4.5) All these findings lend support to the trend shown by Garralda and Bailey (1986) and Ghodsian et al.

Prevalence of mental disorders

(1980) of increased mental health morbidity among children in “larger families”.

Educational qualifications of parent Among the 10,438 parents interviewed for the survey, 94% were the child’s mother. Previous research has suggested a relationship between maternal educational level and mental health of the child. This was examined in the current survey. Table 4.6 shows a clear trend - the prevalence of mental disorders among children increases with a decrease in the educational level of the interviewed parent. Looking at the two extremes of the education level distribution, 15% of children of interviewed parents with no qualifications had a mental disorder compared with 6% of those whose parent had at least a degree level qualification. (Figure 4.6) Having no qualifications in contrast to having any qualifications seemed to have more impact on prevalence rates than differences between educational level. For example, 15% of 11-15 year old boys whose interviewed parent had no qualifications were assessed as having a conduct disorder compared with 5-7% of the same sample whose parents had any qualification up to degree level and 2% of those with parents with at least a degree. (Table 4.6)

4.4

Prevalence of mental health disorders by household characteristics

Family’s employment situation Many studies have shown that unemployed adults fare worse than employed people on several measures of psychological functioning, (Meltzer et al., 1995), Similarly, the working status of the family seemed to be a major factor in understanding the differences in prevalence rates of mental disorders among children and adolescents. About one fifth of children in families without a working parent had a mental disorder, more than twice the proportion among children with at least one working member of the family. (Figure 4.7). The higher prevalence rates of mental disorders among children of non-working compared with working families were shown for all the groups of

4

disorders – emotional, behavioural and hyperkinetic – for both boys and girls and younger and older children. Among working families, the prevalence of childhood disorders did not appear to be associated with whether one or both parents were working. (Table 4.7)

Household income For most families, the majority of their income comes from paid work. Therefore, the relationship between mental disorders among children and household income to some extent reflects the association described above on the family’s working situation. The prevalence of any psychiatric disorder ranged from 16% among children living in families with a gross weekly household income of under £100 to 9% among children of families in the £300-399 weekly income bracket and around 6% in those families earning £500 per week or more. (Figure 4.8) This trend was evident for all three groups of disorders: emotional, behavioural and hyperkinetic. The highest prevalence rate of any mental disorder was found for boys in families with a gross income of under £100 a week, 22%, in contrast to a rate of 3% among 5-10 year old girls in families with an income of at least £500. (Table 4.8)

State Benefits State benefits are paid out for a variety of reasons: one parent benefit, family credit, disability related benefits, invalid care allowance, job seekers allowance etc. The benefits shown in the analysis presented in Table 4.9 have been chosen to indicate at least some degree of disability among a member of the child’s household. The prevalence of mental disorders of children in relation to some of the other state benefits (e.g. lone parent benefit or family credit) are not shown in the table as equivalent data have been presented earlier - on family type and household income. Figure 4.9 shows very strikingly that children living in households that receive Invalid Care Allowance (ICA), Attendance Allowance (AA) and Disability Allowance (DA) were far more likely than other

Mental health of children and adolescents in Great Britain

29

4

Prevalence of mental disorders

children to have a mental disorder. Compared with the overall prevalence rate of 10%, the corresponding percentages for children in families receiving ICA, AA and DA were 29%, 23% and 22%, and these did not vary considerably by age and sex. (Table 4.9)

or housing associations. The principal difference in prevalence rates was between the owner/ occupiers and those living in rented accommodation rather than between types of renter. (Figure 4.11)

Type of accommodation Social class There were marked differences in the prevalence of mental disorders among children by social class (as measured by the occupation of head of household). Children of families in Social Class V (unskilled occupations) were approximately three times more likely to have a mental disorder than those in Social Class I (professionals): 14% compared with 5%, and about twice as likely as those in Social Class II (managerial and technical): 14% compared with 7%. (Figure 4.10) At a more detailed level, 10% of 5-15 year olds in Social Class V families had conduct disorders compared with 2% of their equivalents in Social Class I. These data fit in with Maughan’s review on the mental health of children in Great Britain which examined social class differences from national birth cohort studies and from local epidemiological surveys. (Maughan, 1995) She states that conduct disorders, especially those rated by teachers, show clear social class trends with such disorders more common in lower social groups. She does add a cautionary note: “… more specific indicators of family difficulties and disturbance have been regarded as more important risk factors for children’s psychological well-being than family social position per se.”

The prevalence of mental disorders among children and adolescents by type of accommodation follow the pattern shown for social class, tenure and household income. The overall rate of mental disorder was highest among those living in terraced houses and flats and maisonettes, and lowest among those in detached/semi-detached houses. (Figure 4.12 and Table 4.12)

4.5

Prevalence of mental disorders by areal characteristics

Region There were no significant differences in the prevalence rates of any mental disorder or the three main groups of mental disorders between England, Scotland and Wales nor between the metropolitan and non-metropolitan areas of England. (Figure 4.13 and Table 4.13) This was an unexpected finding considering the variation in prevalence rates described above in terms of social class, tenure, type of accommodation and household income. The answer may lie in the fact that sociodemographic and socio-economic differences may be lost in the aggregated data. This suggests that ACORN (A Classification of Residential Neighbourhoods), a geo-demographic classification, may be a better indicator of regional trends.

Tenure ACORN Just as there were clear social class differences in the prevalence of children and adolescents’ mental health, so there was a marked difference between owner/occupiers and renters. The prevalence of any mental disorder rose from 6% among children in owner/occupier households to 13% of those with parents in private rented accommodation to 17% of children of social sector tenants, i.e. renting from local authorities

30

Mental health of children and adolescents in Great Britain

ACORN is a geo-demographic targeting classification, combining geographical and demographic characteristics to distinguish different types of people in different areas in Great Britain. Although the ACORN classification has various levels, 6 categories, 17 groups and 54 types, for the purposes of this report, the highest level, i.e. the six broad categories have been

Prevalence of mental disorders

chosen for comparative analysis. The ACORN User Guide gives the following description of each category:

A Thriving Wealthy achievers, suburban areas; affluent greys, rural communities; prosperous pensioners, retirement areas. B Expanding Affluent executives, family areas; well-off workers, family areas. C Rising Affluent urbanites, town and city areas, prosperous professionals, metropolitan areas; better off executives, inner city areas. D Settling Comfortable middle agers, mature home owning areas; skilled workers, home owning areas. E Aspiring New home owners, mature communities; white collar workers, better-off, multi-ethnic areas. F Striving Older people, less prosperous areas; council estate residents, better off homes; council estate residents, high unemployment; council estate residents, greater hardship, people in multi-ethnic, lowincome areas. The highest proportion of children with any mental disorder was found among families classified as striving, 13%. This was about twice the rate associated with the expanding ACORN classification (7%) and two and a half times the proportion of those in the thriving category (5%). The overall trend of increased morbidity among children from striving to thriving families not unexpectedly, matches the social class, tenure and household income analysis described above. (Figure 4.14) Age and sex differences in the prevalence rates of mental disorders were found in each geodemographic category. The highest prevalence rate of any mental disorder, 19%, was found for 11-15 year old boys in the striving category with the lowest rate, 3%, among 5-10 year old girls in thriving families. (Table 4.14)

4.6

4

Odds ratios of socio-demographic correlates of mental disorders.

Logistic regression was used to produce odds ratios for the socio-demographic correlates of any disorder and the three principal subgroups – conduct disorders, emotional disorders and hyperactivity – and the two main categories of emotional disorders: anxiety and depression. Each odds ratio shows the increase in odds that a child has a particular disorder when in a particular group compared to a reference group. The variables entered in the model were age, sex, ethnicity, family type, number of children, family employment and the ACORN classification. The latter was chosen as the socio-economic indicator as it takes account of tenure, type of accommodation and income. The significant odds ratios for the sociodemographic correlates of the child having a mental disorder (compared with no disorder) were: age, sex, number of children in the household, family type, the family’s employment situation and the ACORN classification. The odds of having any mental disorder increased by around 50% for boys compared with girls (OR=1.58) for 11-15 year olds compared with younger children (OR=1.48) and for children of lone parents compared with couples (OR=1.57). The two characteristics with the largest significant effect on the odds of having any mental disorder were the family’s employment situation and the ACORN classification. A family with no-one working compared with all adults working nearly doubled the odds of the child having a mental disorder (OR=1.94). Thriving compared with striving families had a similar odds ratio (OR=1.95). The one other characteristic with significant odds ratios for the child having a mental disorder was the number of children in the household. Compared with the lone child family, those with four children increased the odds by about a third (OR=1.32) and those with five children by nearly two-thirds (OR=1.63). The one characteristic entered in the model that showed no significant odds ratios was ethnicity. (Table 4.15)

Mental health of children and adolescents in Great Britain

31

4

Prevalence of mental disorders

The three broad categories of disorders The odds ratios for the socio-demographic correlates for any mental health problem of children and adolescents presented above changed when the three groups of disorders were looked at separately. Whereas the odds of having any mental disorder for boys compared with girls was 1.58, the corresponding odds ratio was 5.56 for hyperactivity, 2.42 for conduct disorders, and was not statistically significant for emotional disorders. Similarly, the odds of having a mental disorder for 11-15 year olds compared with 5-10 year olds at 1.48, rose to 1.84 for conduct disorders, changed very little for emotional disorders at 1.45, and was not significant for hyperactivity. The largest odds ratio for five children compared with one child in the household was found for conduct disorders (OR=2.23) while the corresponding odds ratio for emotional problems was 1.43 and not statistically significant for hyperactivity. Working versus non-working families and thriving as distinct from striving households seemed to have the greatest effect on the odds ratio of having a hyperkinetic disorder. The odds ratio for nonworking compared with working families associated with a hyperkinetic disorder was 2.13 and 2.41 for thriving compared with striving families. At a third level of analysis, odds ratios were calculated for the socio-demographic correlates of the two categories of emotional disorders: anxiety and depression. The most significant finding was the odds of having a depressive episode for 11-15 year olds compared to 5-10 year olds was 8.55. (Table 4.16)

Odds ratios for the co-occurrence of psychiatric disorders Odds ratios were also calculated to estimate the extent of comorbidity between the three main groups of mental disorders and between the two categories of emotional disorders. Following the precedent set by the ECA study, odds ratios were taken to be significant when the ratio exceeded 10.00 and the lower bound of the 95% confidence interval exceeded 4.00. (Robins and Regier, 1991)

32

Mental health of children and adolescents in Great Britain

Conduct disorders were significantly comorbid with hyperkinetic disorders with an odds ratio of 38.43 (26.87 – 54.96) and any anxiety and any depressive episode frequently co-occurred having an odds ratio of 20.13 (13.18 – 39.75) Odds ratios were not calculated for the comorbidity of specific disorders both within and across ICD-10 categories as the base numbers for children with each disorder were too small.

References CACI Information Services, (1993), ACORN User Guide, CACI Limited 1994. All Rights Reserved. Source: ONS and GRO(S) © Crown Copyright 1991. All Rights Reserved. Garralda, M.E., Bailey, D., (1986) “Children with psychiatric disorders in primary care” in Journal of Child Psychology and Psychiatry, 27:611-24 Ghodsian, M., Fogelman, K., Tibbenham, A.,(1980) Changes in behaviour ratings of a national sample of children British Journal of Social and Clinical Psychology 19:247-56 Maughan, B., (1995) “Mental Health” Chapter 12 in The Health of Children”, London: HMSO Robins, L. N. , Locke, B. Z., and Regier, D. An Overview of Psychiatric Disorders in America in Robins L.N and Regier, D (eds) Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (1991) Free Press: New York Standard Occupation Classification 1990 Vol. 1 (1991) Structure and definition of major, minor and unit groups. HMSO: London Zubrick, S.R., Silburn, S.R., Garton, A., Burton, P., Dalby, R., Carlton, J., Shepherd, C., Lawrence, D. (1995) Western Australian Child Health Survey: Developing Health and Well-being in the nineties, Perth, Western Australia: ABS and ICHR.

Prevalence of mental disorders

Table 4.1

4

Prevalence of mental disorders

by age and sex 5-10 year olds Boys

11-15 year olds Girls

All

Boys

All children

Girls

All

Boys

Girls

All

Percentage of children with each disorder Emotional disorders

3.3

3.3

3.3

5.1

6.1

5.6

4.1

4.5

4.3

Anxiety disorders Separation anxiety Specific phobia Social phobia Panic Agoraphobia PTSD OCD GAD Other anxiety

3.2 1.0 1.1 0.4 0.0 0.1 0.3 0.9

3.1 1.0 1.0 0.2 0.1 0.4 0.5

3.1 1.0 1.1 0.3 0.0 0.1 0.4 0.7

3.9 0.7 0.7 0.3 0.4 0.1 0.2 0.5 0.8 1.3

5.3 0.3 1.1 0.4 0.3 0.2 0.5 0.5 1.1 2.3

4.6 0.5 0.9 0.4 0.3 0.2 0.4 0.5 0.9 1.8

3.5 0.9 0.9 0.4 0.2 0.1 0.1 0.3 0.5 1.1

4.0 0.7 1.1 0.3 0.1 0.1 0.2 0.2 0.7 1.3

3.8 0.8 1.0 0.3 0.1 0.1 0.2 0.2 0.6 1.2

Depression Depressive episode Other depressive episode

0.2 0.2 -

0.3 0.2 0.1

0.2 0.2 0.1

1.7 1.2 0.5

1.9 1.4 0.5

1.8 1.3 0.5

0.9 0.6 0.2

1.0 0.7 0.3

0.9 0.7 0.2

Conduct disorders Oppositional defiant disorder Conduct disorder (family context) Unsocialised conduct disorder Socialised conduct disorder Other conduct disorder

6.5 4.8 0.5 0.6 0.6

2.7 2.1 0.1 0.2 0.0 0.3

4.6 3.5 0.0 0.4 0.3 0.4

8.6 2.8 0.1 1.0 2.8 2.0

3.8 1.3 0.4 0.3 1.1 0.7

6.2 2.1 0.2 0.6 1.9 1.4

7.4 3.9 0.0 0.7 1.5 1.2

3.2 1.8 0.2 0.2 0.5 0.5

5.3 2.9 0.1 0.5 1.0 0.9

Hyperkinetic disorders Hyperkinesis Other hyperkinetic disorder

2.6 2.3 0.3

0.4 0.4 0.0

1.5 1.3 0.2

2.3 1.9 0.4

0.5 0.4 0.0

1.4 1.2 0.2

2.4 2.1 0.3

0.4 0.4 0.0

1.4 1.3 0.2

Less common disorders Pervasive developmental disorder Psychotic disorder Tic disorders Eating disorders

0.8 0.6 0.1 -

0.2 0.2 -

0.5 0.4 0.1 -

0.5 0.3 0.1 0.1

0.7 0.0 0.1 0.4

0.6 0.2 0.1 0.3

0.7 0.5 0.1 0.0

0.4 0.1 0.0 0.2

0.5 0.3 0.1 0.1

Any disorder

10.4

5.9

8.2

12.8

9.6

11.2

11.4

7.6

9.5

Base

2909

2921

5830

2310

2299

4609

5219

5219

10438

Figure 4.1

Prevalence of any mental disorder by age and sex

18 16

Percentage

14 12

Boys Girls All

10 8 6 4 2 0 5-10 years

11-15 years Age

All

Mental health of children and adolescents in Great Britain

33

4

Prevalence of mental disorders

Table 4.2

Prevalence of mental disorders

by ethnicity, age and sex All children Ethnic group White

Black

Indian

Pakistani & Bangladeshi

Other groups

All

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

3.2 6.6 2.8 0.8 10.4

1.7 6.9 1.6 10.0

5.3 3.6 7.3

2.6 6.1 5.7

7.1 4.7 1.6 2.8 13.6

3.3 6.5 2.6 0.8 10.4

Base

2667

70

61

39

72

2909

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

4.9 8.6 2.5 0.6 12.6

4.9 17.8 1.5 22.1

5.5 2.3 5.8

12.4 4.6 15.3

6.3 7.2 13.5

5.1 8.6 2.3 0.5 12.8

Base

2077

70

60

51

51

2309

All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

4.0 7.5 2.6 0.7 11.4

3.3 12.3 0.7 0.8 16.0

5.4 3.0 6.6

8.2 5.2 11.2

6.8 5.7 0.9 1.7 13.6

4.1 7.4 2.4 0.7 11.4

Base

4745

140

121

89

123

5217

3.3 2.8 0.5 0.2 5.9

4.2 3.1 7.4

1.9 1.8

1.7 1.9 3.6

5.0 2.6 7.8

3.2 2.7 0.4 0.2 5.9

Base

2638

73

60

61

86

2917

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

6.4 3.9 0.5 0.7 10.1

2.0 6.3 8.1

-

5.3 5.6

4.1 2.1 6.4

6.1 3.8 0.5 0.7 9.7

Base

2091

59

43

45

57

2295

4.7 3.3 0.5 0.5 7.8

3.2 4.6 7.7

1.1 1.0

3.2 1.1 4.4

4.6 2.4 7.2

4.5 3.2 0.4 0.4 7.6

4729

132

103

106

143

5213

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

All Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

34

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.2

4

(continued) Prevalence of mental disorders

by ethnicity, age and sex All children Ethnic group White

Black

Indian

Pakistani & Bangladeshi

Other groups

All

Percentage of children with each disorder

All 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.2

3.2 4.7 1.6 0.5 8.2

2.9 5.0 0.8 8.6

2.7 2.8 4.6

2.0 3.5 4.4

6.0 3.6 0.7 1.3 10.5

3.3 4.6 1.5 0.5 8.1

5305

143

121

99

158

5826

5.7 6.3 1.5 0.7 11.3

3.6 12.6 0.8 15.7

3.2 1.3 3.4

9.0 2.4 10.7

5.2 4.5 9.7

5.6 6.2 1.4 0.6 11.2

4168

129

103

96

107

4604

4.3 5.4 1.6 0.6 9.6

3.3 8.6 0.4 0.4 12.0

2.9 2.1 4.0

5.5 3.0 7.5

5.6 3.9 0.4 0.8 10.2

4.3 5.3 1.4 0.5 9.5

9474

271

224

196

265

10430

Prevalence of any mental disorder by ethnicity

Percentage of children with a mental disorder

14 12 10 8 6 4 2 0 White

Black

Indian

Pakistani & Bangladeshi

Other groups

All

Ethnic group

Mental health of children and adolescents in Great Britain

35

4

Prevalence of mental disorders

Table 4.3

Prevalence of mental disorders

by family type, age and sex All children Child’s family type Married

Cohabiting

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

36

Lone parent single

Lone parent widow, divorced, separated

All lone parents

All

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

All couples

2.2 4.3 2.0 0.9 7.7

5.4 8.6 1.3 11.6

2.5 4.8 1.9 0.8 8.1

6.2 12.4 6.5 1.3 18.7

6.2 13.0 4.0 0.8 18.9

6.2 12.8 4.9 1.0 18.8

3.3 6.5 2.6 0.8 10.4

2046

242

2287

233

388

621

2909

4.4 5.7 1.9 0.5 9.8

3.9 17.0 3.9 2.2 18.4

4.4 6.6 2.0 0.6 10.5

4.3 17.6 1.0 20.1

8.2 14.5 3.6 0.3 20.2

7.5 15.1 3.1 0.2 20.2

5.1 8.6 2.3 0.5 12.8

1626

138

1764

103

444

546

2310

3.2 4.9 1.9 0.7 8.6

4.8 11.7 2.2 0.8 14.1

3.3 5.6 2.0 0.7 9.1

5.6 14.0 4.8 0.9 19.1

7.3 13.8 3.8 0.5 19.6

6.8 13.8 4.1 0.6 19.5

4.1 7.4 2.4 0.7 11.4

3672

379

4051

336

832

1168

5219

3.0 1.8 0.2 0.2 4.9

2.6 3.3 0.4 0.4 6.2

3.0 2.0 0.2 0.2 5.0

4.6 8.3 2.4 12.4

4.2 3.4 0.3 0.3 6.8

4.4 5.4 1.2 0.2 9.1

3.3 2.7 0.4 0.2 5.9

2002

269

2271

264

387

650

2921

4.8 2.7 0.6 0.5 7.3

6.4 6.0 0.7 12.5

4.9 3.0 0.6 0.4 7.8

4.8 7.8 11.6

11.3 5.9 1.9 16.7

9.9 6.3 1.5 15.6

6.1 3.8 0.5 0.7 9.6

1591

158

1749

118

432

550

2299

3.8 2.2 0.4 0.3 6.0

4.0 4.3 0.5 0.2 8.5

3.8 2.4 0.4 0.3 6.2

4.7 8.1 1.7 12.2

7.9 4.7 0.1 1.1 12.0

6.9 5.8 0.6 0.8 12.1

4.5 3.2 0.4 0.4 7.6

3593

427

4019

382

818

1200

5219

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.3

4

(continued) Prevalence of mental disorders

by family type, age and sex All children Child’s family type Married

Cohabiting

All couples

Lone parent single

Lone parent widow, divorced, separated

All lone parents

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.3

2.6 3.1 1.1 0.5 6.3

3.9 5.8 0.8 0.2 8.8

2.7 3.4 1.1 0.5 6.6

5.4 10.2 4.4 0.6 15.4

5.2 8.2 2.1 0.5 12.9

5.3 9.0 3.0 0.6 13.8

3.3 4.6 1.5 0.5 8.2

4047

510

4558

497

775

1272

5829

4.6 4.2 1.2 0.5 8.6

5.3 11.1 2.2 1.0 15.3

4.6 4.8 1.3 0.5 9.1

4.6 12.3 0.5 15.5

9.7 10.3 1.8 1.1 18.5

8.7 10.7 1.6 0.8 17.9

5.6 6.2 1.4 0.6 11.2

3217

295

3513

221

875

1096

4609

3.5 3.6 1.2 0.5 7.3

4.4 7.8 1.3 0.5 11.2

3.6 4.0 1.2 0.5 7.7

5.1 10.9 3.2 0.4 15.4

7.6 9.3 2.0 0.8 15.8

6.8 9.8 2.3 0.7 15.7

4.3 5.3 1.4 0.5 9.5

7264

806

8070

718

1650

2368

10438

Prevalence of any mental disorder by age, sex and family type

Percentage of children with a mental disorder

18 16 14 12 10 8 6 4 2 0 Married

Cohabiting

All couples

Lone parent - Lone parent single w/d/s

All lone parents

All

Child’s family type

Mental health of children and adolescents in Great Britain

37

4

Prevalence of mental disorders

Table 4.4

Prevalence of mental disorders

by family structure, age and sex All Children Reconstituted family No

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

38

All

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Yes

3.2 6.1 2.3 0.8 9.9

4.4 11.4 5.7 1.3 16.3

3.3 6.5 2.6 0.8 10.4

2679

230

2909

4.7 7.9 2.3 0.5 12.0

9.0 14.7 1.9 0.5 19.3

5.1 8.6 2.3 0.5 12.8

2083

227

2310

3.9 6.9 2.3 0.7 10.8

6.7 13.0 3.8 0.9 17.8

4.1 7.4 2.4 0.7 11.4

4762

456

5219

3.2 2.3 0.3 0.2 5.4

3.6 6.9 1.8 0.4 11.3

3.3 2.7 0.4 0.2 5.9

2672

249

2921

6.1 3.1 0.4 0.7 9.2

6.1 9.6 1.0 0.8 13.9

6.1 3.8 0.5 0.7 9.6

2059

240

2299

4.5 2.7 0.3 0.4 7.1

4.8 8.2 1.4 0.6 12.6

4.5 3.2 0.4 0.4 7.6

4730

489

5219

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.4

4

(continued) Prevalence of mental disorders

by family structure, age and sex All Children Reconstituted family No

Yes

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.4

3.2 4.2 1.3 0.5 7.7

4.0 9.0 3.7 0.8 13.7

3.3 4.6 1.5 0.5 8.2

5351

479

5829

5.4 5.5 1.4 0.6 10.6

7.5 12.1 1.4 0.7 16.5

5.6 6.2 1.4 0.6 11.2

4142

467

4609

4.2 4.8 1.3 0.5 8.9

5.7 10.5 2.6 0.7 15.1

4.3 5.3 1.4 0.5 9.5

9493

946

10438

Prevalence of any mental disorder by family structure

16 14

Percentage

12 10 8 6 4 2 0 No

Yes

All

Mental health of children and adolescents in Great Britain

39

4

Prevalence of mental disorders

Table 4.5

Prevalence of mental disorders

by number of children in household, age and sex All children Number of children in household 1

2

5 or more

All

4.0 7.4 4.5 0.9 13.2

2.6 5.0 2.1 0.8 8.4

2.9 6.3 2.6 0.7 9.3

4.7 9.3 2.1 1.5 14.2

10.2 18.3 1.3 24.5

3.3 6.5 2.6 0.8 10.4

448

1385

726

258

92

2909

4.3 8.0 2.1 0.6 11.5

4.7 7.9 2.7 0.5 12.4

5.3 6.8 1.8 0.5 11.2

12.0 18.2 2.5 23.8

3.8 19.5 2.0 20.5

5.1 8.6 2.3 0.5 12.8

657

993

470

133

58

2310

4.2 7.7 3.1 0.7 12.2

3.5 6.2 2.3 0.7 10.1

3.8 6.5 2.3 0.6 10.1

7.2 12.3 2.2 1.0 17.4

7.7 18.7 1.6 22.9

4.1 7.4 2.4 0.7 11.4

1104

2378

1196

390

151

5219

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

3.5 2.5 0.5 0.5 6.6

2.8 2.2 0.4 0.1 4.8

3.7 2.6 0.4 0.3 6.3

3.2 5.0 7.5

5.9 6.3 2.8 12.4

3.3 2.7 0.4 0.2 5.9

Base

435

1383

741

277

85

2921

6.0 2.6 0.2 0.6 9.5

5.4 3.8 0.6 0.6 8.8

7.8 4.7 0.5 0.9 11.1

4.9 4.8 0.7 0.7 9.9

7.7 7.5 1.7 13.5

6.1 3.8 0.5 0.7 9.6

653

958

463

160

64

2299

5.0 2.5 0.3 0.5 8.3

3.9 2.8 0.5 0.3 6.5

5.3 3.4 0.4 0.5 8.1

3.8 4.9 0.3 0.3 8.4

6.7 6.8 1.6 0.7 12.9

4.5 3.2 0.4 0.4 7.6

1088

2341

1204

437

149

5219

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

40

4

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

3

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.5

4

(continued) Prevalence of mental disorders

by number of children in household, age and sex All children Number of children in household 1

2

3

4

5 or more

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.5

3.8 5.0 2.5 0.7 10.0

2.7 3.6 1.2 0.5 6.6

3.3 4.5 1.5 0.5 7.8

3.9 7.1 1.0 0.7 10.7

8.1 12.5 2.0 18.7

3.3 4.6 1.5 0.5 8.2

883

2768

1467

535

177

5829

5.2 5.3 1.1 0.6 10.5

5.1 5.9 1.7 0.5 10.6

6.5 5.8 1.2 0.7 11.2

8.1 10.8 1.5 0.4 16.2

5.9 13.2 1.0 0.9 16.8

5.6 6.2 1.4 0.6 11.2

1310

1951

933

293

123

4609

4.6 5.2 1.7 0.6 10.3

3.7 4.5 1.4 0.5 8.3

4.6 5.0 1.4 0.6 9.1

5.4 8.4 1.2 0.6 12.7

7.2 12.8 1.6 0.4 17.9

4.3 5.3 1.4 0.5 9.5

2192

4719

2400

828

300

10438

Prevalence of any mental disorder by number of children in household

Percentage of children with a mental disorder

20 18 16 14 12 10 8 6 4 2 0 1

2

3

4 Number of children

5 or more

All

Mental health of children and adolescents in Great Britain

41

4

Prevalence of mental disorders

Table 4.6

Prevalence of mental disorders

by educational qualifications of parent, age and sex All children Education level (interviewed parent) Degree level

Teaching/ HND/ Nursing level

A-level (or equivalent)

Other qualification

No qualification

All

2.0 2.8 1.9 0.8 6.9

1.7 2.9 1.5 0.3 5.6

2.6 4.6 2.1 1.6 7.7

2.8 5.0 1.5 0.3 8.1

4.0 8.4 3.5 1.3 13.3

2.6 3.1 14.1 13.7

5.9 13.1 4.2 1.2 18.2

3.3 6.5 2.6 0.8 10.5

372

304

316

887

370

38

598

2884

2.2 2.2 1.0 0.8 5.8

3.7 4.8 0.5 0.4 8.0

5.8 6.6 2.5 0.9 12.5

4.6 7.4 2.1 0.5 11.6

3.6 5.9 3.2 10.0

2.6 18.4 2.9 1.2 17.4

8.0 14.7 3.5 0.4 19.4

5.1 8.6 2.3 0.5 12.8

243

252

227

624

244

80

603

2273

2.0 2.6 1.5 0.8 6.5

2.6 3.7 1.0 0.4 6.7

3.9 5.4 2.2 1.3 9.7

3.6 6.0 1.7 0.4 9.6

3.9 7.4 3.4 0.8 12.0

2.6 13.5 6.5 0.8 16.2

7.0 13.9 3.9 0.8 18.8

4.1 7.5 2.5 0.7 11.5

Base

615

556

543

1511

614

118

1201

5157

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

1.7 1.6 0.6 3.9

3.3 1.4 0.3 4.4

2.2 1.9 0.3 4.5

2.7 1.9 0.1 0.2 4.5

5.1 3.5 0.9 7.5

2.6 2.8 1.4 5.3

4.8 5.4 1.1 0.2 10.3

3.3 2.8 0.4 0.2 6.0

Base

351

300

322

886

348

76

597

2881

4.4 3.2 0.4 0.9 7.3

4.3 3.0 1.0 0.9 8.5

3.9 4.2 0.6 7.0

5.3 2.7 0.4 0.8 8.0

6.4 4.2 0.5 10.3

6.7 1.2 2.1 10.5

8.7 5.9 0.4 0.7 13.4

6.1 3.9 0.5 0.7 9.7

255

232

193

639

252

94

592

2256

2.8 2.3 0.2 0.7 5.3

3.7 2.1 0.4 0.6 6.2

2.9 2.8 0.4 5.4

3.8 2.3 0.2 0.4 6.0

5.7 3.8 0.7 8.7

4.8 1.9 0.6 1.2 8.2

6.8 5.6 0.7 0.4 11.9

4.5 3.3 0.5 0.4 7.6

606

532

515

1525

600

170

1189

5137

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

42

GCSE grades D-F or equivalent

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

GCSE grades A-C or equivalent

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.6

4

(continued) Prevalence of mental disorders

by educational qualifications of parent, age and sex All children Education level (interviewed parent) Degree level

Teaching/ HND/ Nursing level

A-level (or equivalent)

GCSE grades A-C or equivalent

GCSE grades D-F or equivalent

Other qualification

No qualification

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

1.8 2.2 1.0 0.7 5.4

2.5 2.1 0.7 0.3 5.0

2.4 3.2 1.2 0.8 6.1

2.7 3.4 0.8 0.3 6.3

4.6 6.0 2.2 0.7 10.5

2.6 2.9 5.6 0.7 8.1

5.4 9.3 2.7 0.5 14.2

3.3 4.6 1.5

Base

723

603

638

1774

718

114

1196

5766

3.3 2.7 0.7 0.9 6.6

4.0 3.9 0.7 0.7 8.2

5.0 5.5 1.6 0.5 9.9

5.0 5.0 1.2 0.7 9.8

5.0 5.0 1.8 1.7 10.2

4.8 9.1 1.3 0.5 13.7

8.4 10.3 1.9 0.6 16.4

5.6 6.3 1.4 11.2

498

484

420

1263

496

174

1195

4529

2.4 2.4 0.9 0.8 5.9

3.2 2.9 0.7 0.5 6.5

3.4 4.1 1.4 0.7 7.6

3.7 4.1 1.0 0.4 7.8

4.7 5.6 2.1 0.4 10.4

3.9 6.7 3.0 1.0 11.5

6.9 9.8 2.3 0.6 15.3

4.3 5.4 1.5 0.6 9.6

1221

1087

1058

3036

1214

288

2390

10294

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.6

8.2

Prevalence of any mental disorder by education qualifications of parent

Percentage of children with a mental disorder

18 16 14 12 10 8 6 4 2 0 Degree level

Teaching/ A-level (or HND/Nursing equivalent) level

GCSE grades GCSE Other A-C or grades D-F or qualification equivalent equivalent

No qualification

All

Education level

Mental health of children and adolescents in Great Britain

43

4

Prevalence of mental disorders

Table 4.7

Prevalence of mental disorders

by family’s employment, age and sex All children Family’s employment Both parents working (inc. lone parents)

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

44

Neither parents working (inc. lone parents)

All

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

One parent working

2.4 5.2 2.0 0.5 8.2

3.3 5.0 2.5 1.3 9.7

7.3 14.7 5.4 1.7 21.4

3.3 6.5 2.6 0.8 10.4

1834

644

414

2892

3.8 6.5 1.9 0.4 10.2

6.5 8.5 2.4 1.2 13.0

10.3 20.0 4.4 0.4 26.5

5.1 8.6 2.3 0.5 12.8

1612

360

303

2275

3.1 5.8 1.9 0.4 9.1

4.4 6.2 2.5 1.2 10.9

8.6 16.9 5.0 1.1 23.5

4.1 7.4 2.5 0.7 11.5

3446

1004

717

5166

2.4 2.1 0.3 0.3 4.5

3.9 1.7 0.2 5.4

6.4 7.3 1.6 0.2 13.7

3.3 2.8 0.4 0.2 6.0

1859

619

407

2884

5.2 2.9 0.3 0.5 8.0

5.9 4.2 1.7 1.2 10.4

11.3 8.7 1.4 18.4

6.0 3.9 0.5 0.7 9.6

1634

339

288

2261

3.7 2.5 0.3 0.3 6.1

4.6 2.6 0.7 0.4 7.2

8.4 7.9 1.0 0.7 15.7

4.5 3.2 0.5 0.4 7.6

3493

958

695

5146

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.7

4

(continued) Prevalence of mental disorders

by family’s employment, age and sex All children Family’s employment Both parents working (inc. lone parents)

One parent working

Neither parents working (inc. lone parents)

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.7

2.4 3.7 1.1 0.4 6.4

3.6 3.4 1.4 0.6 7.6

6.9 11.0 3.5 1.0 17.6

3.3 4.6 1.5 0.5 8.2

3693

1262

821

5776

4.5 4.7 1.1 0.4 9.1

6.2 6.4 2.1 1.2 11.7

10.8 14.5 2.3 0.9 22.5

5.6 6.3 1.4 0.6 11.2

3249

699

591

4536

3.4 4.1 1.1 0.4 7.6

4.5 4.5 1.6 0.9 9.1

8.5 12.5 3.0 0.9 19.7

4.3 5.3 1.5 0.6 9.5

6939

1961

1411

10312

Prevalence of any mental disorder by family’s employment

Percentage of children with a mental disorder

25

20

15

10

5

0 Both parents working (inc. lone parents)

One parent working

Neither parents working

All

Family's employment

Mental health of children and adolescents in Great Britain

45

4

Prevalence of mental disorders

Table 4.8

Prevalence of mental disorders

by gross weekly household income, age and sex All children (where income data available) Gross weekly household income Under £100

£100 £199

£200 £299

£500 £599

£600 £770

Over £770

All

5.8 14.3 5.6 0.6 21.1

5.5 12.7 4.5 0.6 16.9

2.9 7.6 2.6 1.7 11.9

3.4 5.0 1.9 0.6 9.0

2.5 5.8 2.4 1.5 8.2

0.7 3.7 2.6 0.3 5.3

2.2 2.1 1.7 1.2 6.9

3.1 3.0 0.6 0.2 6.6

3.3 6.7 2.6 0.8 10.6

173

496

416

354

269

278

320

436

2741

7.7 17.0 2.0 22.2

9.5 16.2 4.2 0.9 22.6

7.2 11.7 3.1 0.5 16.7

5.0 7.4 1.6 0.4 11.9

1.9 6.1 1.4 7.2

2.7 3.7 1.0 6.8

2.2 5.1 2.1 0.4 7.7

2.8 3.7 2.2 1.2 7.6

5.0 8.7 2.4 0.5 12.7

107

377

328

261

221

220

278

358

2150

6.5 15.3 4.2 0.4 21.5

7.2 14.2 4.4 0.7 19.4

4.8 9.4 2.8 1.2 14.0

4.1 6.1 1.8 0.5 10.3

2.2 5.9 2.0 0.8 7.8

1.6 3.7 1.9 0.2 6.0

2.2 3.5 1.9 0.8 7.3

3.0 3.3 1.3 0.7 7.1

4.0 7.5 2.5 0.7 11.5

Base

280

872

744

616

490

498

598

794

4891

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

4.5 3.1 7.1

4.0 6.2 1.6 0.4 10.1

5.1 3.5 0.3 8.2

2.1 4.8 0.7 0.3 6.8

4.1 1.8 5.7

1.8 0.4 0.4 2.7

2.3 1.0 0.3 3.1

2.1 0.5 0.4 3.1

3.2 2.8 0.5 0.2 6.0

Base

177

521

362

319

308

266

325

456

2735

8.7 3.6 3.1 14.8

11.0 7.4 1.4 16.9

7.7 4.9 0.3 11.9

6.2 3.2 1.4 9.2

2.5 2.6 0.5 0.5 5.1

4.6 2.9 0.5 0.9 8.1

3.2 0.9 0.5 4.3

3.3 2.0 0.3 0.5 5.6

6.0 3.6 0.4 0.7 9.5

97

376

342

259

219

239

262

355

2150

6.0 3.3 1.1 9.8

6.9 6.7 1.0 0.8 12.9

6.4 4.2 0.3 10.0

4.0 4.1 1.0 0.1 7.9

3.4 2.1 0.2 0.2 5.4

3.1 1.6 0.5 0.4 5.3

2.7 0.9 0.4 3.6

2.6 1.2 0.1 0.5 4.2

4.5 3.2 0.4 0.4 7.6

275

898

704

578

527

505

587

811

4885

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

46

£400 £499

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

£300 £399

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.8

4

(continued) Prevalence of mental disorders

by gross weekly household income, age and sex All children (where income data available) Gross weekly household income Under £100

£100 £199

£200 £299

£300 £399

£400 £499

£500 £599

£600 £770

Over £770

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.8

5.1 8.6 2.8 0.3 14.0

4.7 9.3 3.0 0.5 13.4

3.9 5.7 1.6 0.9 10.2

2.8 4.9 1.3 0.4 8.0

3.4 3.6 1.1 0.7 6.9

1.2 2.1 1.5 0.2 4.0

2.3 1.5 0.8 0.7 5.0

2.6 1.7 0.3 0.3 4.8

3.3 4.7 1.5 0.5 8.3

350

1017

778

674

576

543

646

891

5476

8.2 10.6 1.0 1.5 18.7

10.3 11.8 2.1 1.1 19.8

7.4 8.2 1.7 0.3 14.2

5.6 5.3 1.5 0.2 10.6

2.2 4.4 1.0 0.2 6.2

3.7 3.3 0.7 0.5 7.5

2.7 3.1 1.1 0.4 6.0

3.0 2.8 1.2 0.9 6.6

5.5 6.2 1.4 0.6 11.1

204

753

669

520

441

459

540

714

4300

6.3 9.4 2.1 0.7 15.7

7.1 10.4 2.6 0.8 16.1

5.6 6.9 1.6 0.6 12.0

4.0 5.1 1.4 0.3 9.1

2.9 3.9 1.1 0.5 6.6

2.4 2.6 1.2 0.3 5.6

2.5 2.2 0.9 0.6 5.4

2.8 2.2 0.7 0.6 5.6

4.2 5.4 1.5 0.6 9.5

555

1770

1447

1194

1017

1003

1186

1605

9776

Prevalence of any mental disorder by gross weekly household income

Percentage of children with a mental disorder

18 16 14 12 10 8 6 4 2 0 Under £100

£100£199

£200 £299

£300 £399

£400 £499

£500 £599

£600 £770

Over £770

All

Gross weekly household income

Mental health of children and adolescents in Great Britain

47

4

Prevalence of mental disorders

Table 4.9

Prevalence of mental disorders

by receipt of disability benefits, age and sex Receipt of disability benefits Invalid care allowance

Attendance allowance

Incapacity allowance

All

5.6 15.3 4.9 13.3 31.5

[1] [2] [2] [4]

11.6 16.0 6.5 9.6 31.3

[3] [1] [1] [4]

5.9 8.3 5.1 14.4

7.5 13.1 6.4 6.7 24.5

68

12

103

28

64

210

13.9 17.9 3.1 5.0 33.2

4.8 16.6 5.6 2.3 18.1

12.4 17.1 5.9 3.0 26.4

[2] [2] [3]

9.0 18.0 5.1 22.1

10.6 16.0 3.6 2.4 24.3

72

36

73

14

42

187

9.9 16.6 4.0 9.0 32.4

3.6 15.4 9.0 6.0 22.8

11.9 16.4 6.3 6.8 29.3

13.8 8.9 2.3 18.6

7.1 12.1 5.1 17.5

8.9 14.5 5.1 4.6 24.4

Base

140

48

176

42

107

397

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

17.1 11.8 3.4 1.6 30.9

[5] [2] [7]

9.6 5.6 1.2 15.4

[3] [3]

7.4 7.9

11.0 5.0 1.1 0.5 17.0

64

18

93

19

52

189

12.8 17.4 27.2

[2] [0] [2]

10.4 9.2 1.5 18.3

[1] [1] [1]

11.6 2.0 1.9 14.1

11.5 8.0 1.4 18.4

40

21

76

11

59

164

15.4 13.9 2.1 1.0 29.5

18.1 6.6 25.5

9.9 7.2 1.3 16.7

9.9 4.0 3.9 14.3

9.6 1.1 1.0 11.2

11.2 6.4 1.3 0.3 17.6

103

39

169

30

111

352

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder Base

48

Severe disablement allowance

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Disability allowance

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.9

4

(continued) Prevalence of mental disorders

by receipt of disability benefits, age and sex Receipt of disability benefits Invalid care allowance

Attendance allowance

Disability allowance

Severe disablement allowance

Incapacity allowance

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11.1 13.6 4.2 7.6 31.2

16.6 11.9 7.6 6.7 38.9

10.6 11.0 4.0 5.0 23.8

6.3 7.9 3.0 2.1 16.5

6.6 4.6 2.8 11.5

9.2 9.3 3.9 3.8 20.9

132

30

197

47

116

399

13.5 17.7 2.0 3.2 31.1

6.6 11.2 3.5 1.5 15.9

11.4 13.1 3.7 1.5 22.3

[3] [3] [4]

10.5 8.7 3.3 17.5

11.0 12.3 2.6 1.3 21.5

112

56

148

25

102

350

All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

12.2 15.5 3.2 5.6 31.2

10.1 11.4 5.0 3.3 24.0

11.0 11.9 3.8 3.5 23.1

4.1 9.7 6.8 1.4 16.8

8.4 6.5 3.0 14.3

10.0 10.7 3.3 2.6 21.2

Base

244

87

345

72

218

750

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.9

Prevalence of any mental disorder by receipt of disability benefits

Percentage of children with a mental disorder

35 30 25 20 15 10 5 0 Invalid care allowance

Attendance allowance

Disability allowance

Severe disablement allowance

Incapacity allowance

All

Benefit

Mental health of children and adolescents in Great Britain

49

4

Prevalence of mental disorders

Table 4.10

Prevalence of mental disorders

by social class, age and sex Family’s social class I Professional

II Managerial and technical occupations

IIIN Skilled occupations non-manual

IV Partly-skilled occupations

V Unskilled occupations

Never worked

All*

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

IIIM Skilled occupations manual

2.7 2.4 0.9 1.4 6.7

2.3 3.4 1.5 0.8 7.0

4.8 6.2 4.2 1.5 13.7

2.8 7.4 2.9 0.5 10.4

4.5 9.3 3.2 0.4 12.6

3.9 15.4 1.7 1.4 17.7

9.5 17.0 8.4 1.9 27.7

3.3 6.5 2.6 0.8 10.4

222

873

340

734

458

131

55

2909

1.2 5.7 2.7 2.4 8.1

3.6 5.9 1.1 0.7 9.1

6.7 10.1 2.6 14.9

5.9 7.1 2.1 0.2 12.5

7.1 14.2 5.4 0.1 18.8

6.2 14.3 1.8 17.3

9.5 34.8 33.0

5.1 8.6 2.3 0.5 12.8

166

750

262

572

329

122

23

2310

2.1 3.8 1.7 1.8 7.3

2.9 4.6 1.3 0.8 8.0

5.6 7.9 3.5 0.8 14.2

4.1 7.3 2.5 0.4 11.3

5.6 11.3 4.1 0.3 15.2

5.0 14.9 1.7 0.7 17.5

9.5 22.3 5.9 1.3 29.3

4.1 7.4 2.4 0.7 11.4

Base

387

1623

603

1306

786

252

79

5219

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

1.5 1.0 2.6

2.6 1.7 0.1 0.4 4.2

4.4 3.2 0.6 8.1

3.5 2.1 0.5 0.1 5.8

3.4 4.2 1.0 7.5

5.0 5.0 0.8 0.7 9.2

6.0 9.1 1.1 12.3

3.3 2.7 0.4 0.2 5.9

Base

207

853

339

740

437

138

85

2921

1.7 1.4 1.2 3.7

5.4 2.8 0.8 0.5 8.0

5.5 5.7 0.4 0.4 10.1

6.8 3.5 0.4 0.2 9.7

8.0 4.0 1.6 12.3

8.4 5.9 1.0 0.8 14.4

11.6 15.8 2.8 24.0

6.1 3.8 0.5 0.7 9.7

183

722

283

540

325

121

37

2299

1.6 1.2 0.5 3.1

3.9 2.2 0.4 0.5 6.0

4.9 4.4 0.5 0.2 9.0

4.9 2.7 0.4 0.1 7.5

5.4 4.1 0.6 0.7 9.5

6.6 5.4 0.9 0.8 11.6

7.7 11.1 0.8 0.9 15.9

4.5 3.2 0.4 0.4 7.6

390

1575

622

1280

762

259

122

5219

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

* No answers, members of the Armed Forces, full-time students are excluded from the six social class categories but included in the ‘All’ category.

50

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.10

4

(continued) Prevalence of mental disorders

by social class, age and sex Family’s social class I Professional

II Managerial and technical occupations

IIIN Skilled occupations non-manual

IIIM Skilled occupations manual

IV Partly-skilled occupations

V Unskilled occupations

Never worked

All*

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

2.1 1.8 0.5 0.7 4.7

2.5 2.6 0.8 0.6 5.6

4.6 4.7 2.4 0.7 10.9

3.1 4.8 1.7 0.3 8.1

3.9 6.8 2.1 0.2 10.1

4.5 10.0 1.2 1.1 13.3

7.4 12.2 4.0 0.7 18.4

3.3 4.6 1.5 0.5 8.2

429

1727

679

1474

894

268

141

5829

1.5 3.4 1.3 1.8 5.8

4.5 4.4 1.0 0.6 8.6

6.1 7.8 1.5 0.2 12.4

6.3 5.3 1.3 0.2 11.1

7.6 9.1 2.7 0.8 15.5

7.3 10.1 1.4 0.4 15.8

10.7 23.1 1.7 27.5

5.6 6.2 1.4 0.6 11.2

Base

348

1472

545

1112

654

243

60

4609

All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

1.8 2.5 0.8 1.2 5.2

3.4 3.4 0.9 0.6 7.0

5.3 6.1 2.0 0.5 11.6

4.5 5.0 1.5 0.3 9.4

5.5 7.8 2.4 0.5 12.4

5.8 10.1 1.3 0.8 14.5

8.4 15.5 2.8 1.0 21.1

4.3 5.3 1.4 0.5 9.5

Base

777

3199

1225

2586

1548

511

201

10438

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Figure 4.10 Prevalence of any mental disorder by social class Percentage of children with a mental disorder

25

20

15

10

5

0 I

II

IIIN

IIIM

IV

V

Never worked

All

Family’s social class

Mental health of children and adolescents in Great Britain

51

4

Prevalence of mental disorders

Table 4.11

Prevalence of mental disorders

by tenure, age and sex All children Tenure Owners

5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

5.8 14.3 4.0 0.9 18.6

4.6 6.9 4.5 1.0 13.0

3.3 6.5 2.6 0.8 10.4

1927

783

198

2908

3.6 5.1 1.5 0.5 8.5

9.2 16.5 4.1 0.5 23.1

5.0 15.5 3.5 1.2 17.2

5.1 8.6 2.3 0.5 12.8

1590

596

122

2308

2.8 4.1 1.7 0.6 7.6

7.3 15.3 4.0 0.7 20.6

4.7 10.2 4.1 1.1 14.6

4.1 7.4 2.4 0.7 11.4

3517

1379

320

5216

2.4 1.4 0.1 0.2 3.9

4.8 5.8 1.2 0.3 9.9

6.2 4.0 1.2 10.4

3.3 2.7 0.4 0.2 5.9

1957

771

193

2921

4.5 2.1 0.3 0.6 6.5

9.9 8.5 0.8 0.7 17.4

8.3 5.1 0.9 1.5 13.7

6.1 3.8 0.5 0.7 9.6

1596

564

135

2295

3.3 1.7 0.2 0.4 5.1

7.0 6.9 1.0 0.5 13.1

7.1 4.5 1.1 0.6 11.7

4.5 3.2 0.4 0.4 7.5

3554

1335

327

5216

All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

52

All

2.2 3.3 1.8 0.8 6.8

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Private renters

Percentage of children with each disorder

BOYS

Base

Social sector tenants

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.11

4

(continued) Prevalence of mental disorders

by tenure, age and sex All children Tenure Owners

Social sector tenants

Private renters

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

2.3 2.3 0.9 0.5 5.3

5.3 10.1 2.6 0.6 14.3

5.4 5.5 2.9 0.5 11.7

3.3 4.6 1.5 0.5 8.2

3884

1554

390

5828

4.0 3.6 0.9 0.5 7.5

9.6 12.6 2.5 0.6 20.3

6.7 10.0 2.1 1.3 15.3

5.6 6.2 1.4 0.6 11.2

3186

1160

257

4603

3.1 2.9 0.9 0.5 6.3

7.1 11.2 2.6 0.6 16.9

5.9 7.3 2.6 0.9 13.2

4.3 5.3 1.4 0.5 9.5

7071

2713

648

10432

Figure 4.11 Prevalence of any mental disorder by tenure Percentage of children with a mental disorder

18 16 14 12 10 8 6 4 2 0 Owners

Social sector tenants

Private renters

All

Tenure

Mental health of children and adolescents in Great Britain

53

4

Prevalence of mental disorders

Table 4.12

Prevalence of mental disorders

by type of accommodation type, age and sex All children Accommodation type Detached

Semi-detached

Other

All

2.6 2.6 1.1 0.8 6.3

2.9 6.1 2.4 0.8 9.9

3.8 9.6 3.5 0.8 13.3

6.2 7.0 4.4 1.1 14.2

-

3.3 6.5 2.6 0.8 10.4

688

1083

946

187

4

2909

2.6 3.8 1.9 0.8 7.3

4.4 8.5 2.1 0.6 11.7

8.0 12.6 2.9 0.3 18.3

7.2 10.9 2.5 16.8

-

5.1 8.6 2.3 0.5 12.8

581

931

657

135

6

2310

2.6 3.1 1.5 0.8 6.7

3.6 7.2 2.2 0.7 10.7

5.5 10.8 3.3 0.6 15.3

6.7 8.6 3.6 0.6 15.3

-

4.1 7.4 2.4 0.7 11.4

1269

2014

1603

322

10

5219

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

2.0 1.4 0.2 0.3 3.6

3.3 2.7 0.3 0.1 5.9

3.3 3.7 0.8 0.3 6.8

7.0 3.1 0.5 9.9

-

3.3 2.7 0.4 0.2 5.9

Base

692

1089

915

218

8

2921

4.5 1.2 0.6 0.2 6.3

5.2 5.1 0.5 0.7 9.8

8.3 4.6 0.3 1.2 12.3

7.4 3.4 10.2

[1] [1]

6.1 3.8 0.5 0.7 9.6

597

873

685

136

8

2299

3.2 1.3 0.4 0.2 4.8

4.1 3.7 0.4 0.4 7.6

5.5 4.1 0.6 0.7 9.2

7.2 3.2 0.3 10.0

[1] [1]

4.5 3.2 0.4 0.4 7.6

1288

1962

1600

353

16

5219

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

54

Flat/ maisonette

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Terraced house

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.12

4

(continued) Prevalence of mental disorders

by type of accommodation type, age and sex All children Accommodation type Detached

Semi-detached

Terraced house

Flat/ maisonette

Other

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

2.3 2.0 0.6 0.6 4.9

3.1 4.4 1.3 0.4 7.9

3.6 6.7 2.2 0.5 10.1

6.7 4.9 2.3 0.5 11.9

-

3.3 4.6 1.5 0.5 8.2

1380

2172

1861

405

12

5829

3.6 2.5 1.2 0.5 6.8

4.7 6.8 1.3 0.6 10.8

8.2 8.5 1.6 0.8 15.2

7.3 7.1 1.3 13.5

[1] [1]

5.6 6.2 1.4 0.6 11.2

1178

1804

1342

271

14

4609

2.9 2.2 0.9 0.5 5.8

3.8 5.5 1.3 0.5 9.2

5.5 7.5 1.9 0.6 12.3

6.9 5.8 1.9 0.3 12.5

[1] [1]

4.3 5.3 1.4 0.5 9.5

2558

3976

3203

676

26

10438

Percentage of children with any mental disorder

Figure 4.12 Prevalence of any mental disorder by type of accommodation 14 12 10 8 6 4 2 0 Detached

Semi-detached

Terraced house

Flat/ maisonette

All

Accommodation type

Mental health of children and adolescents in Great Britain

55

4

Prevalence of mental disorders

Table 4.13

Prevalence of mental disorders

by region, age and sex All Children Country/Region London Inner

London outer

England

Scotland

Wales

All

3.7 5.5 3.2 9.1

3.5 5.4 1.9 0.6 10.2

3.8 7.6 2.1 0.8 11.5

3.1 6.1 3.1 1.1 10.5

3.4 6.6 2.6 0.9 10.8

3.0 5.7 1.6 0.3 8.2

2.4 6.2 3.3 0.6 7.7

3.3 6.5 2.6 0.8 10.4

128

180

903

1306

2517

251

140

2909

9.2 11.4 3.1 20.4

4.8 7.2 1.9 1.0 13.9

4.7 7.1 1.5 0.9 11.2

5.1 9.6 3.0 0.1 13.4

5.2 8.7 2.4 0.4 13.1

3.9 7.8 2.5 1.0 10.1

5.6 8.7 0.8 0.8 12.1

5.1 8.6 2.3 0.5 12.8

131

115

730

1000

1977

210

124

2310

6.5 8.5 3.1 14.8

4.0 6.1 1.9 0.8 11.6

4.2 7.4 1.8 0.8 11.4

3.9 7.6 3.0 0.7 11.7

4.2 7.5 2.5 0.7 11.8

3.4 6.7 2.0 0.6 9.0

3.9 7.4 2.1 0.7 9.8

4.1 7.4 2.4 0.7 11.4

Base

259

295

1633

2306

4494

461

264

5219

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

4.1 1.9 0.9 6.1

4.8 3.4 0.6 8.2

3.4 2.6 0.4 0.2 6.0

2.6 3.0 0.5 0.1 5.5

3.2 2.8 0.4 0.2 5.9

5.7 1.3 0.4 0.4 7.3

1.2 3.9 0.6 0.6 5.0

3.3 2.7 0.4 0.2 5.9

Base

143

176

904

1330

2553

231

137

2921

6.5 1.2 1.1 8.0

4.0 2.6 5.8

6.1 4.9 0.7 0.9 11.1

6.0 3.7 0.6 0.6 9.3

5.9 3.9 0.5 0.7 9.6

5.8 3.8 0.4 8.8

9.7 2.3 0.7 11.9

6.1 3.8 0.5 0.7 9.6

115

142

674

1041

1971

201

126

2299

5.1 1.6 0.5 0.5 6.9

4.4 3.0 0.3 7.1

4.6 3.6 0.5 0.5 8.1

4.1 3.3 0.5 0.3 7.2

4.3 3.3 0.5 0.4 7.5

5.8 2.5 0.2 0.4 8.0

5.3 3.2 0.3 0.7 8.3

4.5 3.2 0.4 0.4 7.6

258

318

1578

2370

4524

432

264

5219

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

56

Non-Met England

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Other Met England

-Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.13

4

Prevalence of mental disorders

by region, age and sex All Children Country/Region London Inner

London outer

Other Met England

Non-Met England

England

Scotland

Wales

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

3.9 3.6 2.0 7.5

4.2 4.4 1.0 0.6 9.2

3.6 5.1 1.2 0.5 8.7

2.9 4.5 1.8 0.6 8.0

3.3 4.7 1.5 0.5 8.3

4.3 3.6 1.0 0.4 7.7

1.8 5.1 2.0 0.6 6.4

3.3 4.6 1.5 0.5 8.2

271

356

1807

2636

5070

481

278

5829

7.9 6.6 1.6 0.5 14.6

4.3 4.6 0.9 0.5 9.4

5.3 6.0 1.1 0.9 11.2

5.6 6.6 1.7 0.4 11.3

5.5 6.3 1.5 0.6 11.3

4.8 5.8 1.3 0.7 9.4

7.7 5.5 0.4 0.7 12.0

5.6 6.2 1.4 0.6 11.2

246

257

1404

2041

3948

411

250

4609

5.8 5.0 1.8 0.2 10.9

4.2 4.5 0.9 0.5 9.3

4.4 5.5 1.2 0.7 9.8

4.0 5.4 1.8 0.5 9.4

4.3 5.4 1.5 0.5 9.6

4.6 4.6 1.1 0.5 8.5

4.6 5.3 1.2 0.7 9.0

4.3 5.3 1.4 0.5 9.5

517

613

3211

4677

9018

892

527

10438

Figure 4.13 Prevalence of any mental disorder by country/region Percentage of children with a mental disorder

12

10

8

6

4

2

0 London Inner

London outer

Other Met England

Non-Met England

England

Scotland

Wales

All

Country/Region

Mental health of children and adolescents in Great Britain

57

4

Prevalence of mental disorders

Table 4.14

Prevalence of mental disorders

by ACORN* classification, age and sex All children ACORN classification A - Thriving

B - Expanding

D - Settling

E - Aspiring

All

2.3 3.7 1.1 0.2 6.1

2.9 3.3 2.7 0.7 7.8

4.7 5.4 4.0 1.2 12.2

1.7 5.7 2.7 1.2 8.9

4.0 8.3 3.2 1.2 13.0

5.0 10.0 2.6 0.7 14.2

3.3 6.4 2.5 0.8 10.4

534

408

179

630

405

749

2904

3.2 3.1 1.0 0.7 6.4

3.6 6.2 1.1 8.9

1.5 8.8 2.6 0.7 10.9

5.5 6.8 2.2 0.6 12.2

5.9 11.4 3.5 0.4 15.9

7.3 13.8 3.2 0.5 18.5

5.1 8.6 2.3 0.5 12.8

433

293

136

535

317

595

2309

2.7 3.4 1.0 0.4 6.3

3.2 4.5 2.0 0.4 8.3

3.3 6.9 3.4 1.0 11.6

3.4 6.2 2.5 1.0 10.4

4.8 9.7 3.3 0.8 14.3

6.0 11.7 2.9 0.6 16.1

4.1 7.4 2.4 0.7 11.4

Base

967

701

314

1165

721

1344

5213

GIRLS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

1.9 1.0 0.2 0.4 3.4

2.3 2.1 4.2

3.8 3.2 6.4

3.7 2.7 0.5 0.1 6.5

3.2 3.0 0.6 0.5 6.8

4.2 4.0 0.8 0.1 7.6

3.3 2.7 0.4 0.2 5.9

Base

512

417

182

697

358

749

2916

4.0 2.1 0.2 0.5 5.9

6.6 1.5 0.3 8.7

6.4 2.6 1.7 8.4

5.0 3.0 1.2 0.8 8.3

4.7 7.5 0.4 1.3 10.5

9.4 5.5 0.4 0.4 14.4

6.1 3.8 0.5 0.7 9.7

453

328

135

509

321

549

2296

2.9 1.5 0.2 0.4 4.6

4.2 1.8 0.1 6.2

4.9 3.0 0.7 7.3

4.3 2.8 0.8 0.4 7.2

3.9 5.2 0.5 0.9 8.5

6.4 4.7 0.7 0.2 10.5

4.5 3.2 0.4 0.4 7.6

966

745

317

1206

680

1298

5211

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All boys Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base All girls Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

* CACI Limited 1994. All rights reserved. Source: ONS and GRO(S) © Crown Copyright 1991. All rights Reserved.

58

F - Striving

Percentage of children with each disorder

BOYS 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

C - Rising

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

Table 4.14

4

(continued) Prevalence of mental disorders

by ACORN* classification, age and sex All children ACORN classification A - Thriving

B - Expanding

C - Rising

D - Settling

E - Aspiring

F - Striving

All

Percentage of children with each disorder

ALL 5-10 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

2.1 2.4 0.6 0.3 4.8

2.6 2.7 1.3 0.4 6.0

4.3 4.3 2.0 0.6 9.3

2.8 4.1 1.5 0.7 7.6

3.6 5.8 2.0 0.9 10.1

4.6 7.0 1.7 0.4 10.9

3.3 4.6 1.5 0.5 8.2

1046

825

361

1327

763

1498

5819

3.6 2.6 0.6 0.6 6.2

5.2 3.7 0.5 0.2 8.8

4.0 5.7 1.3 1.2 9.7

5.2 4.9 1.7 0.7 10.3

5.3 9.4 1.9 0.8 13.2

8.3 9.9 1.9 0.4 16.6

5.6 6.2 1.4 0.6 11.2

Base

887

621

271

1044

638

1144

4605

All children Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

2.8 2.5 0.6 0.4 5.4

3.7 3.1 1.0 0.3 7.2

4.1 4.9 1.7 0.9 9.4

3.9 4.5 1.6 0.7 8.8

4.4 7.5 2.0 0.9 11.5

6.2 8.2 1.8 0.4 13.3

4.3 5.3 1.4 0.5 9.5

1933

1446

631

2371

1401

2642

10424

Base 11-15 year olds Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any disorder

Base

Figure 4.14 Prevalence of any mental disorder by ACORN classification Percentage of children with a mental disorder

16 14 12 10 8 6 4 2 0 A - Thriving

B - Expanding

C - Rising

D - Settling

E - Aspiring

F - Striving

All

ACORN classification

Mental health of children and adolescents in Great Britain

59

4

Prevalence of mental disorders

Table 4.15 Odds ratios for sociodemographic correlates of mental disorders All children Conduct disorders Variable

Adjusted Odds ratio

95% C.I.

Adjusted Odds ratio

95% C.I.

1.00 1.84***

(1.51-2.23)

Hyperkinetic disorders Adjusted Odds ratio

Any disorder

95% C.I.

Adjusted Odds ratio

95% C.I.

1.00 0.96

(0.68-1.37)

1.00 1.48***

(1.29-1.70)

Age 5-10 11-15

1.00 1.45***

(1.20 - 1.75)

Sex Female Male

1.00 2.42***

(1.98-2.96)

1.00 0.89

(0.74-1.08)

1.00 5.56***

(3.49-8.88)

1.00 1.58***

(1.37-1.81)

Number of children 1 2 3 4 5

1.00 1.05 1.11 1.8*** 2.23***

(0.81-1.35) (0.82-1.48) (1.27-2.53) (1.43-3.48)

1.00 0.96 1.13 1.23 1.43

(0.74-1.25) (0.84-1.50) (0.85-1.80) (0.86-2.38)

1.00 0.92 0.79 0.65 0.71

(0.60-1.43) (0.47-1.33) ().31-1.40) (0.24-2.09)

1.00 0.94 0.98 1.32* 1.63**

(0.78-1.12) ().80-1.21) (1.01-1.73) (1.14-2.34)

Family type Two parents Lone parents

1.00 1.68***

(1.32-2.14)

1.00 1.55***

(1.20-2.00)

1.00 1.42

(0.89-2.27)

1.00 1.57***

(1.31-1.88)

ACORN Group Thriving Expanding Rising Settling Aspiring Striving

1.00 1.27 1.84* 1.68** 2.48*** 2.45***

(0.82-1.97) (1.10-3.05) (1.16-2.42) (1.70-3.61) (1.73-3.48)

1.00 1.40 1.48 1.34 1.33 1.73**

(0.95-2.07) (0.91-2.43) (0.95-1.90) (0.91-1.95) (1.24-2.41)

1.00 1.61 3.00* 2.47** 2.78** 2.41*

(0.72-3.62) (1.22-7.36) (1.25-4.89) (1.35-5.73) (1.22-4.79)

1.00 1.39* 1.72** 1.58*** 1.85*** 1.96***

(1.04-1.86) (1.20-2.46) (1.23-2.04) (1.41-2.43) (1.54-2.50)

Family’s employment Both parents working One parent working Neither working

1.00 1.14 1.9***

(0.87-1.50) (1.47-2.46)

1.00 1.44** 1.82***

(1.10-1.87) (1.37-2.41)

1.00 1.73* 2.13**

(1.09-2.73) (1.29-3.15)

1.00 1.3** 1.94***

(1.07-158) (1.59-2.37)

*** p<0.001, ** p<0.01, * p<0.05

60

Emotional disorders

Mental health of children and adolescents in Great Britain

Prevalence of mental disorders

4

Table 4.16 Odds ratios for sociodemographic correlates of emotional disorders Children with emotional disorders Anxiety disorders Variable

Depressive disorders

Emotional disorders

Adjusted Odds ratio

95% C.I.

Adjusted Odds ratio

95% C.I.

Adjusted Odds ratio

95% C.I.

Age 5-10 11-15

1.00 1.56***

(1.27 - 1.93)

1.00 8.55***

(4.81-15.20)

1.00 1.84***

(1.51-2.23)

Sex Female Male

1.00 0.85

(0.70-1.05)

1.00 0.84

(0.55-1.27)

1.00 0.89

(0.74-1.08)

Number of children 1 2 3 4 5

1.00 0.97 1.15 1.06 1.37

(0.74-1.28) (0.85-1.56) (0.70-1.61) (0.79-2.36)

1.00 1.26 1.58 2.64** 1.64

(0.70-2.25) (0.84-2.98) (1.27-5.45) (0.53-5.06)

1.00 0.96 1.13 1.23 1.43

(0.74-1.25) (0.84-1.50) (0.85-1.80) (0.86-2.38)

Family type Two parents Lone parent

1.00 1.54**

(1.17-2.02)

1.00 1.69

(0.98-2.90)

1.00 1.55***

(1.20-2.00)

ACORN Group Thriving Expanding Rising Settling Aspiring Striving

1.00 1.39 1.43 1.25 1.68** 2.45***

(0.93-2.09) (0.85-2.42) (0.87-1.80) (0.87-1.95) (1.18-2.38)

1.00 1.68 1.25 1.50 1.18 1.82

(0.72-3.93) (0.38-4.06) (0.70-3.24) (0.49-2.84) (0.87-3.79)

1.00 1.40 1.48 1.34 1.33 1.73**

(0.95-2.07) (0.91-2.43) (0.95-1.90) (0.91-1.95) (1.24-2.41)

Family’s employment Both parents working One parent working Neither working

1.00 1.38* 1.75***

(1.04-1.83) (1.30-2.37)

1.00 1.61 2.48**

(0.89-2.92) (1.40-4.41)

1.00 1.44** 1.82***

(1.10-1.87) (1.37-2.41)

*** p<0.001, ** p<0.01, * p<0.05

Mental health of children and adolescents in Great Britain

61

5 5.1

Characteristics of children with mental disorders

Introduction

The second part of this report focuses on children who were identified as having a mental disorder and looks at their physical health, social functioning, scholastic achievement, and lifestyle behaviours. Overall 936 children were assessed as having a mental disorder (before adjustment for missing teacher data). The numbers of children with each type of disorder were: 450 with an emotional disorder, 495 had a conduct disorder, 139 had a hyperkinetic disorder and 57 children had a less common disorder. Children who were assessed as having more than one disorder were included in each category. This chapter compares children with each type of mental disorder with those who do not have a disorder by looking at the distribution of biographic and socio-demographic characteristics among the two groups of children. The characteristics considered were: • • • • • • • • • • • • •

sex age ethnicity family type number of children in the child’s household educational qualifications of the interviewed parent employment status social class gross weekly household income type of accommodation tenure ACORN classification of the child’s home country and region where the child lives

The commentary on the comparison between children with a disorder and those with no disorder is based on the data shown in Tables 5.1 to 5.5 and illustrated in Figures 5.1 to 5.5. The findings are presented in table order, rather than order of significance. Although some of the variables in the tables are interrelated, the strength of independent effects are not considered here. Chapter 4 of

62

Mental health of children and adolescents in Great Britain

this report shows the odds ratios of sociodemographic and socio-economic correlates in relation to the prevalence of mental disorders.

5.2

Characteristics of children with any disorder

Compared with children who do not have a mental disorder, those with a disorder were more likely to be boys (60% compared with 49%) and 11-15 years old (52% compared with 43%).

Children with any mental disorder were: more likely to be living: • with a lone parent (37% compared with 21%) • in a reconstituted family (14% compared with 9%) • in a household where the interviewed parent had no qualifications (37% compared with 22%) • in a lower income household, less than £200 per week (40% compared with 22%) • in social sector housing (46% compared with 24%) • in a family where neither parent was working (28% compared with 12%) • in a terraced house (40% compared with 30%) • in a household with an ACORN classification of F-striving (36% compared with 24%) less likely to be living: • with married parents (53% compared with 71%) • in a household where the interviewed parent had qualifications above A-level or equivalent (14% compared with 23%) • in social class II households (managerial and technical) (23% compared to 31%) • in owner occupied households (45% compared with 70%) • in a detached house (15% compared with 25%) • in a household with an ACORN classification of A - thriving (11% compared with 19%)

Characteristics of children with mental disorders

In general, children with a mental disorder, compared with other children, were more likely to be male, living in a lower income household, in social sector housing and with a lone parent. They were less likely to be living with married parents or in social class I or II households.

5.3

Emotional disorders

Compared with children who do not have any mental disorder, those with an emotional disorder were more likely to be 11-15 years olds (57% compared with 43%).

Children with emotional disorders were: more likely to be living: • with a lone parent, divorced/widowed/ separated (28% compared with 15%) • in a household where the interviewed parent had no qualifications (37% compared with 22%) • in a household where neither parent was working (27% compared with 12%) • in a lower income household, less than £200 per week (38% compared with 22%) • in social sector housing (43% compared with 24%) • in a household with an ACORN classification of F-striving (36% compared with 24%) less likely to be living: • with a married couple (56% compared with 71%) • in a household where the interviewed parent had qualifications above A-level or equivalent (14% compared with 23%) • with two working parents (53% compared with 69%) • in social classes II (managerial and technical) (23% compared with 31%) • in accommodation owned by their parent(s) (48% compared with 70%) • in a detached house (16% compared with 25%) In summary, children with an emotional disorder in contrast to those with no mental disorder were more likely to be 11 - 15 years olds, living in social sector housing and in lower income households.

5

They were less likely to live in a home that is owned by their parents and for both their parents to be working.

5.4

Conduct disorders

Compared with children who do not have any mental disorder, those with a conduct disorder were more likely to be boys (70% compared with 49%) and 11-15 years old ( 52% compared with 43%).

Children with conduct disorders were: more likely to be living: • in lone parent families (42% compared with 21%) • in a reconstituted family (18% compared with 9%) • with interviewed parent who had no educational qualifications (42% compared with 22%) • in a family where neither parents are working (32% compared with 12%) • with parent(s) who had never worked (6% compared with 2%) • in social class V household (22% compared with 14%) • in a lower income household, less than £200 per week (45% compared with 22%) • in social sector housing (55% compared with 24%) • in a terraced house (43% compared with 30%) • in a household with an ACORN classification of F-striving (39% compared with 24%) less likely to be living: • with married parents (47% compared with 71%) • in a household where the interviewed parent had qualifications above A-level or equivalent (11% compared with 23%) • in a family with both parents working (52% compared with 69%) • in a social class I and II households (24% compared with 39%) • in accommodation owned by their parent(s) (37% compared with 70%) • in a detached house (10% compared with 25%) • in a household with an ACORN classification of A-thriving (9% compared with 19%)

Mental health of children and adolescents in Great Britain

63

5

Characteristics of children with mental disorders

In general, children with a conduct disorder were more likely than children without a mental disorder to be living in social sector housing, with neither parents working, and where the interviewed parent had no educational qualifications. They were less likely to be living with married parents and in accommodation owned by their parent (s).

5.5

Hyperkinetic disorders

Compared with children who do not have any mental disorder, those with a hyperkinetic disorder were more likely to be boys (85% compared with 49%).

Children with hyperkinetic disorders were: more likely to be living: • in lone parent family (37% compared with 21%) • with interviewed parent who had no educational qualifications (36% compared with 12%) • in a reconstituted family (16% compared with 9%) • in a family where neither parent was working (28% compared with 12%) • in a lower income household, between £100 - £199 per week (41% compared with 22%) • in social class IV and V households (28% compared with 19%) Figure 5.1

• •

in social sector housing (46% compared with 24%) in a terraced house (41% compared with 30%)

less likely to be living: • with married parents (56% compared with 71%) • in a household where the interviewed parent had qualifications above A-level or equivalent (12% compared with 23%) • in a family where both parents were working (51% compared with 69%) • in a social class I or II households (23% compared with 39%) • in a household with an ACORN classification of A - thriving (8% compared with 19%) To summarise children with a hyperkinetic disorder were more likely than children without a mental disorder to be living in social sector housing, in a lower income household, and whose interviewed parent had no educational qualifications. They were less likely to be living in a social class I or II households and with parents who were working.

5.6

Less common disorders

Because of the small number of the children who had a less common disorder, such as autism, eating or tic disorders, a comparison could not be made between those who had any of these disorders and the sample of children with no mental disorder.

Sex distribution by type of mental disorder Boys

Girls

100

Sex distribution of children

80

60

40

20

0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Type of mental disorder

64

Mental health of children and adolescents in Great Britain

Any disorder

No disorder

Characteristics of children with mental disorders

Percentage of children in each family employment situation

Figure 5.2

5

Family's employment situation by type of mental disorder Both parents working (inc. lone parents)

One parent working

Neither parents working

100

80

60

40

20

0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

Type of disorder

Figure 5.3

Gross weekly household income by type of mental disorder

Distribution of gross weekly household income

Under £200

£200 - £399

£400 - £599

£600 and over

100

80

60

40

20

0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

Type of disorder

Mental health of children and adolescents in Great Britain

65

5

Characteristics of children with mental disorders

Figure 5.4

Tenure by type of mental disorder

Percentage of children in each tenure category

Owners

Social sector tenants

Private renters

100

80

60

40

20

0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

Type of disorder

Figure 5.5

ACORN classification by type of mental disorder

Percentage of children in each ACORN category

A - Thriving

B - Expanding

C - Rising

D - Settling

F - Striving

100

80

60

40

20

0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Type of disorder

66

E - Aspiring

Mental health of children and adolescents in Great Britain

Any disorder

No disorder

Characteristics of children with mental disorders

Table 5.1

5

Number of children with each mental disorder

by age and sex All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder•

No disorder

All

Number of children with each disorder 5-10 years Boys Girls All

96 95 192

168 71 239

68 12 80

24 6 30

285 164 449

2624 2757 5381

2909 2921 5829

11-15 years Boys Girls All

118 140 258

177 78 255

49 10 58

12 16 27

278 209 487

2032 2089 4121

2310 2299 4609

All children Boys Girls All

214 236 450

345 149 495

117 21 139

36 21 57

563 373 936

4656 4847 9502

5219 5219 10438

* The number of children with any mental disorder exceeds the sum of the numbers of children with each disorder because children could have been assessed as having more than one type of disorder.

Table 5.2

Child’s personal characteristics

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Sex Boys Girls

48 52

70 30

85 15

63 37

60 40

49 51

50 50

Age 5 -10 years 11-15 years

43 57

48 52

58 42

52 48

48 52

57 43

56 44

Ethnicity White Black Indian Pakistani & Bangladeshi Other

91 2 1 2 3

92 4 1 1 2

99 1 1

94 2 4

92 3 1 1 3

91 3 2 2 3

91 3 2 2 3

450

495

139

57

936

9502

10438

Base

Mental health of children and adolescents in Great Britain

67

5

Characteristics of children with mental disorders

Table 5.3

Family characteristics

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Family type Married Cohabiting Lone parent - single Lone parent - w/d/s

56 8 8 28

47 11 14 28

56 7 15 22

64 7 6 23

53 9 11 26

71 8 6 15

70 8 7 16

Reconstituted family No Yes

88 12

82 18

84 16

88 12

86 14

91 9

91 9

20 39 22 13 7

25 44 21 7 3

25 41 23 9 2

23 39 22 11 5

21 46 23 8 3

21 45 23 8 3

5 6 8

7 5 9

16 9 12

7 7 8

12 11 10

12 11 10

23

19

23

24

30

29

12 3 42

17 6 36

9 5 25

13 3 37

12 3 22

12 3 23

495

139

57

936

9502

10438

Number of children in household 1 22 2 39 3 24 4 10 5 or more 5 Parents educational qualifications Degree level 7 Teaching/HND/Nursing level 8 A-level (or equivalent) 8 GCSE grades A-C or equivalent 25 GCSE grades D-F or equivalent 13 Other qualification 3 No qualification 37

Base

68

450

Mental health of children and adolescents in Great Britain

Characteristics of children with mental disorders

Table 5.4

5

Family’s employment status, social class and income

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Family’s employment status Both parents working (inc. lone parents) 53 One parent working 20 Neither parents working 27

52 16 32

51 21 28

48 29 23

54 18 28

69 19 12

67 19 14

Family’s social class Professional Managerial and technical Skilled non-manual Skilled manual Partly skilled Unskilled Armed forces FT student NA inadeq description Never worked

4 20 13 23 22 9 0 2 1 6

4 19 16 26 24 4 1 2 4

16 35 10 12 13 7 2 2 4

4 23 14 25 19 7 0 1 2 4

8 31 11 25 14 5 0 1 2 2

7 31 12 25 15 5 0 1 2 2

10 35 19 12 8 5 5 7

8 33 16 12 8 8 8 8

7 24 16 7 9 6 13 17

9 31 19 12 7 6 7 10

5 17 14 12 11 11 13 17

6 18 15 12 10 10 12 16

495

139

57

936

9502

10438

3 24 14 26 19 7 0 1 2 4

Gross weekly household income Under £100 8 £100 - £199 30 £200 - £299 19 £300 - £399 12 £400 - £499 7 £500 - £599 6 £600 - £770 7 Over £770 11

Base

450

Mental health of children and adolescents in Great Britain

69

5

Characteristics of children with mental disorders

Table 5.5

Household and geographical characteristics

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Type of accommodation Detached Semi-detached Terraced house Flat/maisonette

16 34 39 10

10 40 43 7

15 35 41 8

23 37 36 4

15 37 40 9

25 38 30 6

25 38 31 6

Tenure Owners Social sector tenants Private renters

48 43 9

37 55 9

43 46 11

61 29 10

45 46 9

70 24 6

68 26 6

ACORN classification A - Thriving B - Expanding C - Rising D - Settling E - Aspiring F - Striving

12 12 6 20 14 36

9 8 6 19 19 39

8 9 7 25 18 32

14 7 9 28 21 20

11 11 6 21 16 36

19 14 6 23 13 24

19 14 6 23 13 25

Region London inner London outer Other met England Non-met England

7 6 31 42

5 5 32 46

6 4 25 54

2 6 39 39

6 6 32 44

5 6 31 45

5 6 31 45

Country England Scotland Wales

86 9 5

88 7 5

89 7 4

85 8 6

88 8 5

86 9 5

86 9 5

450

495

139

57

936

9502

10438

Base

70

Mental health of children and adolescents in Great Britain

Mental disorders and physical complaints

6

Part 2: Children and adolescents with specific mental disorders

Mental health of children and adolescents in Great Britain

71

6

Mental disorders and physical complaints

This is a blank page

72

Mental health of children and adolescents in Great Britain

Mental disorders and physical complaints

6 6.1

6

Mental disorders and physical complaints

Introduction

This chapter looks at the extent to which physical complaints co-occur with mental disorders among children and adolescents. In the survey, data were collected on several aspects of the physical health of children. However, all information came from the interview with parents. The topics covered were: • General health • Presence or absence of specified physical complaints • Life threatening illnesses • Accidents and injuries Specific physical complaints were chosen on the basis of their common occurrence in childhood and adolescence (e.g. asthma), findings from previous research showing a strong association with mental disorders (e.g. epilepsy), problems frequently mentioned by parents during the pilot stage of this survey (e.g. food allergies) and their inclusion in other national mental health surveys. Previous research has shown that children with physical health problems or disabilities seem especially vulnerable to mental health problems. Rutter (1970) found in the Isle of Wight studies that children with asthma, epilepsy and neurological disorders in general were far more likely than the general population to have a mental disorder. In a national survey of disabled children in Great Britain, mental and behavioural problems were found among a large proportion of children with physical disabilities (Bone and Meltzer, 1989). They also found that nearly all the children with the most severe disabilities had a mental health disability. In the present study, parents were also asked if they thought their child had: emotional problems, behavioural problems, hyperactivity, learning difficulties and dyslexia. The chapter concludes with a comparison of parents’ perceptions and the clinical evaluation of emotional, behavioural and hyperkinetic disorders. Specific and learning difficulties in relation to mental disorders are discussed in Chapter 8.

6.2

General health

The child’s general health was rated by parents on a five point scale: very good, good, fair, bad or very bad. The overall proportion of children with a fair, bad or very bad rating was 7%, the corresponding proportion among children with a mental disorder was 20% compared with 6% of those without a disorder. This pattern was found for all types of mental disorder. (Table 6.1)

6.3

Physical complaints

To what extent are physical complaints more commonly found in children with mental disorders, and conversely, to what extent are mental disorders more prevalent among children with specific physical complaints? These two questions are answered in this section. Physical complaints can vary in their severity, chronicity, and treatability. This survey did not cover these aspects; the parent just said “yes” if the child had the health problem or condition presented on three lists. Asthma Eczema

Hyperactivity Diabetes Behavioural Obesity problems Emotional problems Cystic fibrosis Learning difficulties Spina bifida

Hay fever Glue ear or otitis media or grommets Bed wetting Dyslexia

Kidney, urinary tract problems Soiling pants Cerebral palsy Missing fingers, hands, arms, toes, feet or legs Stomach or Migraine or Any stiffness digestive severe headaches or deformity of the problems or foot, leg, fingers, tummy pains arms or back A heart problem Chronic Fatigue Any muscle Syndrome disease or weakness Any blood disorder Eye or sight Any difficulty with problems co-ordination Epilepsy Speech or language A condition present problems since birth such as club foot or cleft palate Food allergy Hearing problems Cancer Some other allergy

Mental health of children and adolescents in Great Britain

73

6

Mental disorders and physical complaints

Type of physical complaint

Figure 6.1 Percentage of children with a mental disorder by type of physical complaint Epilepsy Difficulty with co-ordination Soiling pants Muscle disease or weakness Speech or language problems Bed wetting Obesity Stiffness or deformity of foot Kidney/urinary tract problems Stomach or digestive problems Congenital abnormality Migraine/severe headache Food allergy Hearing problems Glue ear/otitis media/grommets Eyesight problems Asthma Diabetes Any blood disorder Heart problems Non-food allergy Hay fever Eczema

0

5

10

15

20

25

30

35

40

% with a mental disorder

Approximately two-thirds of children with a mental disorder had one of the physical complaints listed above (i.e. excluding hyperactivity, emotional problems, behavioural problems, learning difficulties and dyslexia) compared with about half the children who were assessed as not having a mental disorder. (Table 6.2) The most commonly reported physical complaints among the ten and a half thousand children and adolescents were: asthma (16%), eczema (12%) eyesight problems (11%) and hay fever (10%). Although these four complaints occurred more frequently among children with a mental disorder (compared with those with no disorder) the differences in proportions were not particularly large. The physical illness or health conditions which showed the greatest disparity in prevalence rates between children with a mental disorder and those with no disorder were: bedwetting (12% compared with 4%), speech or language problems (12% compared with 3%), co-ordination difficulties (8% compared with 2%), and soiling pants (4% compared with 1%). Among children with any disorder, stomach and digestive problems and migraine and severe headaches were most prevalent among children with emotional problems, 15% and 12% respectively, most probably reflecting the somatic symptoms associated with anxiety and depression. (Table 6.2)

74

Mental health of children and adolescents in Great Britain

Logistic regression analysis shows that having any physical complaint (compared with no physical health condition) increased the odds of having a mental disorder by 82% having adjusted for biographic, socio-demographic, socio-economic and geo-demographic factors. (Table 6.3) Looking at the prevalence of mental disorders by particular physical complaints, children with neurological problems - epilepsy and co-ordination difficulties - were more frequently assessed as having a mental disorder. There were six physical complaints where over 22% of sufferers had a mental disorder: epilepsy (37%), difficulties with co-ordination (35%), soiling pants (31%), muscle disease or weakness (30%), speech or language problems (29%) and enuresis (23%). (Figure 6.1, Table 6.4)

6.4

Life threatening illness

Parents were also asked if their child was ever so ill that they thought s/he may die. Whereas 12% of the parents said “Yes” to this question, a greater proportion was found among children with mental disorders than with no disorder: 22% compared with 11%. There was little difference in the proportions of children who had experienced a lifethreatening illness by type of mental disorder, ranging from 26% of those with emotional disorders to 19% of those with conduct disorders. (Table 6.5)

Mental disorders and physical complaints

Looking at the same data from a different perspective, among children who had a life-threatening illness, about 1 in 6 were found to have a mental disorder.

6.5

Accidents and injuries

The general health section of the questionnaire asked parents to say whether their children ever had four types of accident or injury: • • • •

Head injury with loss of consciousness Accident causing broken bone (excluding head injury) Burn requiring hospitalisation Accidental poisoning requiring hospital admission

Not unexpectedly, a broken bone was the most frequently mentioned accident, reported for 16% of children. Five percent of children had suffered a head injury causing loss of consciousness at some time in their lives, two percent of children had received a burn requiring hospital admission and two percent of children had been accidentally poisoned to the extent that they required hospitalisation. Children with a mental disorder were more likely than those without a disorder to have experienced each of these accidents or injuries: 20% had fractured a bone, 9% had a serious head injury, 5% had a burn requiring hospitalisation, and 5% also had been accidentally poisoned. There was no apparent association between type of accident or injury and type of mental disorder. (Table 6.6) Another way of presenting these data is to look at the prevalence of mental disorders among children with accidents and injuries. Fourteen per cent of children who had any of the four types of injury had a mental disorder compared with eight percent of the sample with no injury. Children who had accidental poisoning had the highest rate of mental disorder, 25%, whereas the prevalence among children who had a broken bone at 12% was just above the national average. (Table 6.7)

6.6

6

Parents’ views of their child’s mental health

Because parents were asked at the start of the interview to indicate whether their child had any of the thirty four health conditions shown above, they had an opportunity to say whether they thought their child had hyperactivity, emotional problems or behavioural problems before being asked the detailed questions on which the assessments of disorders were made. Whereas parents views covered problems (of all severity), the clinical ratings assessed disorders on strict impairment criteria. Therefore, the most meaningful question is - what proportion of children described by their parents as hyperactive or having behavioural or emotional problems were clinically assessed as having mental disorders? Parents could not be expected to differentiate between emotional, behavioural or hyperkinetic disorders but might be aware of their child’s mental health problem. Among the 928 children with a clinical rating on any of the three types of disorder, about a half of their parents thought their child had a mental health problem. This is a surprising result because a clinical diagnosis was only given to children where the mental problem had a significant effect on the child’s life or caused distress to others. A higher proportion might have been expected. Parents may have felt it too embarrassing to say that their child had such problems so early in the interview. The finding that about 6% of children not given a diagnosis during the clinical review were described by their parent as having a problem is not so surprising as the child may exhibit symptoms that do not meet research diagnostic criteria or have several symptoms with minimal social impairment. (Table 6.8) Parents tend to use the terms, emotional problems, conduct problems and hyperactivity to cover a wide range of situations. A thousand parents (10% of those interviewed) said their child had one of the three listed problems: emotional problems (435), behavioural problems (574) and hyperactivity (355). Parents’ attributions compared with the clinical diagnoses suggest that parents use the terms hyperactivity, emotional and behavioural problems in everyday language to express a difference between what

Mental health of children and adolescents in Great Britain

75

6

Mental disorders and physical complaints

they expect of their children and how they behave. This underlines the necessity of including some sort of clinical assessment in psychiatric morbidity surveys among children rather than relying solely on self-reported, general assessments by parents. (Table 6.9)

References Bone, M., and Meltzer, H. (1989) OPCS Surveys of disability in Great Britain, Report 3, The prevalence of disability among children, London: HMSO Rutter, M., Tizard, J. and Whitmore, K. (1970) Education, Health and Behaviour, London: Longmans.

Table 6.1

General health rating

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

General health rating

%

%

%

%

%

%

%

Very good Good Fair Bad Very bad

43 32 19 5 0

52 29 17 2 -

46 34 17 4 -

37 42 12 4 6

49 31 17 3 0

70 24 6 0 0

69 24 6 1 0

Base

76

444

}

24

}

19

492

Mental health of children and adolescents in Great Britain

139

}

21

57

}

22

927

}

20

9380

}

6

10307

}

7

Mental disorders and physical complaints

Table 6.2

6

Type of physical complaint

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Proportion of children with each type of physical complaint Asthma Eczema Eyesight problems Hay fever Stomach or digestive problems Non-food allergy Migraine/severe headache Glue ear/otitis media/grommets Bed wetting Hearing problems Speech or language problems Food allergy Difficulty with co-ordination Stiffness or deformity of foot Heart problems Soiling pants Muscle disease or weakness Kidney/urinary tract problems Obesity Congenital abnormality Epilepsy Any blood disorder Diabetes

23 15 14 12 15 8 12 6 11 5 11 5 7 4 2 3 4 3 2 1 2 1 1

20 12 15 11 8 6 7 7 12 7 10 6 7 4 1 4 2 2 2 1 2 1 1

25 12 15 9 8 7 4 9 18 7 16 6 15 4 2 7 5 3 2 4 1 1 1

22 10 15 6 9 8 6 10 18 7 38 12 32 4 14 3 4 4 11 2 -

20 14 14 11 11 7 8 7 12 7 12 6 8 4 2 4 3 2 2 1 2 1 1

15 12 10 9 6 6 5 5 4 4 3 3 2 2 1 1 1 1 1 1 1 0 0

16 12 11 10 6 6 5 5 5 4 4 4 2 2 1 1 1 1 1 1 1 1 1

Any physical complaint No physical complaint

71 29

64 36

71 29

84 16

67 33

52 48

54 46

445

492

139

57

928

9381

10310

Base

Some physical complaints are not listed in the table above because of their rarity, i.e less than 25 cases: ME (4) Spina bifida (4) Cystic fibrosis (6) Cancer (16) Missing digits (16) Cerebral palsy (24) but are included in the any physical complaint category.

Mental health of children and adolescents in Great Britain

77

6

Mental disorders and physical complaints

Table 6.3

Odds Ratios for physical complaints and sociodemographic correlates of mental disorders

All children Variable

Value

Adjusted Odds ratio

95% C.I.

Physical complaint

No Yes

1.00 1.82***

(1.57-2.10)

Age

5-10 11-15

1.00 1.46***

(1.27-1.68)

Sex

Female Male

1.00 1.55***

(1.35-1.79)

Number of children

1 2 3 4 5

1.00 0.92 0.98 1.35* 1.67**

(0.77-1.11) (0.79-1.20) (1.04-1.77) (1.16-2.39)

Family type

Two parent Lone parent

1.00 1.60***

(1.33-1.92)

ACORN Group

Thriving Expanding Rising Settling Aspiring Striving

1.00 1.38* 1.64** 1.58*** 1.79*** 1.89***

(1.03-1.84) (1.15-2.34) (1.23-2.03) (1.36-2.34) (1.48-2.41)

Family’s employment

Both parents working One parent working Neither working

1.00 1.26** 1.88***

(1.04-1.53) (1.54-2.30)

*** p<0.001, ** p<0.01, * p<0.05

78

Mental health of children and adolescents in Great Britain

Mental disorders and physical complaints

Table 6.4

6

Prevalence of mental disorders

by type of physical complaint All children Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

Base

Percentage of children with mental disorders for each complaint Epilepsy Difficulty with co-ordination Soiling pants Muscle disease or weakness Speech or language problems Bed wetting Stiffness or deformity of foot Obesity Kidney/urinary tract problems Stomach or digestive problems Migraine/severe headache Congenital abnormality Hearing problems Food allergy Glue ear/otitis media/grommets Asthma Eyesight problems Hay fever Non-food allergy Heart problems Any blood disorder Diabetes Eczema

Table 6.5

17 13 13 18 12 10 10 11 12 11 10 6 5 6 5 6 6 6 6 7 8 6 5

18 17 17 10 15 13 12 11 10 7 8 4 9 9 8 7 7 7 6 2 7 10 6

1 10 9 8 7 5 3 4 4 2 1 8 2 2 2 2 2 1 2 2 2 2 1

10 8 7 2 6 2 1 2 1 1 3 1 2 1 1 1 0 1 2 0

37 35 31 30 29 23 21 21 20 17 16 16 15 15 14 13 13 12 12 12 12 12 11

67 235 116 99 393 484 183 84 96 629 513 74 429 370 480 1604 1097 976 581 128 47 47 1289

Experience of a life threatening illness

by type of mental disorder All children Type of mental disorder

Thought child was so ill that s/he may die Yes: in past 12 months Yes: at least 12 months ago No

Base

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

2 25 74

2 17 81

1 22 77

21 79

2 20 79

1 10 89

1 11 88

445

492

139

57

928

9379

10308

Mental health of children and adolescents in Great Britain

79

6

Mental disorders and physical complaints

Table 6.6

Experience of accidents and injuries

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Head injury with loss of consciousness Yes: in past 12 months Yes: at least 12 months ago No

2 7 91

1 9 90

10 90

2 7 90

2 7 91

1 3 96

1 4 96

Accident causing broken bone Yes: in past 12 months Yes: at least 12 months ago No

4 17 79

3 16 80

5 14 81

5 11 84

4 16 80

3 13 84

3 13 84

Burn requiring hospital admission Yes: in past 12 months Yes: at least 12 months ago No

0 4 96

0 6 94

7 93

3 97

0 5 95

0 2 98

0 2 98

Accidental poisoning with hospital admission Yes: in past 12 months Yes: at least 12 months ago No

7 93

0 7 93

1 5 94

7 93

0 5 94

0 2 98

0 2 98

444

492

139

57

927

9380

10307

Base

Table 6.7

Prevalence of mental disorders

by type of accident or injury All children Head injury

Broken bone

Burn

Poisoning

Any injury or accident

No injury or accident

All

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

9 12 3 1

6 7 2 1

7 13 4 1

13 16 4 2

6 8 2 1

4 4 1 1

4 6 1 1

Any mental disorder

19

12

20

25

14

8

10

456

1655

233

222

3173

7133

10306

Base

80

Mental health of children and adolescents in Great Britain

Mental disorders and physical complaints

Table 6.8

6

Parental view of child’s mental health

by clinical assessment of type of mental disorder All children Clinical assessment of type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Any disorder

No disorder

Percentage of children whose parents gave each rating Parents’ view of child’s mental health Emotional problems Behavioural problems Hyperactivity

27 20 10

26 52 21

23 61 50

24 36 17

2 3 2

Any problem

36

62

72

48

6

445

492

139

928

9380

Any of the 3 problems

None of the 3 problems

Base

Table 6.9

Clinical assessment of type of mental disorder

by parental view of child’s mental health All children Parent’s view of child’s mental health Emotional problems

Behavioural problems

Hyperactivity

Percentage of children with each type of clinical rating Clinical assessment of type of mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders

28 34 8

15 50 16

12 32 22

16 35 11

3 2 0

Any of the 3 disorders

51

58

43

46

5

435

574

355

1000

9438

Base

Mental health of children and adolescents in Great Britain

81

7

Use of services

7.1 Introduction Parents were asked about three types of services that their children used: • Contact with primary health care services for any reason over the past 12 months (all children) • Consultations with health, social or educational services (children with a mental disorder) • Advice or help sought from family or friends (children with a mental disorder) The questions on service use for mental health problems asked the parent to specify the area that the service provider came from, for example, specialist health care or social services. Therefore, services could not be categorised according to the four tiers of Child and Adolescent Mental Health Services (CAMHS). More detailed questions (which would have allowed for a CAMHS classification) were piloted but were dropped because parents were not always able to give the job title of the person the child had been seen by, especially if they had been in contact with more than one professional. The chapter concludes by looking at the relationship between mental disorders and the child’s contact with the police.

7.2

Use of health services for any reason

The child’s contact with primary health care providers in the past 12 months was examined in relation to four types of services: • GPs (excluding consultations for immunisation, child surveillance or development tests) • Accident and Emergency departments • In-patient departments • Out-patient or day patient services

GP contacts Overall, 36% of children (or parents on behalf of their children) had been in contact with a GP in the past 12 months. Almost a half of the children

82

Mental health of children and adolescents in Great Britain

with a disorder had been in contact with a GP in the past 12 months for any reason compared with just over a third of children with no disorder. The survey did not include questions on reason for consultation. There was little difference in GP contacts by type of disorder, with proportions ranging from 45% among children with conduct disorders to 52% of those with hyperkinetic disorders. (Table 7.1, Figure 7.1) Children who had a mental disorder also seemed to make more visits to their GP: 25% of those with a disorder had been in contact with their GP on three or more occasions in the past 12 months compared with 13% of those without a disorder.

Accident and Emergency departments Just under a fifth of children (18%) had visited an Accident and Emergency department in the past 12 months and most children needed to go on one occasion only. Children with a disorder were more likely to have been taken to an Accident and Emergency department than those without a disorder (26% compared with 17%) and on more than one occasion (7% compared with 4%). This may be explained by the finding in the previous chapter that accidents and injuries were more commonly reported for children with a disorder. Children with a hyperkinetic disorder were almost twice as likely as those with no disorder to have visited an Accident and Emergency department in the last year (31% compared with 17%). (Table 7.1, Figure 7.1)

Inpatient stays Inpatient stays were rare events for children aged 5-15 years. Only 5% had been in hospital in the past year. Inpatient stays were slightly more common among children with a disorder than those without (9% compared with 5%) (Table 7.1, Figure 7.1)

Use of services

Outpatient or day patients About 1 in 5 children had been to a hospital as an outpatient or as a day patient in the past year. These visits were in addition to the attendance at Casualty Departments. Children with a mental disorder were more likely than other children to have visited an Outpatient Department in the past year: 29% compared with 18% and children with hyperkinetic disorders and less common disorders were the most frequent visitors. (Table 7.1, Figure 7.1)

7.3

Use of services for significant mental health problems

When parents indicated that their children had significant mental health problems, they were asked which health, social or educational service they sought help from. 71% of all children with a mental disorder had been seen by either a GP or a secondary care provider, for example, paediatrician, social worker or educational psychologist. This proportion decreased slightly, to 65% if only secondary care (excluding those who only saw their GP) was considered.

7

Overall, 30% of children with mental disorders had not been seen by a GP or specialist health care services. Children with emotional disorders were the least likely to have been seen by either of these health care services. This finding is not surprising because parents of children with emotional disorders may often be unaware of their child’s problems; children with emotional disorders may keep their worries and anxieties to themselves. Parents also tend to take their child’s emotional problems less seriously. Contact with services varied by type of disorder: 63% of children with any emotional disorder (that is, anxiety and depression) had been in contact with services increasing to about 76% of children with behavioural problems and to 81% of those with hyperkinetic disorders. Nearly all the children and adolescents with the less common disorders (autism, tic and eating disorders) had been seen by at least one of the services. (Figure 7.2) Focusing on the use of particular types of service, half the children with mental disorders had seen someone from the educational services, about a quarter had used the specialist health care services and a fifth had contact with the social services. (Table 7.2)

Figure 7.1 Use of services (for any reason) by mental disorder Percentage of children using services

60 50 40 30 20 10 0

Emotional disorders

Conduct disorders

Any GP contact

Hyperkinetic Less common disorders disorders Type of disorder

Any A & E visit

Any inpatient stay

Any disorder

No disorder

Any outpatient visit or day patient stay

Mental health of children and adolescents in Great Britain

83

7

Use of services

Percentage of children using service(s)

Figure 7.2 Contact with primary and secondary health services by type of mental disorder 100 90 80 70 60 50 40 30 20 10 0 Emotional disorders

Conduct disorders

Hyperkinetic disorders

Any disorder

Type of disorder

Neither consulted GP nor contact with specialist services

7.4

Consulted GP only

Use of professional and non-professional help

Contact with specialist service only

Consulted GP and had contact with specialist service

Approximately 9 in 10 parents had looked for some type of help or advice. The majority, 62% had sought both professional and non-professional help for their children, 20% had sought nonprofessional help only and 8% had sought professional help only. (Table 7.3, figure 7.3)

If parents are concerned about their child’s wellbeing, they may seek the advice of friends, relatives or neighbours instead of or as well as professional help. Parents of children with a disorder were asked if they had sought non-professional help as well as professional help for their child’s problem.

Service use varied by type of disorder. Parents of children with an emotional disorder were the

Percentage of children with a disorder whose parents have sought each type of help

Figure 7.3 Use of professional and non-professional help by type of disorder 100 90 80 70 60 50 40 30 20 10 0 Emotional disorder

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

Type of disorder No help sought

84

Non-professional help only

Mental health of children and adolescents in Great Britain

Professional help only

Professional and non-professional help

Use of services

group most likely to have asked family or friends for advice (23%) and the least likely to have sought professional services (63%) compared with parents of children with other disorders. Service use was also related to the number of specific mental disorders (e.g. separation anxiety, social phobia, generalised anxiety) indicating that the variety or the severity of problems may initiate the search for professional help. The proportion of parents who had sought professional help/advice increased from 66% of those with one disorder to 77% of children with two disorders and to 89% of those with three or more disorders. (Table 7.4)

7.5

Socio-demographic correlates of service use

In order to examine further the characteristics of children who received services, multiple logistic regression was used to produce odds ratios for the socio-demographic correlates of the use of professional services.

7.6

7

Trouble with the police

Parents were asked if their child had been in trouble with the police in the last 12 months. Overall, 2% of children had this experience. Not unexpectedly, more boys than girls and more older than younger children had been in trouble with the police. Nevertheless, the presence of a mental disorder was also a major factor. Ten per cent of children with a mental disorder had been in trouble with the police compared with just 1% of those with no disorder. One in six children with a conduct disorder had been in trouble with the police. (Table 7.6) Among children who had been in trouble with the police, those with a disorder were almost three times more likely than children with no disorder to have been in this situation more than once in the past 12 months (44% compared with 12%). (Table, not shown)

Each odds ratio shows the increase or decrease in odds that a parent of a child with a disorder had sought professional or non-professional advice compared with those who had not. The variables entered into the model were age, sex, number of children, family type, ACORN classification and family’s employment status. ACORN was chosen as the economic indicator because it takes account of tenure, type of accommodation and income.

Young people who were interviewed (11-15 year olds) and who had already admitted to troublesome behaviour were also asked (as part of the selfcompletion questionnaire) whether they had ever been in trouble with the police. It is important to note that the information obtained via the parents about police contact cannot be directly compared with that given by the young person, because parents may not know what their children have been up to and they were only asked if their child had been in trouble with the police in the past 12 months.

The significant odds ratios for the sociodemographic correlates of the parent seeking professional help (compared with not seeking professional help) were the child’s sex and family’s employment status. The odds of having sought professional help increased by about a half for boys compared with girls, and by around two-thirds for families with neither parent working compared with both parents working. (Table 7.5)

Overall, 25% of 11-15 year olds who reported awkward or troublesome behaviour said that at one point in their lives they had been in trouble with the police, which included 43% of children with a disorder and 21% of children with no disorder. Half the children with conduct disorders had been in trouble with the police compared with a third of those with emotional disorders. (Table 7.7)

Mental health of children and adolescents in Great Britain

85

7

Use of services

Table 7.1

Use of health services in the past 12 months (for any reason)

by type of mental disorder All children Type of mental disorder Service contacted in past 12 months

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

General practitioner Not at all Once Twice Three times Four or more times

51 10 11 6 22

55 12 11 8 14

48 14 10 7 21

43 16 9 9 23

53 11 11 7 18

65 12 10 5 8

64 12 10 5 9

Any GP contact

49

45

52

57

47

35

36

443

491

137

57

926

9375

10302

A & E department Not at all Once Twice Three times Four or more times

75 18 4 2 1

73 20 5 2 1

69 21 8 1

77 17 4 2 -

74 18 4 2 1

83 13 3 1 0

82 14 3 1 1

Any A & E visit

25

27

31

23

26

17

18

445

492

139

57

928

9374

10303

Inpatient stay Not at all Once Twice Three times Four or more times

91 8 1 0 1

91 7 1 1 0

90 8 1 1 -

87 9 2 2

91 7 1 1 0

95 4 1 0 0

95 4 1 0 0

Any inpatient stay

9

9

10

13

9

5

5

445

492

139

57

928

9378

10307

Outpatient or day patient Not at all Once Twice Three times Four or more times

71 8 6 3 12

73 8 6 3 9

57 11 10 4 19

45 10 13 5 26

71 8 7 3 11

82 8 4 2 4

81 8 4 2 4

Any outpatient visit or day patient stay

29

27

43

55

29

18

19

445

492

139

57

928

9374

10303

Base

Base

Base

Base

86

Emotional disorders

Mental health of children and adolescents in Great Britain

Use of services

Table 7.2

7

Use of services for significant mental health problems

by type of mental disorder All children with a disorder Type of mental disorder Service used

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorders

%

%

%

%

%

Primary health care services (e.g. GP or Health Visitor)

40

38

46

67

40

Specialist health care services (e.g. Paediatrician or child guidance clinic)

21

26

38

60

27

Social services (e.g. Social worker)

16

27

23

25

20

Educational services (e.g. Class teacher, educational psychologist, school counsellor)

43

55

67

72

50

Alternative therapist

6

5

4

25

6

Other specialist service

7

4

4

12

6

Any of the above services

63

76

81

96

71

Consulted GP and had contact with a specialist service

33

33

41

58

34

Contact with specialist services only

23

38

35

29

31

7

5

5

9

6

37

24

19

4

30

397

403

134

56

793

Consulted GP only Neither consulted GP nor had contact with specialist services

Base

Mental health of children and adolescents in Great Britain

87

7

Use of services

Table 7.3

Use of professional and non-professional help

by type of mental disorder All children with a mental disorder Type of mental disorder Type of help sought

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

%

%

%

%

%

14

5

6

-

9

8

8

6

9

8

Non-professional help only

23

18

13

4

20

Professional and non-professional help

55

68

75

87

62

No help sought Professional help only

Percentage of children whose parents sought each type of help Any professional help

63

76

81

96

70

Any non-professional help

78

86

88

91

83

Any help

86

95

94

100

91

397

403

134

56

793

Base

88

Mental health of children and adolescents in Great Britain

Use of services

Table 7.4

7

Use of professional and non-professional help

by number of mental disorders All children with a disorder Number of disorders One disorder

Two disorders

Three or more disorders

Any disorder

Percentage of children whose parents sought each type of help Sought professional help for significant mental health problems

66

77

88

71

Sought non-professional help for significant mental health problems

81

84

93

83

Sought any help for significant mental health problems

90

91

98

91

522

209

61

793

Base

Table 7.5

Odds Ratios for the socio-demographic correlates of service use

Any psychiatric disorder Variable

Value

Adjusted Odds ratio

95% C.I.

Sex

Female Male

1.00 1.49*

(1.09 - 2.04)

Family‘s employment

Both parents working One parent working Neither working

1.00 0.90 1.63*

(0.59 - 1.39) (1.05 - 2.53)

Others variables entered into the model that were not found to be significant were; age, number of children, family type and ACORN classification. *** p<0.001, **p<0.01, *p<0.05

Mental health of children and adolescents in Great Britain

89

7

Use of services

Table 7.6

In trouble with the police in the past 12 months

by type of mental disorder, age and sex All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

5-10 year olds Yes No

1 100

4 96

2 98

100

3 97

0 100

0 100

Base

192

239

80

30

449

5323

5772

9 91

27 74

26 74

[26] [1]

17 83

2 98

4 96

253

253

58

27

480

4053

4533

8 93

18 82

14 86

100

13 87

2 98

3 97

213

343

117

36

559

4603

5162

3 97

10 90

[20] [1]

[20] [1]

6 94

1 100

1 99

232

149

21

21

369

4773

5143

5 95

16 84

12 88

2 98

10 90

1 99

2 98

445

492

139

57

928

9376

10305

Has child been in trouble with the police in the past 12 months?

11-15 year olds Yes No

Base All boys Yes No

Base All girls Yes No

Base All children Yes No

Base

Table 7.7

Ever been in trouble with the police

by type of mental disorder (11-15 years only) All children aged 11-15 years who completed a self-completion questionnaire and had already admitted to carrying out less serious troublesome behaviour. Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Yes No

34 66

49 51

40 60

[5] [7]

43 57

21 79

25 75

Base

149

169

39

12

284

1145

1430

Whether child has ever been in trouble with the police

90

Mental health of children and adolescents in Great Britain

Scholastic achievement and education

8 8.1

Scholastic achievement and education

Introduction

educational needs also varied greatly by type of disorder. Children with a hyperkinetic disorder were twice as likely as those with an emotional disorder to have special educational needs 71% compared with 37%. (Table 8.1, Figure 8.1)

The aim of this chapter is to look at the relationship between the mental disorders among children and scholastic achievement, special educational needs (SEN) and absenteeism from school.

8.2

Special educational needs

Teachers were asked whether the child had any officially recognised special needs, and if so, to rate the level of special needs according to the five recognised stages: •

Stage 1 - Class teacher or form/year tutor has overall responsibility Stage 2 - SEN co-ordinator takes the lead in co-ordinating provision and drawing up individual educational plans Stage 3 - External specialist support enlisted Stage 4 - Statutory assessment by Local Education Authority (LEA) Stage 5 - SEN statement issued by LEA



• • •

8

Whereas, about 1 in 5 children had officially recognised special educational needs, those with a disorder were three times more likely than other children to have special needs: 49% compared with 15%. The proportion of children with special

Among all the children with special educational needs 17% were at stage 5, the level at which a statement is issued about the child by their Local Education Authority (LEA). Among the children who have a mental disorder and with special educational needs, 28% were at Stage 5. Among the children who do not have a mental disorder but do have special educational needs, 13% were at Stage 5. The distribution of children with special needs across the five stages did not vary by the three main types of disorder, but for the small number of children with a less common disorder, about three quarters were at Stage 5. (Table 8.2) In Table 8.3 the data are presented so that the prevalence of mental disorders among children at different stages of special educational needs can be compared with children with no special educational needs. The prevalence rate of mental disorders ranged from 6% among children who did not have special educational needs to 40% among children who were at stage 5 of the special needs scale. (Table 8.3, Figure 8.2)

Figure 8.1 Officially recognised SEN by type of mental disorder Percentage of children with SEN

100 90 80 70 60 50 40 30 20 10 0

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Type of disorder No special educational needs

Stages 1,2 & 3

Stages 4 & 5

Mental health of children and adolescents in Great Britain

91

8

Scholastic achievement and education

Percentage of children with a mental disorder

Figure 8.2 Prevalence of mental disorders by level of SEN 50 45 40 35 30 25 20 15 10 5 0

No special needs

Stage 1

Stage 2

Stage 3

Stage 4&5

All

Level of special educational needs

It is clear from the findings described above that children who had a mental disorder were more likely, than those without a disorder to have had officially-recognised, special educational needs. Logistic regression was used to look at the strength of the independent association between mental disorders and special educational needs taking account of socio-biographic, socio-demographic, socio-economic and geo-demographic factors. The significant correlates of having special educational needs were: presence of a mental disorder, child’s sex, child’s age, number of children in family and family’s employment situation. Among these five factors the presence of a mental disorder had the greatest influence on the odds of having special educational needs. Children with a mental disorder were around five times more likely (than those with no disorder) to have had special educational needs (OR=4.61) and the odds ratio for boys compared with girls was 2.04. (Table 8.4)

8.3

Specific learning difficulties

All children (aged 5-15 year olds) were invited to participate in a component of the survey, which aimed to explore the relationship between specific learning difficulties (SpLDs) and mental health. Children were individually assessed on their general cognitive, reading and spelling abilities by ONS interviewers who had received training in psychometric test administration. Those who completed the test of general

92

Mental health of children and adolescents in Great Britain

cognitive ability and at least the reading test were included in the analysis.

Assessment materials General cognitive ability The second edition of the British Picture Vocabulary Scale (BPVS-II, Dunn, Dunn, Whetton & Burley, 1997) was used to generate a standard score for receptive vocabulary; that is, the words a child recognises when spoken. The BPVS-II has been considered to be a good measure of global cognitive ability (IQ) for research studies (Dunn et al, 1997, p.4). In this study, using the BPVS-II reduced the risk of overincluding children in the SpLD category who have recently arrived in the UK and may have a lack of knowledge of English. Reading ability Single word reading ability was assessed using the Word Reading Scale of the British Ability Scales, Second Edition (BAS-II, Elliott, Smith & McCulloch, 1996). The printed card of single words was presented to children using the standard instructions and a raw score for total correctly read words obtained. Regional variations in pronunciation were accepted within the constraints specified in the BAS-II Test Manual. Raw scores were transformed into ability scores using the Item Response Theory model developed for the BAS-II (BAS-II Technical Manual) and age-corrected standard scores generated from the BAS-II tables.

Scholastic achievement and education

Spelling ability Children were also invited to try the spelling items from the BAS-II and record their answers in pencil on a standard BAS-II Spelling Sheet. Researchers coded responses as correct or incorrect using BLAISE software developed for the study which subsequently presented easier or harder items depending on the accuracy of the response using decision rules specified for the BAS-II. This method minimised the number of items that were too easy or too hard that each individual had to try. Raw scores were transformed into age-based standard scores via ability scores using the method described above.

Given that the rate of specific learning difficulties (SpLD) was set at 5%, children with a mental disorder were three times more likely than those with no disorder to have SpLD: 12% compared with 4%. There was little difference in the proportions of children with SpLD by type of disorder. (Table 8.5)

Criteria for inclusion in specific learning difficulty category

8.4

Specific learning difficulty (SpLD) was conceptualised as the failure to achieve expected academic progress in reading and spelling despite conventional instruction, adequate intelligence and sociocultural opportunity (Snowling, 1987). This was operationally defined in the current study in terms of ability-achievement discrepancy analysis (Shepard, 1980). Regression equations were generated to predict reading and spelling ability scores from BPVS-II scores based on the entire sample, corrected to two decimal places. The resulting regression equations are shown below. Regression equations for predicted reading and spelling ability Predicted reading ability = 37.701 + 0.6522 x BPVS Standard Score Predicted spelling ability = 49.832 + 0.5205 x BPVS Standard Score

The difference between predicted and actual reading and spelling score for each participant was calculated, and individuals were included in the SpLD category if their discrepancy score fell within the most extreme 5% of the sample for each year group, following the methodology developed by Yule, Lansdown & Urbanowicz (1982). In most cases where both reading and spelling scores were available, the most extreme 5% was identified on the basis of membership of the most extreme 7.5% for reading and spelling; in cases where only reading scores were available, individuals were included in the SpLD category if they were in the most extreme 5%.

8

Another way of examining these data is to look at the prevalence of mental disorders among children with specific learning difficulties. Among children with SpLD, 22% had any mental disorder. In terms of the broad groups of disorders 13% had conduct disorders, 9% emotional disorders and 5% had a hyperkinetic disorder. (Table 8.6)

Absenteeism from school

Teachers were asked how many days the child had been absent during the last term. Overall, 67% of all children had been absent from school for a day or more during the previous term. Forty five per cent had been away from school for up to a week and 21% had been away for more than a week. (Table 8.7) Children with a disorder were slightly more likely to have been absent from school during the previous term: 74% compared with 66%. However, a clearer distinction between the two groups can be seen when looking at the number of days that the child has been absent in the last term. Children with a disorder were about twice as likely as other children to have been absent from school for 11 days or more: 19% compared with 8%. There was some variation between the proportions of children who had been absent from school by type of disorder: 25% of children with emotional disorders had been absent from school for 11 days or more compared with 21% of children with conduct disorders and 14% with hyperkinetic disorders.

8.5

Truancy

All three types of respondent (young person, parent and teacher) were asked about truanting. However, because of differences in question wording, type of administration and routing it is not possible to directly compare the information which was collected from the three sources.

Mental health of children and adolescents in Great Britain

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8

Scholastic achievement and education

The question directed at parents was: (In the past 12 months) Has s/he often played truant (‘bunked off ’) from school? This was only asked of parents of children who were more troublesome than average. According to parents, 4% of the children had ‘definitely’ and 2% had ‘perhaps’ often played truant in the past year. Children who had a disorder were six times more likely, than those without a disorder, to have ‘definitely’ played truant in the past year: 12% compared with 2%. According to parents 1 in 5 children with conduct disorders may have or did play truant in the past twelve months. (Table 8.8) The wording of the truancy question for the 11-15 year olds was the same as that asked of parents. However, owing to the sensitive nature of the topic, the question was included in the self-completion questionnaire. Five per cent of the young people reported that they had ‘definitely’ and 7% had ‘perhaps’ played truant in the past year. Whereas parents may have been unsure whether their children were playing truant, the young people themselves must have known. Therefore, those in the ‘perhaps’ category were probably in the ‘definitely’ category but were concerned about admitting it. Adding the two groups together young people with a disorder were four times more likely than other children to have played truant: 33% compared with 9%. Children with conduct disorders most frequently reported truanting behaviour, at 44%. (Table 8.9)

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Mental health of children and adolescents in Great Britain

The question on truancy presented to teachers was different to those addressed to parents and children, because teachers did not have a face-toface interview but were sent a postal questionnaire. The questionnaire included the statement: ‘plays truant’ and the teacher had to respond by ticking one of three boxes labelled, not true, somewhat true or certainly true. According to the teachers 3% of children played truant. This percentage represents 15% of children assessed as having a mental disorder and just 2% of those with no disorder. Following the pattern of the parent and young person data, children with conduct disorders had the highest reported rate of truancy, 19%. (Table 8.10)

References Dunn, L.M., Dunn, L.M., Whetton, C. & Burley, J. (1997). The British Picture Vocabulary Scale Second Edition Testbook. Windsor: NFER Elliott, C., Smith, P. & McCulloch, K. (1996). British Ability Scales - Second Edition: Administration and Scoring Manual. Windsor: NFER. Shepard, L. (1980). An evaluation of the regression discrepancy method for identifying children with learning disabilities. Journal of Special Education, 14 (1). 79 - 91. Snowling, M. (1987). Dyslexia - a Cognitive Developmental Perspective. Oxford: Blackwell. Yule, W., Lansdown, R. & Urbanowicz, M. (1982). Predicting educational attainment from WISC-R in a primary school sample. British Journal of Clinical Psychology. 21. 43 - 46.

Scholastic achievement and education

Table 8.1

8

Officially recognised special educational needs (SEN)

by type of mental disorder All children (where teacher data available) Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

No special needs

63

43

29

32

51

84

81

Officially recognised special needs at: Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

10 9 7 2 9

Base

} } } } } } } 14 11 15 3 13

37

339

13 11 24 4 19

57

399

5 2 9 52

71

120

11 10 12 2 14

68

47

6 5 2 0 2

49

736

15

7282

7 5 3 0 3

19

8018

Stage 1 - Class teacher or form/year tutor has overall responsibility Stage 2 - SENCO takes the lead in co-ordinating provision and drawing up IEP Stage 3 - External specialist support enlisted Stage 4 - Statutory assessment by LEA Stage 5 - Statement issued by LEA

Table 8.2

Level of officially recognised special educational needs (SEN)

by type of mental disorder Children with special educational needs Type of mental disorder

Officially recognised special needs at: Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Base

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

28 25 18 6 24

25 20 27 5 23

18 15 34 6 27

7 3 13 77

22 20 25 5 28

39 32 15 0 13

35 29 18 1 17

127

225

85

32

361

1133

1494

Stage 1 - Class teacher or form/year tutor has overall responsibility Stage 2 - SENCO takes the lead in co-ordinating provision and drawing up IEP Stage 3 - External specialist support enlisted Stage 4 - Statutory assessment by LEA Stage 5 - Statement issued by LEA

Mental health of children and adolescents in Great Britain

95

8

Scholastic achievement and education

Table 8.3

Prevalence of mental disorder

by level of officially recognised SEN All children (where teacher data available) Special educational needs No special needs

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

All

Percentage of children with a mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders

3 3 1

7 12 3

7 12 3

8 26 12

[8] [11] [5]

12 24 10

4 6 2

Any disorder

6

16

18

36

[17]

43

10

6524

528

433

264

20

249

8018

Base

Table 8.4 Odds ratios for mental disorder and socio-demographic correlates of SEN

Variable

Value

Any mental disorder

Present Not present

1.00 4.61***

(3.90 - 5.44)

11-15 years 5-10 years

1.00 1.46***

(1.28 -1.65)

Female Male

1.00 2.04***

(1.80 - 2.31)

1 2 3 4 5 or more

1.00 1.00 1.13 1.30* 1.77**

(0.85 - 1.19) (0.94 - 1.37) (1.01 - 1.66) (1.24 - 2.52)

Both parents working One parent working Neither working

1.00 1.32*** 1.71***

(1.13 - 1.55) (1.40 - 2.08)

Age

Sex

Number of children

Family’s employment

Adjusted OR

Other variables entered into the model that were not significant were ethnicity, family type and ACORN classification. “*** p<0.001, **p<0.01, *p<0.05

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Mental health of children and adolescents in Great Britain

95% CI

Scholastic achievement and education

Table 8.5

8

Specific learning difficulties by type of mental disorder

All children (who completed the tests) Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

89 11

87 13

83 17

85 15

88 12

96 4

95 5

385

424

113

40

791

8543

9334

Specific learning difficulties (SpLD) Not present Present

Base

Table 8.6

Prevalence of mental disorders

by specific learning difficulties (SpLDs) All children (who completed the tests) Specific learning difficulties Not present

Present

All*

Percentage of children with a mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders

4 5 1

9 13 5

4 5 1

Any disorder

8

22

9

8865

468

9334

Base *

Percentages are different to the prevalence rates shown in chapter 4 owing to the reduced number of children who undertook the SpLD assessments.

Table 8.7

Absenteeism from school

by type of mental disorder All children (where teacher data were available) Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

No days absent

22

23

29

40

26

34

33

1 - 5 days 6 - 10 days 11 - 15 days 16 days and over

35 18 9 16

38 18 9 12

43 15 5 9

30 24 3 3

37 17 7 12

46 13 4 4

45 13 4 4

Any days absent

78

77

71

60

74

66

67

244

294

82

34

539

5726

6265

Base

}

25

}

21

}

14

}

6

}

19

}

8

}

8

Mental health of children and adolescents in Great Britain

97

8

Scholastic achievement and education

Table 8.8

Truancy (parent interview)

by type of mental disorder All children (who were more troublesome than average) Type of mental disorder

No Perhaps Definitely

Base

Table 8.9

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

83 6 11

80 5 14

87 4 8

91 3 6

83 5 12

97 2 2

94 2 4

216

425

117

34

607

1970

2576

Truancy (young person interview)

by type of mental disorder All 11-15 year olds who completed the self-completion questionnaire Type of mental disorder

No Perhaps Definitely

Base

Table 8.10

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

68 11 21

57 16 28

60 8 31

69 15 16

65 13 22

90 6 3

88 7 5

239

223

50

20

431

3891

4321

Truancy (teacher questionnaire)

by type of mental disorder All children (where teacher data were available) Type of mental disorder

Not true Somewhat true Certainly true

Base

98

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

85 7 7

81 8 11

89 8 3

91 9

85 7 8

98 1 0

97 2 1

345

408

123

47

752

7569

8321

Mental health of children and adolescents in Great Britain

Social functioning of the family

9 9.1

Social functioning of the family

Introduction

This chapter is concerned with the relationship between the mental health of the child and the social functioning of the child’s family. The term, social functioning, is used in a very broad sense to refer to several aspects of parental attitudes and behaviour and for the purposes of the survey includes: • • • • •

9.2

9

Mental health of interviewed parent Family functioning Reward strategies and punishment regimes Stressful life events Impact of child’s health on the family

Mental health of parent

The parent who was interviewed about the child’s mental health, in most cases the mother, was also asked about her own mental health by means of the GHQ-12 (General Health Questionnaire, Goldberg and Williams, 1988). The GHQ-12 is a self administered screening test of twelve questions designed to detect non-psychotic psychiatric disorders in community settings. 1. Have you recently been able to concentrate on whatever you’re doing? 2. Have you recently lost much sleep over worry? 3. Have you recently felt that you are playing a useful part in things? 4. Have you recently felt capable about making decisions about things? 5. Have you recently felt constantly under strain? 6. Have you recently felt you couldn’t overcome your difficulties? 7. Have you recently been able to enjoy your day to day activities? 8. Have you recently been able to face up to your problems? 9. Have you recently been feeling unhappy or depressed? 10.Have you recently been losing confidence in yourself? 11.Have you recently been thinking of yourself as a worthless person? 12.Have you recently been feeling happy, all things considered?

Each item is scored with a 1 according to whether it applied more than usual (for a negative item) or less than usual (for a positive item). A score in the range of 0 (no problem) to 12 (severe problem) was calculated for each person. In the present survey the threshold score was set at 3, i.e., all those with a score of 3 or more were deemed to have screened positive for a neurotic disorder. Of the 10,252 parents who completed the GHQ12, a quarter screened positive. This proportion is typical of that found in other community surveys. The distribution of GHQ12 scores was markedly different among parents of children with a mental disorder from those with no disorder: 47% of children assessed as having a mental disorder had a parent who scored 3 or more on the GHQ12, approximately twice the proportion of the sample of children with no disorder, 23%. The corresponding proportions for a GHQ12 score of 6 or more were 29% and 10%. Among the sample of children with a mental disorder, the proportions having a parent with a GHQ12 score of 3 or more did not vary considerably by type of disorder, ranging from 42% of those with a hyperkinetic disorder to 50% with an emotional disorder. (Table 9.1) The proportion of children with parents who screened positive on the GHQ12 increased with the severity of the child’s mental health problem, as measured by the number of diagnosed, specific mental disorders. The proportion of children with GHQ12 screen-positive parents rose from 23% of the no-disorder group to 44% of children with one disorder to 50% of those with two disorders and to 68% of children with three disorders. (Table 9.2) The association between the child’s and the interviewed parent’s mental health status can be seen most clearly in Figure 9.1. It shows that the proportion of children with mental disorders increased steadily by the ungrouped GHQ12 score with a minimum prevalence rate of any mental disorder of 5% among children whose parents scored zero to a maximum of 37% among children with parents who scored 11. In summary, children with parents who screened positive on the GHQ12

Mental health of children and adolescents in Great Britain

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9

Social functioning of the family

Percentage of children with a mental disorder

Figure 9.1 Children with a mental disorder by parent‘s GHQ-12 score 40 35 30 25 20 15 10 5 0 0

1

2

3

4

5

6

7

8

9

10

11

12

Parent’s GHQ-12 score

were three times more likely to have a mental disorder than those whose parents had sub-threshold scores 18% compared with 6%. Data on the relationship between the parent GHQ12 scores and types of disorder are shown in Tables 9.3 and 9.4.

9.3

Family functioning

The instrument used to estimate family functioning was the General Functioning Scale of the MacMaster Family Activity Device (FAD-GFS). It comprises 12 statements that parents rate on a four point scale: strongly agree, agree, disagree and strongly disagree. The scale has been shown to have good reliability, internal consistency and validity in distinguishing between non-clinical families and families attending a psychiatric service. (Miller et al., 1985, Byles et al., 1988, Fristad., 1989) 1. Planning family activities is difficult because we misunderstand each other. 2. In times of crisis we can turn to each other for support. 3. We can not talk to each other about the sadness we feel. 4. Individuals are accepted for what they are. 5. We avoid discussing our fears and concerns. 6. We can express feelings to each other. 7. There is lots of bad feeling in the family. 8. We feel accepted for what we are. 9. Making decisions is a problem for our family. 10. We are able to make decisions on how to solve problems. 11. We don’t get along well together. 12. We confide in each other.

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Mental health of children and adolescents in Great Britain

A scoring system is used to calculated “healthy” or “unhealthy” family functioning. Overall, 19% of children lived in families assessed as having unhealthy family functioning. The Western Australian Child Health Survey also used the FAD and reported that over 12% per cent of the 1500 families surveyed were considered to have a high level of family discord.(Silburn et al., 1996) It is difficult to compare this figure with the GB survey as their method of calculating high discord was not presented. In the present survey, children with a mental disorder were twice as likely to live in families rated as unhealthy than children with no disorder: 35% compared with 17%. Among children assessed as having a conduct disorder, 43% were part of a family with an unhealthy FAD-GFS rating. (Table 9.5) These findings add to the accumulated evidence from a number of sources which suggest that disordered family functioning is implicated in a wide range of psychiatric problems in children. (Tamplin et al., 1998). More specifically, they found marked differences between the mean FAD scores of control families and those with depressed adolescents. Among the small number of children in the survey, 65 in total, who turned out to have had three or more specific mental disorders, the proportion with an unhealthy family functioning rating was 55%. (Table 9.6) Another way of analysing the data on family functioning is to look at the prevalence of mental disorders among children by the level of family

Social functioning of the family

functioning. Given that the overall prevalence of mental disorders among children and adolescents was 10%, the rate among children in healthy functioning families was 7% compared with 18% among unhealthy, functioning families. Among the 255 children in families with the worst family functioning score, about a third had a mental disorder. (Table 9.7)

9.4

Reward strategies and punishment regimes

How parents reward their children for good behaviour and punish them for bad behaviour was investigated by asking parents to rate the frequency of their use of three reward strategies and six punishment regimes.

Reward strategies 1. Giving encouragement or praise. 2. Giving treats such as extra pocket money, staying up late or a special outing. 3. Giving child favourite things. Punishment regimes 1. Sending child to his/her room. 2. Grounding or keeping him/her in. 3. Shouting or yelling at him/her. 4. Smacking him/her with your hand. 5. Hitting him/her with a strap or something else. 6. Shaking him/her. Parents had a choice of saying whether they carried out each activity, never, seldom, sometimes or frequently. Among all children, 82% were frequently encouraged or praised, 34% were frequently treated and 30% were given favourite things. There were no great differences in the distribution of reward strategies by whether or not the children had a mental disorder. However, there was a very slight increase in the proportion of children who frequently got treats or received favourite things among children with a disorder compared to those with no disorder: 40% compared with 33% for treats and 35% compared to 30% for given favourite things. (Table 9.8) The six punishment regimes listed above can be split into two groups: those involving no physical punishment (sending to room, grounding, and shouting) and those with a physical element (smacking with hand, hitting with strap, and

9

shaking). Looking at the differences in the frequency of punishment by the presence or type of disorder can only be done for the non-physical punishments as very few parents do or admit to sometimes or frequently smacking, hitting or shaking their children. In terms of the non-physical punishments, children with mental disorders were far more likely to be frequently punished than children with no mental disorder: 18% compared with 8% were sent to their rooms; 17% compared with 5% were grounded, and 42% compared with 26% were shouted at. Not unexpectedly, the major contribution to these differences derive from the higher rates of frequent punishment among children with conduct or hyperkinetic disorders, i.e., disorders that have a behavioural impact, in contrast to emotional problems. (Table 9.9) Looking at the prevalence of mental disorders by punishment regimes is a complimentary way of looking at the association between these two characteristics. Table 9.10 shows the higher rates of mental disorder among children more frequently punished: 20% of those frequently sent to their room; 27% of frequently grounded children; 15% of children shouted at frequently; and 38% of children frequently smacked. Conduct disorders made a major contribution to these prevalence rates. For example, 21% of frequently grounded children and 34% of frequently smacked child had a conduct disorder. (Tables 9.10, 9.11)

9.5

Stressful life events

All parents were asked if the child experienced ten stressful life events. The items in the list were chosen because they are thought to be highly (psychologically) threatening for the child. Goodyer (1990) has suggested that moderately or highly undesirable recent life events exert potential causal effects on the onset of emotional and behavioural symptoms in school aged children. 1. Since child was born, parent had a separation due to marital difficulties or broken off a steady relationship. 2. Since child was born, parent (or partner) had a major financial crisis such as losing the equivalent to at least three months income. 3. Since child was born, parent (or partner) had a problem with the police involving a court appearance.

Mental health of children and adolescents in Great Britain

101

9

Social functioning of the family

4. At some stage in the child’s life, s/he had a serious illness which required a stay in hospital. 5. At any stage in the child’s life, s/he had been in a serious accident or badly hurt in an accident. 6. At any stage in the child’s life, a parent, brother or sister died. 7. At any stage in the child’s life, a close friend died. 8. At any stage in the child’s life, a grandparent died. 9. At any stage in the child’s life, a pet died. 10. In the past year, child has broken off a steady relationship with a boy or girl friend. (applies if aged 13 or above) Children with a mental disorder were more likely than those with no disorder to have experienced eight of the ten events. For example, 50% of children with a mental disorder had at one time seen the separation of their parents, compared with 29% of the sample with no disorder. The corresponding figures for a parent having problems with the police were 15% and 5% and for a parent or sibling dying - 6% compared with 3%. The two events which showed little difference in the frequency of their occurrence by presence or absence of disorder were the death of a grandparent at around 13% and the death of a pet at 27%. There was no clear relationship between type of disorder and type of event. Nevertheless, the disorder with the greatest proportion of children who had a serious illness, 39%, was hyperkinetic disorder and children with emotional disorders included the largest percentage of those who had broken off a relationship with a boy or girl friend, 24%. (Table 9.12) Many children experienced more than one stressful event in the course of their lives. Among all the children in the sample, about a third had never had a stressful life event, a third had experienced one event and around a third had to cope with two or more stressful events. Although children with a mental disorder were more likely than other children to have had one stressful life event: 82% compared with 70%, they were far more likely to have experienced three or more events: 31% compared with 13%. The proportion of children who had experienced several stressful life events was very similar for those with emotional, behavioural and hyperkinetic disorders. (Table 9.13)

102

Mental health of children and adolescents in Great Britain

The prevalence of mental disorder by type of event is difficult to interpret because of the relatively large proportion of children who had more than one stressful life event. Nevertheless, the data indicate that the two factors associated with the highest prevalence rates were: split with boyfriend or girlfriend (24%) and parent or partner in trouble with the police (22%). (Table 9.14) The number of stressful life events does seem to have a cumulative effect on psychiatric morbidity with prevalence rates ranging from 7% among children with one event to 16% of those who had three events to 34% of children who had experienced five or more stressful life events. (Table 9.15)

9.6

Social functioning correlates of mental disorders

Logistic regression analysis was used to look at the increased odds of having any mental disorder (compared to no disorder) in terms of the independent association with the four factors described above - parent’s GHQ12, punishment regime, family functioning and number of stressful life events. Six socio- and geo-demographic characteristics were also inserted into the model: sex, age, number of children, family structure, family employment and the ACORN measure. A screen-positive, parental GHQ12 score increased the odds of the child having a mental disorder by 2.23. Frequent punishment increased the odds by 1.97, unhealthy family functioning by 1.82 and at least one stressful life event by 1.35. (Table 9.16)

9.7

Impact of child’s mental disorder on the family

The last section of this chapter focuses solely on children who had been assessed as having a mental disorder and were described by their parent as having a significant health problem: 792 children. The children with a mental disorder not covered in this impact section are those where the diagnosis came primarily from the child or teacher. The parents of these children either did not mention the child’s problem, or did not think it had a major significance in their lives, and thus, were routed past the impact questions.

Social functioning of the family

The impact of the child’s mental problems can be grouped under three headings: • Impact of child’s problems on family relationships • Impact of child’s problems on the social life of the family and stigma • Impact of child’s problems on parents’ health

9

Finally, a quarter of parents said their children’s problems caused difficulties with other family members. This proportion included a third of parents of children with conduct and hyperkinetic disorders and a fifth of parents who had children with emotional disorders. (Table 9.17)

Social life and stigma The questions on impact in the survey were based on the Child and Adolescent Burden Assessment. (Patrick et al., 1994)

Family relationships Among children with a mental disorder who were living in households with two parents or a parent and partner, about 1 in 3 of their parents said the child’s problem made their relationship more strained, around 1 in 6 said it made their relationship stronger and, for the remaining children, 1 in 2, it made no difference. Because we are only looking at children with mental disorders, identified by parents, within a particular family structure, the base numbers are relatively small. This means the data will be interpreted to indicate patterns rather than statistically significant differences. Conduct disorders do seem to cause a greater strain on parent and partner relationships than emotional disorders: parents of 49% of children with conduct disorders reported that the child’s problem made their relationship more strained, the corresponding proportion for parents of children with emotional disorders was 27%. Parents with no partner in the household were asked if the child’s mental disorder was a contributory factor to a previous relationship breaking up. Overall, 20% of parents replied that it was a factor, which included 26% of parents of children with conduct disorders and 16% with emotional disorders. The third family structure scenario examined was the impact of the child’s problem on the parent’s (and the partner’s) relationship with their other children. The responses for parent and partner were similar in that 25%-30% reported the child’s problem made their relationships with other children more difficult.

About 15 % of children with any mental disorder had parents who reported their own social difficulties caused by their child’s problem: difficulties with their friendships, major disruptions to their social and leisure activities, and, to a great extent, preventing them from doing things socially with the child. These difficulties seemed more likely to be experienced by parents of children with conduct or hyperkinetic than with emotional disorders. This difference by type of disorder was more distinct when looking at the parents’ responses to the stigma questions - whether child’s difficulties caused embarrassment and whether parent felt disapproved of or avoided because of the child’s problems. Overall, the proportion of children with mental disorders whose parents expressed these views was around 30%, yet for the embarrassment question the proportion for children with conduct disorders was 46%. (Table 9.18)

Effect on parents’ health The mental health problems of the child had a considerable impact on the health of the interviewed parent. Eighty seven per cent of parents said their child’s problems made them worried and 58% felt that their child’s problems caused them to be depressed. About two thirds of parents said their child’s mental health problem made them tired and a quarter said it made them physically ill. Children with emotional disorders seemed less likely to have an impact on their parents’ health than those with conduct or hyperkinetic disorders. (Table 9.19) Parents reacted to their worry, depression, tiredness or physical illness in different ways: 31% sought help from a doctor (of which two thirds received medication), 9% drank more alcohol and 30% increased their smoking. (Table 9.20)

Mental health of children and adolescents in Great Britain

103

9

Social functioning of the family

References Byles, J., Byrne, C., Boyle, M.H., Offord, D.R. (1988) Ontario Child Health Study: Reliability and validity of the General Functioning Scale of the MacMaster Family Assessment Device. Family Process, 30(1), 116-123 Fristad, M.A. (1989) A comparison of the MacMaster and circumplex family assessment instruments. Journal of Marital and Family Therapy, 15, 259-269. Goodyer, I.M., Wright, C., and Altham. P.M.E., (1990) The Friendships and Recent Life Events of Anxious and Depressed School-Age-Children. British Journal of Psychiatry, 156, (May), 689-698 Miller, I.W., Epstein, N.B., Bishop, D.S. and Keitner, G.I. (1985) The MacMaster Family Assessment Device: reliability and Validity. Journal of Marital and Family Therapy, 11, 345356 Patrick, M.K.S., Angold, A., Burns, B.J., and Costello, E.J., The Child and Adolescent Burden Assessment (CABA) Parent Interview, Version 4.1, Developmental Epidemiology Program, Duke University. Silburn, S.R., Zubrick, S.R., Garton, A., Gurrin, L., Burton, P., Dalby, R., Carlton, J., Shepherd, C., Lawrence, D. (1996) Western Australian Child Health survey: Family and Community Health, Western Australia: Australian Bureau of Statistics and the TVW Telethon Institute for Child Health Research. Tamplin, A., Goodyer, I.M. and Herbert, J. (1998) Family functioning and parent general health in families of adolescents with major depressive disorders. Journal of Affective Disorders, 48, 1-13.

104

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.1

9

Distribution of parent’s GHQ-12 scores

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

0-2 3-5 6-8 9-12

50 16 17 17

51 20 14 15

58 18 16 8

52 19 17 13

53 18 15 14

77 13 6 4

75 13 7 5

3 or more

50

49

42

48

47

23

25

444

491

139

56

925

9297

10252

Parent’s GHQ-12

Base

Table 9.2

Distribution of parent’s GHQ-12 scores

by number of mental disorders All children Number of mental disorders 0

1

2

3+

All

%

%

%

%

%

0-2 3-5 6-8 9-12

77 13 6 4

56 17 14 13

50 18 18 14

32 24 18 26

75 13 7 5

3 or more

23

44

50

68

25

9326

640

220

65

10252

Parent’s GHQ-12

Base

Table 9.3

Prevalence of mental disorders

by parent’s GHQ-12 score All children Parent’s GHQ score 0

1

2

3

4

5

6

7

8

9

10

11

12

All

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

2 3 1 0

4 4 2 1

5 7 2 0

5 7 2 1

5 9 3 1

6 9 1 1

9 11 4 -

10 8 2 2

12 13 3 2

13 16 1 -

14 12 2 2

19 21 5 2

18 19 1 2

4 6 1 1

Any mental disorder

5

8

11

12

13

13

19

20

23

24

24

37

34

10

5221

1567

886

595

438

339

278

239

206

148

126

123

87

10252

Base

Mental health of children and adolescents in Great Britain

105

9

Social functioning of the family

Table 9.4

Prevalence of mental disorders

by parent’s GHQ-12 score (grouped) All children Parent’s GHQ score 0-2

3-5

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

3 3 1 0

5 8 2 1

Any mental disorder

6

7673

Base

Table 9.5

6-8

9-12

Below threshold

At or above threshold

All

Percentage of children with each disorder 10 16 3 11 17 3 3 2 1 1 2 0

9 10 2 1

4 6 1 1

13

20

30

6

18

10

1372

723

483

7673

2578

10252

Distribution of family functioning scores

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Up to 1.50 1.51 - 2.00

27 39

17 40

21 42

30 42

23 41

37 46

36 46

Healthy family functioning

66

57

64

73

65

83

81

2.01 - 2.50 2.51 or higher

26 8

31 12

30 7

18 9

27 8

15 2

16 2

Unhealthy family functioning

34

43

36

27

35

17

19

438

485

139

56

915

9297

10212

Family functioning score

Base

106

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.6

9

Distribution of family functioning scores

by number of mental disorders All children Number of mental disorders 0

1

2

3+

All

%

%

%

%

%

Up to 1.50 1.51 - 2.00

37 46

25 42

20 42

20 27

36 46

Healthy family functioning

83

68

62

47

81

2.01 - 2.50 2.51 or higher

15 2

25 7

30 8

30 23

16 2

Unhealthy family functioning

17

32

38

53

19

9297

632

217

65

10212

Family functioning score

Base

Table 9.7

Prevalence of mental disorders

by family functioning score All children Healthy family functioning

Unhealthy family functioning

1.00-1.50

1.51-2.00

All healthy

2.01-2.50

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

3 2 1 1

4 4 1 1

4 3 1 1

7 10 2 1

Any mental disorder

6

8

7

3621

4665

8286

2.51-4.00

All unhealthy

All

15 25 4 2

8 12 3 1

4 6 1 1

16

32

18

10

1671

255

1926

10212

Percentage of children with each disorder

Base

Mental health of children and adolescents in Great Britain

107

9

Social functioning of the family

Table 9.8

Reward strategies

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Encouragement or praise Never Seldom Sometimes Frequently

0 1 19 79

1 2 23 74

1 2 18 78

2 16 82

0 1 21 78

0 1 16 82

0 1 17 82

Treats (pocket money or staying up late) Never Seldom Sometimes Frequently

6 6 46 43

4 8 48 40

1 11 49 39

8 6 47 40

4 7 48 40

4 8 55 33

4 8 54 34

Giving child favourite things Never Seldom Sometimes Frequently

5 9 48 37

6 11 48 34

1 14 48 38

8 4 55 34

6 10 49 35

4 10 56 30

4 10 56 30

445

492

139

57

928

9376

10305

Reward strategies

Base

108

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.9

9

Punishment regimes

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

Sending child to his/her room Never Seldom Sometimes Frequently

26 27 35 12

21 20 34 25

23 18 34 26

29 35 29 7

23 25 34 18

26 35 31 8

26 34 31 9

“Grounding” or keeping him/her in Never Seldom Sometimes Frequently Too young to go out alone

28 24 27 13 8

16 20 34 24 7

19 22 31 18 10

38 22 21 8 11

23 22 30 17 8

34 27 24 5 10

33 26 24 6 10

Shouting or yelling at him/her Never Seldom Sometimes Frequently

8 15 43 34

3 8 37 53

5 7 33 55

7 18 46 29

5 12 41 42

6 19 50 26

6 18 49 28

Smacking him/her with your hand Never Seldom Sometimes Frequently

58 32 8 1

41 41 15 3

37 48 12 2

63 24 12 -

49 37 12 2

56 35 9 0

55 35 9 0

Hitting him/her with strap Never Seldom Sometimes Frequently

99 1 0 -

96 3 1 -

96 3 1 -

97 2 2 -

97 2 1 -

99 1 0 0

98 1 0 0

Shaking him/her Never Seldom Sometimes Frequently

96 3 1 -

94 5 1 -

93 6 1 -

98 2 -

96 4 1 -

98 2 0 0

98 2 0 0

445

492

139

56

928

9374

10302

Punishment regimes

Base

Mental health of children and adolescents in Great Britain

109

9

Social functioning of the family

Table 9.10

Prevalence of mental disorders

by type of non-physical, parental punishment All children Frequency of sending child to his room Never

Seldom

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

4 4 1 1

3 3 1 1

Any mental disorder

8

Sometimes

Frequently

All

5 6 2 1

6 16 4 1

4 6 1 1

6

11

20

10

2669

3530

3215

884

10299

Never

Seldom

Frequently

All*

Percentage of children with each disorder

Base

Frequency of grounding child or keeping him/her in Sometimes Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

4 2 1 1

4 4 1 1

5 8 2 1

9 21 4 1

4 6 1 1

Any mental disorder

6

8

12

27

10

3444

2722

2489

612

10300

Frequently

All

Base

* Includes 1033 children too young to go out alone Frequency of shouting or yelling at child Never

Seldom

Sometimes Percentage of children with each disorder

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

6 2 1 1

4 2 1 1

4 4 1 1

5 10 3 1

4 6 1 1

Any mental disorder

8

6

8

15

10

565

1879

5030

2829

10303

Base

110

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.11

9

Prevalence of mental disorders

by type of physical, parental punishment All children Frequency of smacking child with hand Never

Seldom

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

5 4 1 1

4 7 2 0

Any mental disorder

8

5690

Sometimes

Frequently

All

4 9 2 1

10 34 7 -

4 6 1 1

11

13

37

10

3594

966

51

10302

Frequently

All

Percentage of children with each disorder

Base

Frequency of hitting child with a strap or something else Never

Seldom

Sometimes

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any mental disorder

Base

4 6 1 1

4 13 3 1

[1] [4] [1] [1]

-

4 6 1 1

10

16

[6]

-

10

10140

123

29

8

10301

Never

Seldom

Frequently

All

Frequency of shaking child Sometimes

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders Any mental disorder

Base

4 6 1 1

7 16 5 -

[3] [3] [1] [1]

-

4 6 1 1

10

19

[6]

-

10

10081

187

27

7

10302

Mental health of children and adolescents in Great Britain

111

9

Social functioning of the family

Table 9.12

Stressful life events

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Proportion of children who have experienced each stressful life event Stressful life event Since child was born parent had a separation due to marital difficulties or broken off steady relationship

49

58

47

39

50

29

31

Since child was born parent (or partner) had a major financial crisis such as losing the equivalent of three months income

28

25

20

25

24

15

16

Since child was born parent (or partner) had a problem with the police involving a court appearance

15

18

13

5

15

5

6

At some stage in the child’s life s/he had a serious illness which required a stay in hospital

33

28

39

30

30

20

20

At any stage in child’s life, child had been in a serious accident or badly hurt in an accident

10

9

8

8

9

5

5

At any stage in child’s life, a parent, brother or sister died

5

7

8

4

6

3

3

At any stage in child’s life, a close friend died

12

9

9

12

10

5

6

At any stage in child’s life, a grandparent died

16

12

17

9

14

13

13

At any stage in child’s life, a pet died

32

22

27

13

27

27

27

In the past year child has broken off a steady relationship with a boy or girl friend (asked if aged 13 or above)

24

17

14

[5]

18

8

10

445 174

492 163

139 31

57 19

928 313

9376 2347

10305 2661

Base = all children Base = children aged 13 or above

112

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.13

9

Number of stressful life events

by type of mental disorder All children Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

0 1 2 3 4 5+

15 26 21 19 11 7

17 27 24 15 13 4

16 27 28 14 12 4

28 25 22 18 4 4

18 27 24 16 11 4

30 35 22 9 3 1

29 34 22 10 4 1

At least one event

85

83

84

72

82

70

71

Base = all children

445

492

139

57

928

9380

10309

Number of stressful life events

Table 9.14

Prevalence of mental disorders

by type of stressful life events All children Marital difficulties

Financial crisis

Trouble with police*

Serious illness

Serious accident

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

7 10 2 1

8 9 2 1

10 16 3 1

7 7 3 1

8 9 2 1

Any mental disorder

16

15

22

14

16

3151

1599

646

2108

548

Death of parent/sibling

Death of close friend

Death of grandparent

Death of pet

Split up with boy/girl friend

Base * Parent or partner’s trouble with the police

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

6 11 3 1

10 9 2 1

6 4 2 0

5 4 1 0

16 11 2 2

Any mental disorder

17

17

11

10

24

338

579

1315

2735

257

Base

Mental health of children and adolescents in Great Britain

113

9

Social functioning of the family

Table 9.15

Prevalence of mental disorders

by number of stressful life events All children 0

1

2

3

4

5+

All

Percentage of children with each disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

2 3 1 1

3 4 1 0

4 6 2 1

9 8 2 1

12 18 4 1

24 18 4 2

4 6 1 1

Any mental disorder

6

7

11

16

27

34

10

2992

3550

2264

979

396

128

10309

Base

Table 9.16

Odds Ratios for social functioning and socio-demographic correlates of mental disorders

Variable

Value

Parent’s GHQ-12 score

0-2 3+

1.00 2.23***

................. (1.93-2.59)

Punishment regime

Infrequent Frequent

1.00 1.97***

................. (1.70-2.39)

Family functioning

Healthy Unhealthy

1.00 1.82***

................... (1.56 - 2.13)

Stressful life events

None At least one

1.00 1.35**

.................. (1.12-1.63)

Age of child

5 - 10 years 11-15 years

1.00 1.52***

................. (1.32-1.76)

Sex of child

Girl Boy

1.00 1.50***

................. (1.30-1.73)

Family type

Two parent family One parent family

1.00 1.33**

................. (1.10-1.60)

Family employment

All working One parent working All not working

1.00 1.26* 1.75***

................. (1.03-1.54) (1.42-2.15)

ACORN classification

Thriving Expanding Rising Settling Aspiring Striving

1.00 1.37* 1.58* 1.50** 1.71*** 1.67***

................. (1.02-1.84) (1.11-2.26) (1.16-1.94) (1.30-2.25) (1.30-2.15)

Other variables entered which were not significant were: number of children *** p<0.001, ** p<0.01, * p<0.05

114

Mental health of children and adolescents in Great Britain

Adjusted OR

95% CI

Social functioning of the family

Table 9.17

9

Impact of child’s problems on family relationships

by type of mental disorder

Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

%

%

%

%

%

27 54 18

49 37 14

41 43 16

18 52 30

34 49 17

249

233

85

39

491

Child’s problems put a strain on a previous relationship and was part of the reason the relationship broke up...... to a great extent to some extent not at all problem started before split

9 7 75 8

12 14 64 10

8 12 71 8

[2] [11] [2]

9 11 70 10

Base = parent with no partner in household

147

171

50

15

300

23 60 11 6

34 54 7 6

31 57 2 9

24 55 12 10

25 59 9 7

395

402

134

54

789

25 51 14 10

39 44 4 12

34 48 3 14

24 57 8 11

30 50 9 11

372

378

122

49

736

19 81

35 65

35 65

34 66

26 74

397

401

134

56

791

Impact of child’s problems (as described by parent) on family relationships Child’s problems made relationship with partner...... more strained no different stronger

Base = parent with partner

Child’s problems made relationship with other children...... more difficult no different stronger no other children

Base = all parents Child’s problems made partner’s relationship with his/her other children...... more difficult no different stronger no other children

Base = all parents Child’s problems caused difficulties with other family members Yes No

Base = all parents

Mental health of children and adolescents in Great Britain

115

9

Social functioning of the family

Table 9.18

Impact of child’s problems on social life and stigma

by type of mental disorder Children with disorder whose parents reported at least one significant mental health problem of child Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

%

%

%

%

%

Child’s problems caused difficulties with parent’s own relationships with friends Yes No

14 86

21 79

17 83

29 71

15 85

Child’s problems disrupted parents leisure and social activities... to a great extent to some extent not at all

14 30 56

18 35 48

18 33 49

27 39 34

14 32 54

Child’s difficulties have kept parent from doing things socially with child.... to a great extent to some extent not at all

12 25 63

21 32 47

28 31 41

25 39 36

16 29 55

Child’s difficulties have caused embarrassment to parent Yes No

19 81

46 54

42 58

40 60

31 69

Parent has felt disapproved of or avoided because of child’s difficulties Yes No

23 77

36 64

41 59

44 56

29 71

397

402

134

56

792

Impact of child’s problems (as described by parent) on social life and stigma

Base = all parents

116

Mental health of children and adolescents in Great Britain

Social functioning of the family

Table 9.19

9

Impact of child’s problems on parent’s health

by type of mental disorder Children with disorder whose parents reported at least one significant mental health problem of child Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

%

%

%

%

%

Child’s problems caused parent to be worried...... to a great extent to some extent not at all

37 48 15

44 48 8

41 50 9

57 34 9

38 49 12

Child’s problems caused parent to be depressed...... to a great extent to some extent not at all

19 35 46

24 43 33

20 42 38

22 40 39

19 39 42

Child’s problems caused parent to be tired...... to a great extent to some extent not at all

24 38 39

33 44 23

35 44 20

39 45 16

27 41 31

Child’s problems caused parent to be physically ill...... to a great extent to some extent not at all

11 16 74

12 20 68

11 9 80

11 20 69

10 16 74

397

402

134

56

792

Impact of child’s problems (as described by parent) on parent’s health

Base = all parents

Mental health of children and adolescents in Great Britain

117

9

Social functioning of the family

Table 9.20

Impact of child’s problems on parent’s health behaviour

by type of mental disorder Children with disorder whose parents reported at least one significant mental health problem of child Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

%

%

%

%

%

32 68

35 65

30 70

37 63

31 69

361

385

128

54

736

70 30

64 36

60 40

[10] [10]

63 37

114

135

38

20

227

9 91

9 91

8 92

15 85

9 91

361

385

128

54

736

29 71

37 63

28 72

16 84

30 70

361

385

128

54

736

Parent’s behaviour if child’s problems had caused worry, depression, tiredness or physical illness to some or a great extent Went to see a doctor Yes No

Base = Parents whose child caused them health problems Prescribed medicine by doctor Yes No

Base = Parents who went to see doctor owing to health problems caused by child’s problem Drank more alcohol Yes No

Base = Parents whose child caused them health problems Smoked more cigarettes Yes No

Base = Parents whose child caused them health problems

118

Mental health of children and adolescents in Great Britain

Children’s social functioning and lifestyle behaviours

10

10

Children’s social functioning and lifestyle behaviours

10.1 Introduction Whereas the previous chapter looked at the relationship between mental disorders among children and measures of family functioning, this final chapter focuses on the social life of children in terms of their friendships, help-seeking behaviour and lifestyle. The term, lifestyle behaviour, is used to cover smoking, drinking and drug use.

hyperkinetic disorders were slightly more likely, than those with emotional disorders not to have a ‘best’ friend: 28% compared with 16%. (Table 10.1) Young people spent a lot of their spare time with friends. Among all young people, who had friends, only 12% spent little or none of their spare time with their friends. Again, there was very little difference in the amount of time that children spent with their friends by presence of a mental disorder or by type of disorder. (Table 10.1)

10.2 Friendships A child’s social life usually revolves around their friends so to find out more about their friendships 11-15 year olds were asked the following questions: • Do you have any friends? • How much time do you spend together (with your friends)? • How often do friends come to your home? • How often do you go to your friend’s home? • Can you confide in any of your friends such as sharing a secret or telling them private things? • Do you have a ‘best’ friend or special friend? • Over the past 12 months have you belonged to any teams, clubs or other groups with an adult in charge? Looking at the responses to the individual questions permits a more detailed examination of the relationship between mental disorders and friendship behaviour. In reviewing previous studies Goodyer et al. (1990) have commented that good peer relationships are probably necessary for healthy mental development. Absence of close relationships may increase the risk of psychiatric disorder. The first question in the friendship section asked young people if they had any friends. Not surprisingly, virtually all young people reported that they had friends. However, a quarter of these children said that they did not have a ‘best’ or special friend. There was very little difference in the proportions of children without friends or ‘best’ friends by presence of or type of disorder. The only notable difference was that children with

The next two questions in the friendship section asked young people how often friends came to their house and how often they went to their friend’s homes. Just over a quarter (28%) of all young people only had friends round to their home for just a little or none of the time. Children with a mental disorder were more likely, than those with no disorder, to have friends round infrequently: 35% compared with 27%. There was some difference by the three broad types of disorder: 15% of children with hyperkinetic disorders did not have any friends round, compared with 9% with conduct disorders, 7% with emotional disorders and 4% of children with no disorder. (Table 10.1) Young people’s behaviour in going round to their friend’s homes followed a similar pattern to their friends coming round to their homes. Just under a quarter (24%) of children did not visit or only spent a little time at their friends. Children with a mental disorder were less likely than other children to spend time at their friends’ houses: with 31% compared with 23% spending only a little or none of their spare time at their friends. There was little difference in the amount of time spent in their friends’ homes by type of mental disorder. (Table 10.1) Young people were also asked if they felt able to confide in any of their friends such as sharing secrets or telling them private things. Only a small proportion of children (6%) felt unable to confide in friends. Children with a mental disorder were more likely, than those with no disorder, to report that they did not feel able to confide in friends: 8% compared with 5%. This proportion varied

Mental health of children and adolescents in Great Britain

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10

Children’s social functioning and lifestyle behaviours

slightly by type of disorder, ranging from 6% of those with an emotional disorder, to 8% with hyperkinetic disorder and 10% with conduct disorders. (Table 10.1)

10.3 Help-seeking behaviour All 11-15 year olds were asked if they had ever felt so unhappy or worried that they asked someone for help. Overall, a quarter of them had sought help because they had felt so unhappy or worried in the past. Children with a disorder were almost twice as likely, as those without a disorder, to have been in this situation (41% compared with 23%). About half the children with an emotional disorder had sought help, and a third of those with hyperkinetic and conduct disorders. (Figure 10.2)

The final question in the friendship section was about membership of teams, clubs or other groups (with an adult in charge) over the past 12 months. Just over a quarter (27%) of children had not been a member of a club, team or group over the past 12 months. However, this applied to over a third (36%) of children with a mental disorder. (Table 10.1) An overall friendship score was computed by allocating a score of one to the more positive responses and zero to the negative answers to the friendship questions. Thus children with no friends scored zero and those who; (a) had a best friend (b) spent some or all of their spare time with friends (c) frequently had friends visiting them in their home (d) went round to their friends home some or all of the time (e) confided in their friends and (f) were club members, scored six. Across the whole population of 11-15 year olds, just 6% had a severe lack of friendship (a score of 0 - 2). However, this proportion was greater among those with mental disorders than those with no disorder: 9% compared with 5%. The group containing the largest proportion with severe lack of friendship, 12%, were children assessed as being hyperkinetic. (Table 10.2, Figure 10.1)

This group of young people, who had sought help in the past, were then asked who they had turned to for help when they needed it; this could have been more than one person. Mothers were the most frequently mentioned (58%). A special friend was the next most popular, 52%, and the child’s father was the third most common response (28%). Overall, a small proportion of children had asked for help from professional advisors, such as school nurses, doctors, social workers or had used a telephone helpline. However these services were used by a far greater proportion of children with a mental disorder than those with no disorder: 27% compared with 4%. (Table 10.3) The majority of children who had sought help (56%) wanted a chance to talk things over, 15% required practical advice and 29% were seeking both practical advice and a chance to talk things over. (Table 10.4)

Figure 10.1 Distribution of friendship scores by type of mental disorder Distribution of friendship scores

100 90 80 70 60 50 40 30 20 10 0

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Any disorder

No disorder

All

Type of disorder Score 5 - 6 Little or no lack of friends

120

Mental health of children and adolescents in Great Britain

Score 3 - 4 Moderate lack of friends

Score 0 - 2 Severe lack of friends

Children’s social functioning and lifestyle behaviours

Percentage of children who have sought help in the past because the felt so unhappy or worried

Figure 10.2

10

Help seeking behaviour by type of mental disorder

60 50 40 30 20 10 0

Emotional disorders

Conduct disorders

Hyperkinetic disorders

Any disorder

No disorder

All

Type of disorder

The young people who had not sought help were asked to imagine who they would turn to for assistance if they ever needed it. Again, it was the child’s mother who was the most popular choice, proposed by 79% of children. The child’s father and a special friend were the next two most commonly reported (46%). Twenty four per cent of children mentioned brother or sister. (Table 10.5) When asked what type of help they would expect to receive, 14% hoped to get practical advice, 37% wanted the opportunity to talk things over and 49% thought they would get both practical advice and a chance to talk things over. (Table 10.6)

A comparison of the data from both sources, presented in Tables 10.7, 10.8 and 10.9, suggest that children interviewed at home systematically underreport their smoking, drinking and drug use compared to the rates from the school survey. Therefore, the only analysis presented in this report is the prevalence of mental disorders by the lifestyle behaviours of children and not the prevalence of smoking, drinking and drug use by type of mental disorder. Therefore, any differences in the rates of mental disorder by smoking, drinking or drug use are probably an underestimate of the true difference between users and non-users.

10.4 Smoking, drinking and drug use Questions on smoking, drinking and drug use were included in the survey so that the relationship between mental disorders and life style behaviours could be examined. The questions asked in the mental health survey were taken from the national surveys of smoking, drinking and drug use among young teenagers in England and Scotland, carried out by ONS (Goddard and Higgins, 1999). Although the question wording was similar in both surveys, the mode of administration was different. In the surveys dedicated to estimating the prevalence of smoking, alcohol consumption and drug use, young people were given a paper questionnaire to complete in a group setting in school. Samples of saliva were taken from fifty percent of the children, for cotinine analysis, to monitor the accuracy of the results on smoking. For the current survey, 11-15 year olds were asked to complete a questionnaire on a lap-top computer at home.

Smoking Children were categorised into five groups according to their smoking behaviour: regular smokers, occasional smokers, those who used to smoke, children who had tried it once and those who had never smoked. Whereas the overall prevalence rate of mental disorders among 11-15 year olds was 11%, the mental health profile of regular smokers (>6 cigarettes a day) was different from all other groups: 41% of 11-15 year olds who regularly smoked were assessed as having a mental disorder (28% had a conduct disorder, 20% had an emotional disorder and 4% were rated as having a hyperkinetic disorder). The group with the second highest prevalence of mental disorders were those who used to smoke; a rate of 16%. The prevalence among children who had never smoked was 7%. (Table 10.10)

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Drinking Children were placed into seven groups in terms of their alcohol consumption: more than once a week, about once a week, about once a fortnight, about once a month, a few times a year, never drinks alcohol now and never had an alcoholic drink. As found for smoking, the most frequent users, those who drank alcohol more than once a week, had by far the highest proportion of children with a mental disorder, 24%. This represents three times the proportion of children with a mental disorder among the group who had never drunk any alcohol. (Table 10.11)

Use of cannabis Cannabis was the most frequently used drug by 1115 year olds: 234 children admitted to trying it. The number of children who reported using other drugs was far too small to accurately estimate their prevalence of mental disorders. Cannabis users were divided into two group - those using the drug at least once a month, 42% of all users, and the remainder who used cannabis less frequently. About one half of the frequent users had a mental disorder - 32% conduct disorders; 25% emotional disorders - compared with one fifth of the less than once a month users and one tenth of those who had never used cannabis. (Table 10.12)

References Goddard, E. & Higgins, V. (1999) Smoking, drinking and drug use among young teenagers in 1998 (Volume I : England). London:The Stationery Office. Goodyer, I.M.,Wright, C. & Altham, P. M. E. (1990) The friendships and recent life events of anxious and depressed school-age-children. British Journal of Psychiatry, 156 (MAY), 689-698.

122

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Children’s social functioning and lifestyle behaviours

Table 10.1

10

Friendship behaviour

by type of mental disorder All 11-15 year olds who completed a personal interview Type of mental disorder

Do you have any friends? Yes No

Base Do you have a ‘best’ friend or a special friend? Yes No

Base How much time do you spend together... all of your spare time some of your spare time a little time or not at all?

Base How often do friends come to your house... all or most of the time some of the time a little time or not at all?

Base How often do you go to your friend’s home... all or most of the time some of the time a little time or not at all?

Base Can you confide in any of you friends such as sharing a secret or telling them private things? Definitely Sometimes Not at all

Base Over the past 12 months have you belonged to any teams, clubs or other groups with an adult in charge? Yes No

Base

Emotional disorders

Conduct disorders

Any disorder

No disorder

All

%

%

%

%

%

%

%

99 1

100 0

98 2

[20] -

99 1

100 0

100 0

239

225

51

20

434

3897

4331

84 16

76 24

72 28

[14] [5]

79 21

76 24

76 24

236

224

50

20

429

3892

4321

33 50 14 16 2

[7] [7] [5] -

50

20

19 39 27 42 15

[7] [6] [5] [1]

50

20

18 50 25 31 6

[7] [5] [5] [2]

32 54 13 14 1

}

237

Hyperkinetic Less common disorders disorders

41 46 11 12 1

}

224

26 43 22 31 9

}

237

24 39 30 37 7

}

224

24 46 26 30 4

}

26 44 25 30 5

}

}

}

}

34 52 13 14 1

}

430

21 67 11 12 1

}

3890

23 42 27 35 8

}

430

}

}

4319

15 58 23 27 4

}

3891

23 46 26 31 5

23 65 11 12 1

16 56 24 28 4

}

4321

16 61 21 23 2

}

16 60 21 24 3

}

237

224

50

20

430

3892

4332

48 46 6

51 39 10

46 46 8

[8] [8] [3]

49 43 8

54 40 5

54 41 6

237

224

49

20

429

3889

4318

68 32

61 39

70 30

[10] [9]

64 36

74 26

73 27

239

225

50

20

433

3894

4326

Mental health of children and adolescents in Great Britain

123

10

Children’s social functioning and lifestyle behaviours

Table 10.2

Friendship score

by type of mental disorder All 11-15 year olds who completed a personal interview Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Friendship score *

%

%

%

%

%

%

%

0 1 2 3 4 5 6

1 1 6 8 22 30 31

1 1 6 14 20 33 24

2 2 8 19 14 27 29

[1] [3] [1] [4] [7] [3]

1 1 7 12 20 31 27

0 1 4 10 17 31 37

0 1 4 10 17 31 36

Score 0 - 2 Severe Score 3 - 4 Moderate Score 5 - 6 Little or no lack

8 30 62

9 34 58

12 33 55

[4] [5] [10]

9 32 59

5 27 68

6 27 67

239

225

50

20

433

3893

4325

Base

* Score 1 for each of: Child spends some or all of spare time with friends;Friends visit child’s home some or all of the time; Child visits friend’s home some or all of the time; Child can definitely or sometimes confide with friend; Has a best or special friend; Belongs to team, club or group with adult in charge.

Table 10.3

People asked for help

by type of mental disorder All 11-15 year olds who had been so worried or unhappy that they had asked for help Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All

Percentage of children seeking each type of help Mother Special friend Father School teacher Brother or sister Telephone helpline Doctor School nurse Social worker None of these

Base

124

48 54 20 21 17 7 7 6 8

48 48 20 25 15 4 9 3

[9] [5] [1] [4] [1] [-] [1] [-] [-]

[6] [4] [3] [3] [4] [1] [-] [-] [-]

51 52 22 22 18 5 7 4 5

59 52 29 19 17 2 1 1 0

58 52 28 20 17 2 2 2 1

8

4

[2]

[-]

6

7

6

119

74

16

11

175

884

1059

Mental health of children and adolescents in Great Britain

Children’s social functioning and lifestyle behaviours

Table 10.4

10

Type of help sought

by type of mental disorder All 11-15 year olds who completed a personal interview and had sought help because they had felt unhappy or worried Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder

No disorder

All disorder

Type of help

%

%

%

%

%

%

%

Practical advice Talk things over Both practical advice and to talk things over

11 55

16 56

[2] [9]

[1] [6]

12 56

16 56

15 56

35

28

[3]

[4]

32

29

29

116

72

14

11

172

855

1026

Any disorder

No disorder

All

Base

Table 10.5

Potential helpers

by type of mental disorder All 11-15 year olds who had not sought help in the past Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Percentage of children who would seek each type of help Mother Father Special friend Brother or sister School teacher Telephone helpline School nurse Doctor Social worker

72 33 44 25 14 2 1 2 4

67 33 35 15 17 1 1 1 4

59 39 36 3 15 3 5

[6] [3] [1] [4] -

68 36 40 19 16 1 1 2 4

80 47 47 25 12 2 2 2 1

79 46 46 24 12 2 2 2 1

None of these

12

15

22

-

14

6

7

120

149

34

8

256

3005

3260

Base

Mental health of children and adolescents in Great Britain

125

10

Children’s social functioning and lifestyle behaviours

Table 10.6

Type of potential help

by type of mental disorder All 11-15 year olds who had not sought help Type of mental disorder Emotional disorders

Conduct disorders

Hyperkinetic disorders

Less common disorders

Any disorder disorder

No disorder

All

Type of help expected

%

%

%

%

%

%

%

Practical advice Talk things over Both practical advice and to talk things over

13 44

16 50

[7] [10]

[1] [4]

15 47

14 36

14 37

43

34

[10]

[2]

38

49

49

110

139

27

7

232

2874

3106

Base

Table 10.7

Smoking behaviour

by age, survey source and sex Smoking behaviour

Boys Regular smoker Occasional smoker Used to smoke Tried smoking Never smoked

Base Girls Regular smoker Occasional smoker Used to smoke Tried smoking Never smoked

Base All Regular smoker Occasional smoker Used to smoke Tried smoking Never smoked

Base

11

11

12

12

13

13

14

14

15

15

All

All

School

H’hold

School

H’hold

School

H’hold

School

H’hold

School

H’hold

School

H‘hold

%

%

%

%

%

%

%

%

%

%

%

%

1 3 3 16 78

1 1 11 88

3 7 5 18 67

1 1 3 19 77

5 8 12 21 54

3 2 4 26 66

15 8 11 23 42

8 4 7 29 53

19 11 15 21 34

13 6 10 30 40

9 8 9 20 54

5 3 5 23 65

300

448

349

434

302

440

612

413

754

424

2317

2159

1 3 2 12 82

0 1 9 90

3 6 7 18 66

1 1 4 17 77

9 9 13 21 48

3 5 7 20 66

19 13 13 17 37

10 5 10 28 46

29 11 16 18 26

18 7 8 24 44

12 8 10 18 51

6 4 6 19 65

303

441

375

442

390

441

670

416

673

420

2411

2160

1 3 2 14 80

1 1 10 89

3 6 6 18 67

1 1 3 18 77

7 9 13 21 50

3 3 6 23 66

17 11 12 20 40

9 4 9 29 50

24 11 15 20 30

16 6 9 27 42

11 8 10 19 53

6 3 5 21 65

603

887

724

876

692

882

1282

831

1427

842

4728

4318

School = Data collected at school (Goddard and Higgins, 1999) “ H’hold = Data collected from this survey at home

126

Mental health of children and adolescents in Great Britain

Children’s social functioning and lifestyle behaviours

Table 10.8

10

Drinking behaviour

by age, survey source and sex Drinking

Boys Almost every day About twice a week About once a week About once a fortnight About once a month Only a few times a year Never drinks now Never had a drink

Base Girls Almost every day About twice a week About once a week About once a fortnight About once a month Only a few times a year Never drinks now Never had a drink

Base All Almost every day About twice a week About once a week About once a fortnight About once a month Only a few times a year Never drinks now Never had a drink

Base

11

11

12

12

13

13

14

14

15

15

All

All

School

H’hold

School

H’hold

School

H’hold

School

H’hold

School

H’hold

School

H’hold

%

%

%

%

%

%

%

%

%

%

%

%

1 2 2 2 3 17 6 68

1 1 2 3 3 13 1 77

2 2 2 6 4 22 4 58

1 2 3 4 22 3 65

0 5 5 8 7 32 6 38

1 2 3 4 8 29 2 52

2 9 10 11 12 30 4 22

1 5 8 9 16 27 2 34

4 18 20 11 14 19 4 11

1 9 14 14 15 30 1 16

2 8 8 8 8 24 5 38

1 3 6 6 9 24 2 49

287

447

335

436

294

439

601

414

741

424

2258

2160

0 0 1 1 3 10 5 80

0 0 1 1 15 1 82

0 1 3 3 4 25 6 57

2 1 5 20 2 69

1 3 7 3 11 30 3 42

1 2 5 8 31 2 51

2 10 10 12 12 28 3 23

1 6 8 11 38 1 35

1 14 18 17 15 19 2 14

1 9 14 14 15 30 1 16

0 6 8 7 9 23 4 42

0 2 4 5 8 27 1 52

291

440

368

442

380

442

655

416

665

421

2359

2161

0 1 1 2 3 13 6 74

1 1 1 2 2 14 1 80

1 2 3 4 4 24 5 57

1 2 2 5 21 2 67

1 4 6 5 10 31 4 40

1 2 3 4 8 30 2 51

2 10 10 12 12 29 4 22

1 3 7 9 13 32 1 34

3 16 19 13 14 19 3 12

1 8 11 13 16 31 1 20

2 7 8 7 9 23 4 40

0 3 5 6 8 26 2 51

580

887

704

876

676

882

1254

832

1405

843

4619

4320

School = Data collected at school (Goddard and Higgins, 1999) H’hold = Data collected from this survey at home

Mental health of children and adolescents in Great Britain

127

10

Children’s social functioning and lifestyle behaviours

Table 10.9

Drug taking

by survey source All children aged 11-15 years old School

H’hold

Percentage of children using each type of drug Ever used... Cannabis Inhalants (Glue) Ecstasy Amphetamines LSD Tranquilisers Cocaine Heroin

Base

12 2 1 3 1 0 1 0

5 1 0 1 0 0 0 0

4649

4313

School = Data collected at school (Goddard and Higgins, 1999) H’hold = Data collected from this survey at home

Table 10.10 Prevalence of mental disorders

by smoking behaviour Children aged 11-15 years old Regular smoker

Occasional smoker

Used to smoke

Tried smoking once

Never smoked

All children

Percentage of children with each mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

20 28 4 2

6 6 1 -

8 9 3 1

6 8 2 0

4 3 1 0

6 6 1 1

Any mental disorder

41

10

16

13

7

11

236

129

235

911

2808

4319

Base

128

Mental health of children and adolescents in Great Britain

Children’s social functioning and lifestyle behaviours

10

Table 10.11 Prevalence of mental disorders

by drinking behaviour Children aged 11-15 years old More than once a week

About once a week

About once a fortnight

About once a month

Only a few times a year

Never now drinks alcohol

Never had an alcohol drink

All children

Percentage of children with each mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

14 15 2 1

8 8 2 -

7 6 1 2

7 8 1 1

5 7 1 0

6 7 0 -

5 4 1 0

6 6 1 1

Any mental disorder

24

14

15

14

10

13

8

11

133

205

251

368

1101

67

2193

4319

Base

Table 10.12 Prevalence of mental disorders

by use of cannabis Children aged 11-15 years old At least once a month

Less than onece a month

Has never used cannabis

All children

Percentage of children with each mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders

25 32 3 2

8 12 7 1

5 4 1 0

6 6 1 1

Any mental disorder

49

21

10

11

Base

98

136

4080

4314

Mental health of children and adolescents in Great Britain

129

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130

Psychiatric morbidity among prisoners in England and Wales

Part 3: Appendices

Psychiatric morbidity among prisoners in England and Wales

131

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132

Psychiatric morbidity among prisoners in England and Wales

Appendix A: Sampling, weighting and adjustment procedures

Appendix A

A1

Sampling, weighting and adjustment procedures

Sampling procedures

The sampling frame The Child Benefit Register (CBR), held by the Department of Social Security, was used as the sampling frame for the survey. Of the 7,134,968 records on the file, 6,536,570 had a postcoded address (91.6%). Whereas, the Child Benefit Register had entries for 25,810 postal sectors, at the time of the sampling phase of the survey, mid 1998, in reality, there were around 9,000 valid sectors in Great Britain. Many of the non-valid sectors were clearly mistakes on the CBR caused by the transcription or imputation of a wrong letter or a number - these sectors had only one or two children in them. However, Table A1.1 shows that there were some very large sectors in the non-valid category. Further investigation found that many of these large sectors represented discontinued postcodes. (Table A1.1)

Table A1.1 Size of non-current sectors on the CBR file Sector size 1 2 3 4 5 6-10 11-20 21-30 31-50 51-100 101-200 201-500 501-1000 1001+ Total

A

Frequency

Cumulative %

5597 4423 2194 1394 909 1757 440 112 136 127 90 103 138 102

31.9 57.2 69.7 77.7 82.9 92.9 95.4 96.0 96.8 97.5 98.0 98.6 99.4 100.0

17522

The sampling design for the survey involved a two-stage process: the selection of 475 sectors with 30 children selected per sector. Because it was not possible to group small sectors prior to the selection nor vary the number of children to be selected from each sector, all sectors with fewer than 100 children were excluded from the sampling frame. In order to reduce bias, we included all sectors, subject to the minimum size constraint and, for non-current sectors, subject to a minimum of 100 discontinued postcodes. (ONS is able to reallocate discontinued postcodes to their new versions). This produced a population of 7905 current sectors and 360 non-current sectors. These sectors included 6,422,402 (98.3%) of the children in addresses with postcodes so the overall coverage of the CBR by the ONScreated, sampling frame was 90.0%. After dropping the 24 sectors selected for the pilot survey, introducing another small potential bias, a Regional Health Authority (RHA) code was imputed for the 360 noncurrent sectors. Stratification and selection of sectors The frame was stratified by RHA and within that by socio-economic group (SEG) and then the sectors were selected with probability proportional to the number of children: 400 sectors were selected in England, 25 in Wales and 50 in Scotland. 5 sectors were wanted in the Scottish Highlands and Islands, i.e., those north of the Caledonian Canal plus the Islands.

Mental health of children and adolescents in Great Britain

133

A

Appendix A: Sampling, weighting and adjustment procedures

Table A1.2 Allocation of the 475 sectors to (health) regions Region

Children

%

Sectors selected

Sectors expected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

354,145 439,280 541,872 234,953 381,551 423,259 416,493 326,463 348,041 306,677 373,213 636,191 287,489 481,529 317,883 530,992 22,371

5.5 6.8 8.4 3.7 5.9 6.6 6.5 5.1 5.4 4.8 5.8 9.9 4.5 7.5 4.9 8.3 0.3

26 32 39 17 27 30 30 24 25 22 27 46 21 35 25 45 5

26.19 32.49 40.08 17.38 28.22 31.30 30.80 24.15 25.74 22.68 27.60 47.05 21.26 35.61 23.51 39.27 1.65

6,422,402

100

475

475.00

Total

The numbers of sectors per region were fixed in advance and were not strictly proportional to size. In particular, the Scottish Highlands and Islands would have warranted only 1-2 selections. The number of sectors chosen per country/region were preselected for practical and financial reasons with the view that the survey data would be weighted to take account of any imbalance in the distribution of sectors by geographical area. (Table A1.2)

A2

Weighting procedures

Weighting occurred in three steps. First, weights were applied to adjust for differential probability of postal sector selection by country. Second, sample weights were applied to take account of the variations in response by region. Third, all respondents were weighted up or down to represent the age-sex structure of the total national population of children and adolescents, aged 5-15, living in private households. (a) Weighting to correct for over-sampling in Scotland and Wales As described in Section A1 above, more sectors were selected in Scotland and Wales

134

Mental health of children and adolescents in Great Britain

Table A2.1 Sample weights by country England Wales Scotland-other Scotland H&I

1.0264 0.9404 0.8727 0.3309

than would have emerged from a random sampling design for practical and financial reasons. The compensatory weights to take account of this are shown in Table A2.1. (b) Weighting to take account of variation in response by region Previous research in psychiatric epidemiology indicate higher prevalence rates of mental disorders among those living in cities than in rural communities (Blazer et al., 1987; Dohrenwend and Dohrenwend 1974; Giggs and Cooper, 1987; Lewis and Booth, 1994; Neff et al., 1987; Vazquez-Barquero et al., 1982) and experience from national surveys, irrespective of topic, show quite clearly, poorer co-operation from sampled respondents in urban than rural sectors. (Beerton, 1999; Brehm, 1993; House and Wolf, 1978; Goyder et al., 1992; Groves and Couper, 1998; Lievesley, 1988; Market Research Society, 1981; Smith, 1983; Steeh, 1981) These two research findings influenced the decision to take account of the different response rates by region when weighting the survey data. As expected the sample in Inner London produced the lowest response (72%) whereas the participation rate in Wales was 91%. (Table A2.2)

Table A2.2 Sample weights by region Region* Inner London Outer London Metropolitan England Non-metropolitan England Wales Glasgow Met Other Scotland ALL

Response rate (%)

Number

Weight

71.60 79.10 83.80 84.50 91.10 78.50 82.70 83.30

433 569 3149 4621 611 487 568 10438

1.1634 1.0531 0.994 0.9858 0.9144 1.0611 1.0073

*Regions were based on groupings of the Government Office Classification of Region (Version 2).

Appendix A: Sampling, weighting and adjustment procedures

the child (aged 11-15), and the teacher. In most cases, data were available from both the parent and child where appropriate, but for a substantial number of cases (20%), the teacher did not provide any information.

(c) Weighting to correct for non-response bias by age and sex The next step in the weighting process involved calculating weights to correct for non-response bias associated with age and sex. The age-sex distribution of the sample was calculated for boys and girls separately, with age grouped into one-year intervals. This was then compared with the age-sex distribution of the population (excluding children in institutions) from population projections from the 1991 Census to produce the age-sex weights shown in Table A2.3.

We can assume that, given a complete set of data from both home and school, the psychiatrists would on average, make the right assessment. Therefore, if they were able to use both home and school information to assess all children in the population and we were able to average the results of this census over a large number of repeats under identical circumstances, they would arrive at the prevalence level in the population. Therefore if this complete information were available for all sampled children in the survey, the estimated prevalence level would be unbiased for the actual prevalence level, differing only through sampling error and response error.

(d) Calculation of final weight factor The product of the three weights for postal sector selection, response by region, and agesex distribution was calculated. After this weight was applied to the original data, the weighted sample bases differed very slightly from the original. A final correction factor was therefore applied to return the weighted sample size to its original size.

A3

A

On the other hand, if repeated censuses were taken but collecting only the home information, another average prevalence would be measured. The question is: would the prevalence level measured with the school and home information taken together be the same as with just the home information? If the measures were the same, then we would not need to carry out adjustments for the missing teacher data. If the measures were different, some adjustment factor would need to be incorporated into the reported data.

Adjustment procedures for teacher non-response

Description of the issue The assessments of mental disorders among children and adolescents by psychiatrists were based on the data obtained from the parent, Table A2.3 Distribution of children by age and sex Boys Age

5 6 7 8 9 10 11 12 13 14 15

Base

Girls

Unweighted survey database

ONS pop estimates for 1998

% 9.2 9.7 9.2 8.7 9.7 9.6 9.7 9.6 8.3 7.9 8.4

% 9.03 9.38 9.50 9.27 9.22 9.36 9.08 9.01 8.93 8.60 8.67

5212

4178366

Weight Factor

0.98 0.97 1.03 1.07 0.95 0.98 0.94 0.94 1.08 1.09 1.03

Unweighted survey database

ONS pop estimates for 1998

% 9.0 9.2 10.6 9.5 9.7 9.3 8.4 8.7 8.8 8.7 8.2

% 9.06 9.41 9.50 9.28 9.23 9.33 9.08 8.97 8.94 8.58 8.62

5226

3968829

Weight Factor

1.01 1.02 0.90 0.98 0.95 1.00 1.08 1.03 1.02 0.99 1.05

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A

Appendix A: Sampling, weighting and adjustment procedures

Table A3.2 Clinical-parent ratios by absence/ presence of teacher data

Estimating and measuring the difference in the two measures The evidence for the need to carry out this readjustment comes from looking at the ratio of parent-based to clinical-based diagnoses in no teacher information (t=0) and with teacher information (t=1) groups. If the ratio is the same, it suggests that having the teacher report doesn’t make a significant contribution. If the ratio is higher for the t=1 group, it suggests that clinical diagnoses underestimate prevalence in the absence of teacher reports. The prevalence rates for the three types of disorder and for any disorder are shown below for t=0 and t=1 conditions, followed by the clinical-parent ratios. (Tables A3.1 and A3.2) These findings fit in with clinical experience, namely, that teacher reports contribute little if anything to the diagnosis of emotional disorders but make a substantial difference to the diagnosis of conduct and hyperkinetic disorders, though for rather different reasons. As far as conduct disorder is concerned, the key issue is that there are a lot of children who are oppositional, aggressive and antisocial at school but not at home. Psychiatrists rarely get to know about these children unless they have a teacher report. As far as hyperkinetic disorders are concerned, there are many children where the parental evidence is inconclusive and where the teacher report tips the balance.(Goodman, 1999) Therefore, the adjustment factors applied to the prevalence rates of mental disorders (excluding emotional disorders), incorporated in all the tables in Chapter 4,

No teacher data t=0

With teacher data t=1

1.16 1.11 1.00 1.22

1.17 1.88 1.88 1.58

Emotional disorders Conduct disorders Hyperkinetic disorders Any disorder

were calculated on the raw number according to the following rules. (a) Calculate revised number of children with each clinically-assessed type of mental disorder with no teacher data: N (clin) revised =

N(clin) t=1 N(parent) t=1

x N(parent) t=0

N(clin) t=1 = No. of children with disorder from a clinical assessment with teacher data N(parent)t=1 = No. of children with disorder from a parent only assessment with teacher data N(parent)t=0 = No. of children with disorder from a parent only assessment with no teacher data (b) Calculate adjustment factor Adjustment factor = N (clin) revised + N(clin) t=1 N(clin) t=0

+ N(clin) t=1

Table A3.3 Final adjustment factors Disorder

Adjustment factor

Emotional disorders Conduct disorders Hyperkinetic disorders

1.00 1.12 1.09

Any disorder

1.06

Table A3.1 Prevalence of mental disorders by type of assessment with and without teacher data. Clinical diagnoses

Emotional disorders Conduct disorders Hyperkinetic disorders Any disorder

136

Parental assessments

t=0

t=1

All

t=0

t=1

All

5.1 4.1 0.7 8.8

4.1 4.9 1.5 9.0

4.3 4.7 1.3 9.0

4.4 3.7 0.7 7.2

3.5 2.6 0.8 5.7

3.7 2.8 0.8 6.0

Mental health of children and adolescents in Great Britain

Appendix A: Sampling, weighting and adjustment procedures

A

References Beeton, R. (1999) The effect of interviewer and area characteristics on survey response rates: an exploratory analysis. Survey Methodology Bulletin, 45, 7-15 Blazer, D., Bradford, A.C., George, L.K. Alcohol abuse and dependence in the rural South. Archives of General Psychiatry, 42: 651-656. Brehm, J. (1993) The Phantom respondents: Opinion Surveys and Political Representation. Ann Arbor: University of Mitchigan Press Dohrenwend, B.P. and Dohrenwend, B.S. (1974) Psychiatric disorders in urban settings, in American Handbook of Psychiatry (ed. G Caplan) Vol II, 2nd edition, Basic Books, New York. Giggs, J.A. and Cooper, J.F. (1987) Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham, British Journal of Psychiatry, 151:627-633 Goodman, R. (1999) Personal communication. Goyder, J., Lock, J., and McNair, T. (1992) Urbanization Effects on Survey Nonresponse: A Test Across ansd Within Cities. Quality and Quantity, 26, 39-48. Groves, R.M., and Cooper, M.P. (1998) Nonresponse in Household Interview Surveys, John Wiley and Sons: New York. House, J.S., and Wolf, S. (1978) Effects of Urban residence on Interpersonal Trust and Helping Behaviour. Journal of Personality and Social Psychology, 36, 9, 1029-1043 Lewis, G. and Booth, M. (1994) Are cities bad for your mental health? Psychological Medicine 24: 913-915 Lievesley, D. (1988) Unit nonresponse in interview surveys, Unpublished working paper, London: Social and Community Planning Research Market Research Society (1981) Report of the Second Working Party on Respondent Co-operation : 1977-1980, Journal of the Market Research Society, 23, 3-25 Neff, J. and Husaini, B.A. (1987) Urbanicity, Race, and Psychological Distress. Journal of Community Psychology 15: 520-536. Smith, T.W., (1983) The Hidden 25 Percent: An Analysis of Nonresponse on the 1980 General Social Survey, Public Opinion Quarterly, 47, 386-404 Steeh, C.G. (1981) Trends in Nonresponse Rates, 19521979. Public Opinion Quarterly, 45, 40-57 Vazquez-Banquero, J.L., Munoz, P.E., Madoz Jauregui, V. (1982) The influence of the process of urbanicity on the prevalence of neurosis: a community survey. Acta Psychiatrica Scandinavica 65:161-170

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B

Appendix B: Statistical terms and their interpretation

Appendix B

Statistical terms and their interpretation

Confidence interval The percentages quoted in the text of this report represent summary information about a variable (e.g., presence of a mental disorder) based on the sample of people interviewed in this study. However, extrapolation from these sample statistics is required in order to make inferences about the distribution of that particular variable in the population. This is done by calculating confidence intervals around the statistic in question. These confidence intervals indicate the range within which the “true” (or population) percentage is likely to lie. Where 95% confidence intervals are calculated, this simply indicates that one is “95% confident” that the population percentage lies within this range. (More accurately, it indicates that if repeated samples were drawn from the population, the true percentage would lie within this range in 95% of the samples). Confidence intervals are calculated on the basis of the sampling error (q.v.). The upper 95% confidence intervals are calculated by adding the sampling error multiplied by 1.96 to the sample percentage or mean. The lower confidence interval is derived by subtracting the same value. 99% confidence intervals can also be calculated by replacing the value 1.96 by the value 2.58.

Sampling errors The sampling error is a measure of the degree to which a percentage (or other summary statistic) would vary if repeatedly calculated in a series of samples. For example, if the prevalence rate of a mental disorder was calculated for a random sample of children and adolescents drawn from the population

138

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at large, then another sample was drawn and the rate calculated again its value would be unlikely to be identical to the first. If this process was continued, the rate would continue to vary from sample to sample. Thus, the sampling error provides a measure of this variability, and is used in the calculation of confidence intervals and statistical significance tests. In this survey simple random sampling did not take place; rather, a multi-stage stratified sampling design was used. To take account of the design of this survey, sampling errors were calculated using STATA. However, this does not affect the interpretation of the sampling errors or their use in the calculation of confidence intervals.

Multiple logistic regression (MLR) and Odds Ratios (OR) Logistic regression analysis has been used in the analysis of the survey data to provide a measure of the effect of, for example, various sociodemographic variables on mental disorders among children. Unlike the crosstabulations presented elsewhere in the report, MLR estimates the effect of any sociodemographic variable while controlling for the confounding effect of other variables in the analysis. Logistic regression produces an estimate of the probability of an event occurring when an individual is in a particular sociodemographic category compared to a reference category. This effect is measured in terms of odds. For example, Table 4.15 shows that being in the family type “lone parent” increases the odds of having an emotional disorder compared to the reference category of “two parent family”.

Appendix B: Statistical terms and their interpretation

The amount by which the odds of this disorder actually increases is shown by the Adjusted Odds Ratio (OR). In this case, the OR is 1.55 indicating that being a child in a lone parent household increases the odds of having an emotional disorder by about one half, controlling for the possible confounding effects of the other variables in the statistical model, i.e. age, sex, number of children, family employment and the ACORN classification. To determine whether this increase is due to chance rather than to the effect of the variable, one must consult the associated 95% confidence interval.

Confidence intervals around an Odds Ratio The confidence intervals around odds ratios can be interpreted in the manner described earlier in this section. For example, Table 4.15, shows an odds ratio of 5.56 for the association between sex and hyperkinetic disorders, with a confidence interval from 3.49 to 8.88, indicating that the ‘true’ (i.e., population) OR is likely to lie between these two values. If the confidence interval does not include 1.00 then the OR is likely to be significant - that is, the association between

B

the variable and the odds of a particular disorder is unlikely to be due to chance. If the interval includes 1.00, then it is possible that the ‘true’ OR is actually 1.00, that is no increase in odds can be attributed to the variable.

Odds ratios and how to use them multiplicatively The odds ratios presented in the tables show the adjusted odds due solely to membership of one particular category - for example, being a boy rather than a girl. However, odds for more than one category can be combined by multiplying them together. This provides an estimate of the increased odds of a disorder or symptom due to being a member of more than one category at once - for example, being a boy and aged 11-15. For example, in Table 4.15 being a boy rather than a girl increases the odds of any mental disorder (OR=1.48), while being aged 11-15 (compared with 5-10 year olds) also independently increases the odds (OR=1.58). The increased odds for 11-15 year old boys compared with 5-10 year old girls is therefore the product of the two independent odds ratios, 2.34.

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C

Appendix C: Sampling errors

Appendix C

Sampling errors

This survey involved a multi-stage sampling design with both clustering and stratification. Clustering can lead to a substantial increase in standard error if the households or individuals within the primary sampling units (postal sectors) are relatively homogenous but the primary sampling units differ from one another. Stratification tends to reduce standard error and is of most advantage where the stratification factor is related to the characteristics of interest on the survey. The effect of a complex sampling design on the precision of survey estimates is usually quantified by means of the design factor (deft). For any survey estimate , the deft is calculated as the ratio of the standard error allowing for the full complexity of the survey design to the standard error assuming a simple random sample. The standard error based on a simple random sample multiplied by the deft gives the standard error of a complex design. se(p) = deft x se(p)sys where: se(p)sys = p(1-p) N

The formula to measure whether the differences between the percentages is likely to be due entirely to sampling error for a complex design is: se(p1-p2) = deft 21 p1(100-p1) + deft 22 p2(100-p2) n1 n2

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where p1 and p2 are observed percentages for the two subsamples and n1 and n2 are the subsample sizes. The 95% confidence interval for the difference between two percentages is then given by; (p1-p2) +/- 1.96 x se(p1-p2) If this confidence interval includes zero then the observed difference is considered to be a result of chance variation in the sample. If the interval does not include zero then it is unlikely (less than 5% probability) that the observed differences could have occurred by chance. The standard errors of survey measures which are not presented in the following tables for sample subgroups may be estimated by applying an appropriate value of deft to the sampling error. The choice of an appropriate value of deft will vary according to whether the basic survey measure is included in the tables. Since most deft values are relatively small (1.1 or less) the absolute effect of adjusting sampling errors to take account of the survey’s complex design will be small. In most cases it will result in an increase of less than 10% over the standard error assuming simple random sampling. Whether it is considered necessary to use deft or to use the basic estimates of standard errors assuming a simple random sample is a matter of judgement and depends chiefly on how the survey results will be used.

Appendix C: Sampling errors

Table C1

Standard errors and 95% confidence intervals for prevalence rates of mental disorders by sex, age and ethnicity

Base

Characteristic

All children

Boys

True standard error of p

%(p) (adj)

Sample size

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.31 5.31 1.45 9.50

10438 10438 10438 10438

0.21 0.23 0.11 0.30

1.08 1.09 0.96 1.07

3.89 4.81 1.22 8.88

-

4.73 5.81 1.68 10.13

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.11 7.41 2.45 11.44 4.51 3.20 0.45 7.57

5213 5213 5213 5213 5225 5225 5225 5225

0.28 0.36 0.20 0.45 0.30 0.24 0.09 0.37

1.02 1.05 0.97 1.05 1.04 1.04 1.02 1.04

3.56 6.62 2.03 10.50 3.92 2.68 0.25 6.80

-

4.66 8.20 2.88 12.37 5.10 3.73 0.64 8.34

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.29 4.59 1.50 8.16 5.60 6.20 1.38 11.20

5913 5913 5913 5913 4525 4525 4525 4525

0.24 0.25 0.14 0.33 0.41 0.38 0.17 0.55

1.03 0.97 0.92 0.95 1.20 1.12 1.02 1.20

2.82 4.04 1.21 7.48 4.80 5.37 0.98 10.06

-

3.76 5.14 1.80 8.85 6.40 7.04 1.74 12.35

White

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.31 5.38 1.57 9.58

9529 9529 9529 9529

0.22 0.24 0.12 0.31

1.06 1.10 0.98 1.06

3.88 4.85 1.31 8.94

-

4.74 5.90 1.83 10.23

Black

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.25 8.56 0.38 11.99

247 247 247 247

1.07 1.73 0.35 2.02

0.95 1.02 0.93 1.00

1.15 4.76 -0.37 7.79

-

5.35 12.35 1.13 16.19

Indian

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

2.90 2.11 0.00 4.02

215 215 215 215

1.20 0.89 0.00 1.31

1.05 0.96 0.00 1.00

0.55 0.15 0.00 1.30

-

5.25 4.06 0.00 6.74

Pakistani and Bangladeshi

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

5.47 2.99 0.00 7.52

189 189 189 189

1.98 1.32 0.00 2.41

1.19 1.12 1.29

1.59 0.09 0.00 2.51

-

9.35 5.89 0.00 12.52

Other

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

5.63 3.94 0.44 10.17

251 251 251 251

1.51 1.27 0.39 1.99

1.04 1.09 0.98 1.07

2.67 1.15 -0.40 6.03

-

8.59 6.73 1.27 14.30

Girls

5-10 year olds

11-15 year olds

C

Deft

95% confidence Interval

Mental health of children and adolescents in Great Britain

141

C

Appendix C: Sampling errors Table C2

142

Standard errors and 95% confidence intervals for prevalence rates of mental disorders by family and household characteristics

Base

Characteristic

Two parent families

True standard error of p

%(p) (adj)

Sample size

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.57 3.99 1.19 7.67

8092 8092 8092 8092

0.22 0.22 0.11 0.29

1.07 1.07 0.95 1.01

3.14 3.50 0.95 7.07

-

4.00 4.47 1.42 8.28

Lone parent families

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

6.87 9.81 2.34 15.77

2346 2346 2346 2346

0.54 0.58 0.31 0.74

1.03 0.99 1.03 1.01

5.81 8.54 1.68 14.24

-

7.93 11.08 3.01 17.31

Both parent working (inc. lone parents)

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.40 4.14 1.11 7.62

6941 6941 6941 6941

0.23 0.23 0.12 0.33

1.06 1.02 0.99 1.06

2.95 3.64 0.86 6.94

-

3.85 4.65 1.37 8.31

One parent working

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.52 4.46 1.62 9.05

1974 1974 1974 1974

0.50 0.47 0.27 0.68

1.07 1.07 0.99 1.08

3.54 3.43 1.05 7.64

-

5.50 5.49 2.20 10.47

No parent working

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

8.52 12.50 3.00 19.66

1404 1404 1404 1404

0.77 0.81 0.46 1.04

1.03 0.96 1.05 1.00

7.01 10.72 2.01 17.50

-

10.03 14.28 3.98 21.82

Owner occupiers

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.07 2.89 0.92 6.33

7072 7072 7072 7072

0.20 0.21 0.12 0.27

0.97 1.11 1.11 0.96

2.68 2.43 0.66 5.77

-

3.46 3.35 1.17 6.89

Social sector tenants

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

7.12 11.16 2.56 16.88

2709 2709 2709 2709

0.51 0.60 0.29 0.69

1.03 1.04 1.00 0.98

6.12 9.84 1.94 15.44

-

8.12 12.47 3.18 18.31

Private renters

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

5.92 7.28 2.58 13.18

651 651 651 651

0.93 1.00 0.61 1.36

1.00 1.03 1.02 1.05

4.10 5.08 1.28 10.35

-

7.74 9.48 3.89 16.00

Mental health of children and adolescents in Great Britain

Deft

95% confidence Interval

Appendix C: Sampling errors Table C3

C

Standard errors and 95% confidence intervals for prevalence rates of mental disorders by area characteristics

Base

Characteristic

ACORN: Cat.A Thriving

True standard error of p

%(p) (adj)

Sample size

Deft

95% confidence Interval

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

2.78 2.48 0.63 5.44

1928 1928 1928 1928

0.36 0.35 0.16 0.50

0.96 1.05 0.92 0.99

2.07 1.71 0.29 4.40

-

3.49 3.24 0.97 6.48

ACORN: Cat.B Expanding

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.72 3.14 0.97 7.21

1453 1453 1453 1453

0.47 0.44 0.22 0.64

0.95 1.02 0.89 0.97

2.80 2.17 0.50 5.88

-

4.64 4.10 1.44 8.54

ACORN: Cat.C Rising

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.14 4.91 1.70 9.44

599 599 599 599

0.70 0.91 0.51 1.15

0.86 1.09 1.01 0.99

2.77 2.91 0.61 7.06

-

5.51 6.90 2.79 11.83

ACORN: Cat.D Settling

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

3.86 4.48 1.61 8.78

2381 2381 2381 2381

0.45 0.42 0.26 0.61

1.14 1.05 1.05 1.08

2.98 4.74 3.56 - 5.40 1.06 - 2.17 7.51 - 10.04

ACORN: Cat.E Aspiring

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.36 7.48 1.95 11.50

1406 1406 1406 1406

0.54 0.62 0.34 0.77

0.99 0.93 0.96 0.93

3.30 6.12 1.22 9.90

-

5.42 8.84 2.68 13.10

ACORN: Cat.F Striving

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

6.20 8.24 1.79 13.35

2657 2657 2657 2657

0.48 0.54 0.25 0.68

1.03 1.07 1.01 1.06

5.26 7.06 1.25 11.93

-

7.14 9.43 2.32 14.76

England

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.27 5.38 1.49 9.62

8772 8772 8772 8772

0.24 0.25 0.12 0.33

1.11 1.10 0.97 1.08

3.80 4.83 1.24 8.94

-

4.74 5.92 1.75 10.31

Scotland

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.55 4.64 1.13 8.52

1055 1055 1055 1055

0.48 0.60 0.30 0.76

0.75 0.98 0.96 0.91

3.61 3.32 0.49 6.94

-

5.49 5.95 1.77 10.10

Wales

Emotional disorders Conduct disorders Hyperkinetic disorders Any mental disorder

4.60 5.28 1.23 9.03

611 611 611 611

0.74 0.88 0.48 1.23

0.87 1.03 1.12 1.09

3.15 3.34 0.21 6.48

-

6.05 7.21 2.26 11.59

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143

C

Appendix C: Sampling errors Table C4

Base

Standard errors and 95% confidence intervals for key characteristics of children within the three broad categories of mental disorders: emotional disorders %(p) (adj)

Sample size

True standard error of p

Deft

95% confidence Interval

49.38 50.62

441 441

2.35 2.35

0.99 0.99

44.77 - 53.99 46.01 - 55.23

28.56 71.44

441 441

2.12 2.12

0.98 0.98

24.40 - 32.72 67.28 - 75.60

A&E visit in past year No A&E visit in past year

25.43 74.57

441 441

2.47 2.47

1.19 1.19

20.59 - 30.27 69.73 - 79.41

Parental GHQ12 score 0-2 Parental GHQ12 score 3-12

50.18 49.82

440 440

2.42 2.42

1.01 1.01

45.44 - 54.92 45.08 - 54.56

No stressful life events 1+ stressful life events

15.30 84.70

441 441

1.65 1.65

0.96 0.96

12.07 - 18.53 81.47 - 87.93

Healthy family functioning Unhealthy family functioning

65.73 34.27

434 434

2.36 2.36

1.03 1.03

61.10 - 70.36 29.64 - 38.90

Severe lack of friendship (score 0-2) Moderate lack of friendship (score 3-4) Little/no lack of friendship (score 5-6)

7.80 30.49 61.71

233 233 233

1.87 3.25 3.42

1.06 1.08 1.07

4.13 - 11.47 24.12 - 36.86 55.01 - 68.41

Smoker Non-smoker

22.51 77.49

233 233

2.74 2.74

1.00 1.00

17.14 - 27.88 72.12 - 82.86

Regular drinker (once a week or more) Non-regular drinker

14.81 85.19

233 233

2.21 2.21

0.95 0.95

10.48 - 19.14 80.86 - 89.52

Ever used cannabis Never used cannabis

14.78 85.22

233 233

2.26 2.26

0.97 0.97

10.35 - 19.21 80.79 - 89.65

Characteristic

Children with Seen GP in past year emotional Not seen GP in past year disorders Outpatient in past year Not outpatient in past year

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Appendix C: Sampling errors

Table C5

Base

C

Standard errors and 95% confidence intervals for key characteristics of children within the three broad categories of mental disorders: conduct disorders Characteristic

%(p)

Sample size

44.71 55.29

490 490

26.84 73.16

A&E visit in past year No A&E visit in past year

True standard error of p

Deft

95% confidence Interval

2.56 2.56

1.14 1.14

39.69 - 49.73 50.27 - 60.31

490 490

2.03 2.03

1.01 1.01

22.86 - 30.82 69.18 - 77.14

27.29 72.71

490 490

1.96 1.96

0.97 0.97

23.45 - 31.13 68.87 - 76.55

Parental GHQ12 score 0-2 Parental GHQ12 score 3-12

51.28 47.82

489 489

2.27 2.27

1.00 1.00

46.83 - 55.73 43.37 - 52.27

No stressful life events 1+ stressful life events

17.05 82.95

490 490

1.71 1.71

1.01 1.01

13.70 - 20.40 79.60 - 86.30

Healthy family functioning Unhealthy family functioning

57.39 42.61

483 483

2.26 2.26

1.00 1.00

52.96 - 61.82 38.18 - 47.04

Severe lack of friendship (score 0-2) Moderate lack of friendship (score 3-4) Little/no lack of friendship (score 5-6)

8.74 33.99 57.27

219 219 219

1.94 3.35 3.27

1.01 1.04 0.98

4.94 - 12.54 27.42 - 40.56 50.86 - 63.68

Smoker Non-smoker

28.89 71.11

217 217

2.73 2.73

0.89 0.89

23.54 - 34.24 65.76 - 76.46

Regular drinker Non-regular drinker

13.73 86.27

217 217

2.37 2.37

1.01 1.01

9.08 - 18.38 81.62 - 90.92

Ever used cannabis Never used cannabis

19.76 80.24

215 215

2.52 2.52

0.93 0.93

14.82 - 24.70 75.30 - 85.18

Children with Seen GP in past year conduct Not seen GP in past year disorders Outpatient in past year Not outpatient in past year

Mental health of children and adolescents in Great Britain

145

C

Appendix C: Sampling errors

Table C6

146

Standard errors and 95% confidence intervals for key characteristics of children within the three broad categories of mental disorders: hyperkinetic disorders Sample size

True standard error of p

Deft

51.98 48.02

137 137

4.32 4.32

1.01 1.01

43.51 - 60.45 39.55 - 56.49

Outpatient in past year Not outpatient in past year

42.68 57.32

137 137

4.38 4.38

1.03 1.03

34.10 - 51.26 48.70 - 65.90

A&E visit in past year No A&E visit in past year

30.80 69.20

137 137

3.66 3.66

0.92 0.92

23.63 - 37.97 62.03 - 76.37

Parental GHQ12 score 0-2 Parental GHQ12 score 3-12

58.02 41.98

137 137

4.03 4.03

0.95 0.95

50.12 - 65.92 34.08 - 49.88

No stressful life events 1+ stressful life events

15.71 84.29

137 137

3.29 3.29

1.05 1.05

9.26 - 22.16 77.84 - 90.74

Healthy family functioning Unhealthy family functioning

63.45 36.55

137 137

3.90 3.90

0.94 0.94

55.81 - 71.09 28.91 - 44.19

Severe lack of friendship (score 0-2) 11.88 Moderate lack of friendship (score 3-4) 32.76 Little/no lack of friendship (score 5-6) 55.36

49 49 49

4.58 6.54 6.88

0.98 0.97 0.96

2.90 - 20.86 19.94 - 45.58 41.88 - 68.84

Smoker Non-smoker

18.44 81.56

49 49

5.42 5.42

0.97 0.97

7.82 - 29.06 70.94 - 92.18

Regular drinker Non-regular drinker

14.43 85.57

49 49

4.93 4.93

0.97 0.97

4.77 - 24.09 75.91 - 95.23

Ever used cannabis Never used cannabis

21.56 78.44

48 48

5.86 5.86

0.98 0.98

10.07 - 33.05 66.95 - 89.93

Base

Characteristic

Children with hyperkinetic disorders

Seen GP in past year Not seen GP in past year

Mental health of children and adolescents in Great Britain

%(p)

95% confidence Interval

Appendix D: Follow-up findings

Appendix D

D1

Follow-up findings

Background and aims

A six-month follow-up procedure was incorporated into the study to examine the persistence or chronicity of the three main groups of mental disorders. The strength of follow-up surveys is “that they allow a focus on chronic or persistent psychiatric disorders.... This is potentially important because a high proportion of otherwise normal children exhibit transient disorders at some time during their development” (Rutter,1989). Emotional and behavioural problems which resolve rapidly and spontaneously are far less relevant for service planning than problems that persist unless help is provided. A prospective approach to determine the prevalence of persistent disorders, asking informants on two separate occasions about symptoms and resultant impairments was regarded as preferable to asking informants to recall how long symptoms (and resultant impairments) have been present at the time of interview.

D2

D

interviewed and did not object to the child taking part again • Response from teachers Assuming an 80% response from all three possible sources and subsampling teachers by the ratio 1 in 3, we estimated the follow-up survey would yield data from approximately 2100 parents, 900 children and 900 teachers.

D3

Content of interview

The questionnaire designed for the follow-up survey included the following elements: For parents of all subjects - a repeat of the twosided Strengths and Difficulties Questionnaire (SDQ). For young people aged 11-15 - a repeat of the two-sided SDQ. For teachers: a repeat of the two-sided SDQ plus a few additional questions on any new service provision through schools (e.g. school counselling, advice from educational psychologist).

Sampling strategy D4

All parents and all children aged 11 or over from Wave 1 interviews (4 January to 14 February) who agreed to be contacted again, and a sample of teachers, were allocated for follow-up.

Response to the follow up procedures

The response to the follow-up procedure was better than expected - approximately 8 in 10 parents and children and 9 in 10 teachers responded.

The calculation of response was based on the following factors: Table D4.1 Response to follow up survey

• Number of postal sectors selected in the Wave 1 quota of work • Total number of achieved parent interviews in that quota • Total number of interviews with the 11-15 year olds, assuming the parent was

Questionnaires Questionnaires Response sent out returned rate Parents Children (11-15) Teachers

2797 1097 1037

2234 844 940

80% 77% 91%

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147

D

Appendix D: Follow-up findings

D5

Results

Two approaches were used to analyse the chronicity of disorders. First, the SDQ scores themselves were used to see how far these drifted back to the population mean over the follow-up period. The second method used a specially created SDQ algorithm to try to predict whether the child was still likely to meet diagnostic criteria at follow-up. The findings from the first method, as judged by serial SDQ scores, are summarised in the Figures D5.1 to D5.5. Four of the graphs deal with symptom scores and one with impact score. All the symptom scores fall with time (both for children with and without disorders). This sort of “attenuation” effect is well-recognised when the same measure is administered a second time, though the reason for this is not clear. In most cases, the gap between the children with and without disorder narrows slightly but not much - this narrowing is most evident for the children with emotional disorders. Overall, symptoms generally persist at a high level, though there is some “normalisation”, particularly for emotional symptoms. The graph showing change in impact scores is more dramatic. The normal group does not change at all, the group with emotional symptoms improves markedly and significantly, but the groups with hyperkinesis and conduct disorder seem to get worse (though the change is not significant). So as far as impact is concerned, emotional disorders clearly have a much better prognosis than the externalising disorders. It is curious that emotional symptoms only improve a little while their impact improves a lot, but this may be due to “ceiling” effects on the SDQ emotional symptoms scale. The findings from the second method, as derived from an SDQ algorithm, are summarised in Table D5.1. The algorithm for predicting persistence was based on finding that the child had elevated symptom and impact scores at both times. It was only possible to apply this algorithm to children who had a disorder plus “potentially

informative” SDQs. For example, imagine a child who as part of the initial assessment had parent, teacher and self-report SDQs, and who was independently diagnosed on the basis of the clinical assessment as having a conduct disorder primarily limited to the school setting. Imagine too that the only follow-up SDQ available on the child was a parent SDQ. If the initial parent SDQ was normal (with conduct and impact scores in the normal range), then it would not be possible to use the follow-up SDQ to decide if the child’s conduct disorder had persisted. This is because if the follow-up SDQ completed by the parent again shows normal SDQ scores, it is impossible to judge from this whether the school-based conduct disorder had persisted or not. This was an “uninformative” case and was excluded from the analyses summarised in the table above. The inference which can be reasonably drawn from the SDQ algorithm is that emotional disorders have a better prognosis than conduct or hyperactivity disorders - in line with all previous findings. The extent to which emotional disorders seem to recover over 4-6 months is probably exaggerated. Had the children been reassessed with the complete interview and clinical assessment, it is likely that a higher proportion would still have had a disorder. Even the ones who no longer met the criteria for a disorder would rarely be completely recovered - as the graphs suggest, the most likely outcome is that the child has slipped just below the diagnostic threshold, but still has some continuing symptoms and impact.

D6

Conclusions

• Psychiatric disorders were generally very persistent - few of the initially surveyed children were entirely normal 4-6 months later, and many were still severely affected. • Persistence varied with the type of disorder, with recovery being more likely for emotional disorders, less likely for hyperkinesis and intermediate for conduct disorders.

Table D5.1 Persistence of mental disorders Persistence Any ICD-10 disorder Emotional disorder Conduct disorder Hyperkinesis

148

75% (84/112) 51% (24/47) 74% (51/69) 91% (29/32)

Mental health of children and adolescents in Great Britain

References Rutter, M., (1989) Isle of Wight Revisited: Twenty five years of Child Psychiatric Epidemiology American Academy of Child and Adolescent Psychiatry.

Appendix E: Survey documents

Appendix E

E

Survey documents

Parent questionnaire.......................................... ...................................................................... 150 - 186 Parent self-completion........................................ ..................................................................... 186 - 188 Child questionnaire............................................. ..................................................................... 188 - 209 Child self-completion........................................... ..................................................................... 209 - 218 Teacher questionnaire......................................... .................................................................... 219 - 227

Note The Strength and Difficulties Questionnaire (SDQ) • Section D in Parent Questionnaire • Section CB in Child Questionnaire • Section B in Teacher Questionnaire is copyrighted © to Professor Robert Goodman, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Denmark Hill, London, SE5 8AF

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Appendix E: Survey documents

HOUSEHOLD DETAILS FOR ALL ADDRESSES Area Address

Information already entered Information already entered

INFORMATION COLLECTED FOR ALL PERSONS IN HOUSEHOLD WhoHere

RECORD THE NAME (OR A UNIQUE IDENTIFIER) FOR HOH, THEN A NAME/IDENTIFIER FOR EACH MEMBER OF THE HOUSEHOLD

Code ...’s sex Male Female

Nation What is (PERSON’S NAME) nationality? UK, British Irish Republic Hong Kong China Other

IF: NATION = OTHER

NatSpec

Age

TYPE IN (MAIN) NATIONALITY

What was your age last birthday? 98 or more = CODE 97

IF: NATION = OTHER

NatCode

0..97

PRESS TO ENTER THE CODING FRAME

IF: AGE < 20

DOB (As you are under 20, may I just check) What is your date of birth? USE 1 FOR DAY OR MONTH NOT KNOWN, e.g. 1-1-94

IF: AGE >= 16

MarStat ASK OR RECORD CODE FIRST THAT APPLIES Are you

In what country was (PERSON’S NAME) born? (1) (6) (36) (58) (59)

UK, British Irish Republic Hong Kong China Other

CrySpec

single, that is, never married? married and living with your husband/wife? married and separated from your husband/wife? divorced? or widowed?

ADULT IN HOUSEHOLD

LiveWith

TYPE IN COUNTRY

IF: CRY = OTHER

CryCode PRESS TO ENTER THE CODING FRAME 1..138

ASK OR RECORD May I just check, are you living with someone in the household as a couple? Yes No SPONTANEOUS ONLY - same sex couple

IF AGE 16+ AND MORE THAN ONE ADULT

Cry

IF: CRY = OTHER

IF: AGE 16+ AND MARSTAT=1,3,4 OR 5 AND MORE THAN ONE

IN HOUSEHOLD

Hhldr In whose name is the accommodation owned or rented?

150

HoHprtnr

(1) (6) (36) (58) (59)

Sex

(1) (2) (3)

ENTER PERSON NUMBER OF HOH.

ENTER THE PERSON NUMBER OF HOH’s SPOUSE/ PARTNER - NO SPOUSE/PARTNER = 11

Name

(1) (2) (3) (4) (5)

HoHnum

THE HoH IS (NAME)

Who normally lives at this address?

(1) (2)

ASK FOR WHOLE GRID, THEN ASK OR RECORD (1) This person alone (3) This person jointly (5) NOT owner/renter

Mental health of children and adolescents in Great Britain

IF: (CRY <> UK) AND NOT (CRYSPEC = 01)

CameYr Which year did (PERSON’S NAME) arrive in this country? (ENTER ALL 4 DIGITS OF YEAR)

IF: (CRY <> UK) AND NOT (CRYSPEC = 01) IF: (NATION = UK) AND ((CRY = HK) OR (CRY = CHINA ))

Citizn Is (PERSON’S NAME):

Appendix E: Survey documents

(1)

a British Dependent Territories Citizen, or a British National Overseas or a Full British Citizen with right of abode in the UK? Other/Don’t Know

(2) (3)

(1) (2) (3) (4) (5)

Ethnic (6) USE SHOW CARD [*] To which of these groups do you consider you belong? (1) (2) (3) (4) (5) (6) (7) (8) (9)

White Black - Caribbean Black - African Black - Other Black groups Indian Pakistani Bangladeshi Chinese None of these

E

Own outright Buying it with the help of a mortgage or loan Pay part rent and part mortgage (shared ownership) Rent it Live here rent-free (including rent-free in relative’s/friend’s property; excluding squatting) Squatting

IF: (TEN1 = RENT ) OR (TEN1 = RENT F)

Tied Does the accommodation go with the job of anyone in the household? (1) (2)

Yes No

IF: (TEN1 = RENT ) OR (TEN1 = RENT F)

LLord Who is your landlord?... CODE FIRST THAT APPLIES

Accommodation and tenure ASK OR

RECORD

Accom IS THE HOUSEHOLD’S ACCOMMODATION: N.B. MUST BE SPACE USED BY HOUSEHOLD (1) (2) (3) (4)

a house or bungalow a flat or maisonette a room/rooms or something else?

(1) the local authority/council/New Town Development/ Scottish Homes (2) a housing association or co-operative or charitable trust (3) employer (organisation) of a household member (4) another organisation (5) relative/friend (before you lived here) of a household member (6) employer (individual) of a household member (7) another individual private landlord?

IF: (TEN1 = RENT ) OR (TEN1 = RENT F)

Furn

IF: ACCOM = HSE

HseType

Is the accommodation provided: ...

IS THE HOUSE/BUNGALOW:

(1) (2) (3)

(1) (2) (3)

detached semi-detached or terraced/end of terrace?

furnished partly furnished (eg carpets and curtains only) or unfurnished?

Details of child and interviewed parent IF: ACCOM = FLAT

FltTyp

ASK ALWAYS:

Childno IS THE FLAT/MAISONETTE: (1) (2)

a purpose-built block a converted house/some other kind of building?

ENTER PERSON NUMBER OF THE SELECTED CHILD

DISPLAY ALWAYS: IF: ACCOM = OTHER

ChldAge

AccOth Selected child’s age IS THE ACCOMMODATION A:

DISPLAY ALWAYS: (1) (2)

caravan, mobile home or houseboat or some other kind of accommodation?

ChldDOB child’s DOB

ASK ALWAYS:

Ten1

DISPLAY ALWAYS:

ChldSex In which of these ways do you occupy this accommodation? SHOW CARD 2 MAKE SURE ANSWER APPLIES TO HoH

child’s sex (1) (2)

Male female

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Appendix E: Survey documents B4a

ASK ALWAYS:

Adultno ENTER PERSON NUMBER OF Child’s PRIMARY CARE GIVER WHO HAS AGREED TO BE INTERVIEWED

AdltSex Selected adult’s sex (1) (2)

Male female

ASK ALWAYS:

TranSDQ INTERVIEWER: Code ‘YES’ if the parent will only be completing a translated version of the strengths and difficulties questionnaire. If you will be proceeding with a full interview with the parent code ‘NO’ (1) (2)

Yes, translation only No, full interview

Parent interview General health

Here is another list of health problems or conditions which some children or adolescents may have. Please can you tell me whether (CHILD’S NAME) has... SHOW CARD 4 SET [11] OF (1) Hyperactivity (2) Behavioural problems (3) Emotional problems (4) Learning difficulties (5) Dyslexia (6) Cerebral palsy (7) Migraine or severe headaches (8) The Chronic Fatigue Syndrome or M.E (9) Eye/Sight problems (10) Speech/or language problems (11) Hearing problems (12) None of these

B5 And finally, another list of health problems or conditions which some children or adolescents may have. Please can you tell me whether (CHILD’S NAME) has... SHOW CARD 5

B2

SET [11] OF (1) Diabetes (2) Obesity (3) Cystic fibrosis (4) Spina Bifida (5) Kidney, urinary tract problems (6) Missing fingers, hands, arms, toes, feet or legs (7) Any stiffness or deformity of the foot,leg, fingers, arms or back (8) Any muscle disease or weakness (9) Any difficulty with co-ordination (10) A condition present since birth such as club foot or cleftpalate (11) Cancer (12) None of these

Is (CHILD’S NAME) registered with a GP?

AnyElse

(1) (2)

Does (CHILD’S NAME) have any other health problems?

GenHlth [*] How is (CHILD’S) health in general? Would you say it was ... RUNNING PROMPT (1) (2) (3) (4) (5)

very good good fair bad or is it very bad?

Yes No

B4 Here is a list of health problems or conditions which some children or adolescents may have.

(1) (2)

Yes No

IF: ANYELSE = YES

ElseSpec Please can you tell me whether (CHILD’S NAME) has... SHOW CARD 3 SET [12] OF (1) Asthma (2) Eczema (3) Hay fever (4) Glue ear or otitis media, or having grommets (5) Bed wetting (6) Soiling pants (7) Stomach/digestive problems or abdominal/ tummy pains (8) A heart problem (9) Any blood disorder (10) Epilepsy (11) Food allergy (12) Some other allergy (13) None of these

152

Mental health of children and adolescents in Great Britain

What are these other health problems?

HeadInj Has s/he ever had a head injury with loss of consciousness? (1) (2)

Yes No

IF: HEADINJ = YES

HeadInja How long is it since s/he had a head injury? (1) Less than a month ago

Appendix E: Survey documents

(2) At least one month but less than 6 months ago (3) At least 6 months but less than a year ago (4) A year ago or more

(2) (3) (4)

B7

IF: (CHILD 11+

E

At least one month but less than 6 months ago At least 6 months but less than a year ago A year ago or more YEARS

AND

FEMALE)

B11 Has s/he ever had an accident causing broken bones or fractures that is not a head injury?

Have her periods started yet?

(1) (2)

(1) (2)

Yes No

Yes No

Strengths and difficulties

IF: B7 = YES

B7a IntrSDQ How long is it since s/he had a broken bone? (1) (2) (3) (4)

Less than a month ago At least one month but less than 6 months ago At least 6 months but less than a year ago A year ago or more

The next section is about (CHILD’S) personality and behaviour this is to give us an overall view of his/her strengths and difficulties - we will be coming back to specific areas in more detail later in the interview.

B8

SectnD

Has s/he ever had a burn requiring admission to hospital?

For each item that I am going to read out can you please tell me whether it is ‘not true’, ‘somewhat true’ or ‘certainly true’ for (CHILD’S NAME) - over the past six months

(1) (2)

Yes No

IF: B8 = YES

B8a How long ago is it since s/he had this burn? (1) (2) (3) (4)

Less than a month ago At least one month but less than 6 months ago At least 6 months but less than a year ago A year ago or more

D4 [*] Considerate of other people’s feelings SHOW CARD 6

D5 [*] Restless, overactive, cannot stay still for long SHOW CARD 6

B9

D6

Has s/he ever had an accidental poisoning requiring admission to hospital?

[*] Often complains of headaches, stomach aches or sickness SHOW CARD 6

(1) (2)

D7

Yes No

IF: B9 = YES

B9a

[*] Shares readily with other children (treats,toys, pencils etc) SHOW CARD 6

How long ago is it since s/he was accidentally poisoned?

D8 (1) (2) (3) (4)

Less than a month ago At least one month but less than 6 months ago At least 6 months but less than a year ago A year ago or more

[*] Often has temper tantrums or hot tempers SHOW CARD 6

D9 B10 Has (CHILD’S NAME) ever been so ill that you thought that s/he may die?

[*] Rather solitary, tends to play alone SHOW CARD 6

D10 (1) (2)

Yes No

[*] Generally obedient, usually does what adults request SHOW CARD 6

IF: B10 = YES

B10a

D11

How long ago was this?

[*] Many worries, often seems worried SHOW CARD 6

(1)

Less than a month ago

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153

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Appendix E: Survey documents

D12

SHOW CARD 6

[*] Helpful if someone is hurt, upset or feeling ill SHOW CARD 6

D26

D13 [*] Constantly fidgeting or squirming SHOW CARD 6

D14 [*] Has at least one good friend SHOW CARD 6

D15 [*] Often fights with other children or bullies them SHOW CARD 6

D16 [*] Often unhappy, down-hearted or tearful SHOW CARD 6

D17 [*] Generally liked by other children SHOW CARD 6

[*] Gets on better with adults than with other children SHOW CARD 6

D27 [*] Many fears,easily scared SHOW CARD 6

D28 [*] Sees tasks through to the end,good attention span? SHOW CARD 6

D29 [*] SHOW CARD 7 Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or getting on with other people? (5) (6) (7) (8)

No Yes: minor difficulties Yes: definite difficulties Yes: severe difficulties

IF: D29 >= 6

D18

D29a

[*] Easily distracted, concentration wanders SHOW CARD 6

How long have these difficulties been present?

D19 [*] Nervous or clingy in new situations,easily loses confidence SHOW CARD 6

D20 [*] Kind to younger children SHOW CARD 6

D21 [*] Often lies or cheats SHOW CARD 6

D22 [*] Picked on or bullied by other children SHOW CARD 6

D23

(1) (2) (3) (4)

Less than a month One to five months Six to eleven months A year or more

IF: D29 >= 6

D29b Do the difficulties upset or distress your child.. RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: D29 >= 6

D30 Do the difficulties interfere with your child’s everyday life in terms of his or her ...home life? SHOW CARD 8

[*] Often volunteers to help others (parents, teachers, other children) SHOW CARD 6

(5) (6) (7) (8)

D24

IF: D29 >= 6

[*] Thinks things out before acting SHOW CARD 6

D25

not at all only a little quite a lot a great deal

D30a [*] (Do the difficulties interfere with your child’s everyday life in terms of his or her) ... friendships? SHOW CARD 8

[*] Steals from home, school or elsewhere (5) (6)

154

Mental health of children and adolescents in Great Britain

not at all only a little

Appendix E: Survey documents

(7) (8)

quite a lot a great deal

E

AtHome Do any of these people live at home with the (CHILD’S NAME)

IF: D29 >= 6

D30b [*] (Do the difficulties interfere with your child’s everyday life in terms of his or her) ... classroom learning? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: D29 >= 6

D30c [*] (Do the difficulties interfere with your child’s everyday life in terms of his or her) ... or leisure activities? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

(1) (2)

Yes No

IF: ATHOME = YES

Home Who are these people who live at home with (CHILD’S NAME) ?

F2intr This section of the interview is about how much (CHILD’S NAME) worries about being separated from (ATTACHMENT FIGURES). Most children have some worries of this sort, but what I would like to know about is how (CHILD’S NAME) compares with other children of his/her age. I am interested in how s/he is usually - not in the occasional ‘clingy day’ or ‘off day’.

F2 [*] Overall, in the past month, has s/he been particularly worried about being separated from his/her (ATTACHMENT FIGURES)?

IF: D29 >= 6

D31

(1) (2)

[*] Do the difficulties put a burden on you or the family as a whole? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

Separation anxiety IntroF Most children are particularly attached to one person or a few key people, looking to them for security, and turning to them when distressed. They can be mum and dad, grandparents, favourite teachers, neighbours etc. INTERVIEWER NOTE: Though children and teenagers can be particularly attached to other people of about the same age (sisters, brothers, friends), aim to identify ADULT attachment figures.

Yes No

IF: F2=YES OR SDQ EMOTION

[*] Over the past month, and compared to with other children of the same age.. has s/he often been worried either about something unpleasant happening to (ATTACHMENT FIGURES), or about losing you/them? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION

[*] (Over the past month, and compared with other children of the same age...) ... has s/he often worried that he might be taken away from (ATTACHMENT FIGURES) for example, by being kidnapped, taken to hospital or killed? SHOW CARD 9 (5) (6) (7)

[*] Who would you say (CHILD’S NAME) was particularly attached to? - RECORD THE NAME (OR A UNIQUE IDENTIFIER) FOR EACH PERSON

IF: F2=YES OR SDQ EMOTION AND: ATHOME = YES

[*] Who are the three most important for (CHILD’S NAME) IF THREE OR LESS ENTER ALL ATTACHMENT FIGURES

SCORE>3

F2b

FigName

F1a1

SCORE>3

F2a

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age SCORE>3

F2c [*] (Over the past month, and compared with other children of the same age...) ... has s/he often not wanted to go to school in case something nasty happened to (ATTACHMENT FIGURES AT HOME) while at school? SHOW CARD 9

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Appendix E: Survey documents

(DO NOT INCLUDE RELUCTANCE TO GO TO SCHOOL FOR OTHER REASONS, EG. FEAR OF BULLYING OR EXAMS) (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION SCORE>3

F2i IF: F2=YES OR SDQ EMOTION SCORE>3

F2d [*] (Over the past month, and compared with other children of the same age...) ... has s/he worried about sleeping alone? DNA = CODE 5 SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] (Over the past month, and compared with other children of the same age...) ... has s/he had repeated nightmares or bad dreams about being separated from (ATTACHMENT FIGURES)? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION SCORE>3 IF: F2=YES OR SDQ EMOTION SCORE>3 AND: ATHOME = YES

F2j

F2e

[*] (Over the past month, and compared with other children of the same age...) ... has s/he had headaches, stomach aches or felt sick when s/he has to leave (ATTACHMENT FIGURES) or when s/he knew it was about to happen? SHOW CARD 9

[*] (Over the past month, and compared with other children of the same age...) ... has s/he often come out of his/her bedroom at night to check on, or to sleep near (ATTACHMENT FIGURES AT HOME)? DNA = CODE 5 SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION SCORE>3

F2f [*] (Over the past month, and compared with other children of the same age...) ... has s/he worried about sleeping in a strange place? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION SCORE>3

F2k [*] (Over the past month, and compared with other children of the same age...) ... has being apart or the thought of being apart from (ATTACHMENT FIGURES) led to worry, crying,tantrums,clinginess or misery? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: ANY F2A - F2K = 7 IF: F2=YES OR SDQ EMOTION SCORE>3 AND: (ATHOME = YES) AND (CHILD <11 YEARS)

F3

F2g

[*] You have told me about (CHILD’S) worries about separations. Has s/he been like that for at least a month?

[*] (Over the past month, and compared with other children of the same age...) ... has s/he been particularly afraid of being alone in a room alone at home without(ATTACHMENT FIGURES AT HOME) even if you or they are close by? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F2=YES OR SDQ EMOTION SCORE>3 AND: (ATHOME = YES) AND (CHILD 11+ YEARS)

(1) (2)

Yes No

IF: ANY F2A - F2K = 7 AND F3 = YES AND: CHILD 6 + YEARS

F3a [*] Was s/he like this by the age of 6? (1) (2)

Yes No

F2h IF: ANY F2A - F2K = 7 AND F3 = YES [*] (Over the past month, and compared with other children of the same age...) ...s/he been particularly afraid of being alone at home if (ATTACHMENT FIGURES AT HOME) pop out for a moment?

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F4 [*] Thinking still of (CHILD’S) worries about separation, how much do you think they have upset him/her

Appendix E: Survey documents

Specific phobias

RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

F5Intr I now want to ask you about the extent to which these worries have interfered with his/her day to day life.

IF: ANY F2A - F2K = 7 AND F3 = YES

F5a [*] Have they interfered with... ... How well s/he gets on with you and the rest of the family? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY F2A - F2K = 7 AND F3 = YES

F5b [*] (Have they interfered with...) ....Making and keeping friends? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

E

F6Intr This section of the interview is about any particular things or situations that (CHILD’S NAME) is PARTICULARLY scared of, even though they aren’t really a danger to him/her. I am interested in how s/he is usually - not in the occasional ‘off day’.I shall ask you first about particular fears, but will ask later about social fears.

F7 [*] Is (CHILD’S NAME) PARTICULARLY scared about any of the things or situations on this list? CODE ALL THAT APPLY SHOW CARD 10 SET [7] OF (1) ANIMALS: Insects, spiders, wasps, bees, mice, snakes, birds or any other animal (2) Storms, thunder, heights or water (3) Blood-injection-Injury - Set off by the sight of blood or injury or by an injection (4) Dentists or Doctors (5) The dark (6) Other specific situations: for example: lifts, tunnels, flying, driving, trains, buses, small enclosed spaces (7) Any other specific fear (specify) (9) Not particularly scared of anything

IF: ANYO TH IN F7

F7Oth What is this other fear? ENTER A SHORT DESRIPTION

IF: ANY F2A - F2K = 7 AND F3 = YES

F5c

IF: F7 = 1 - 7

F7a [*] (Have they interfered with...) ...learning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

[*] Is this fear/are these fears a real nuisance to him/her, or to you, or to anyone else? (5) (6) (7)

No Perhaps Definitely

IF: F7A = DEFINITELY OR SDQ EMOTION SCORE > 3 IF: ANY F2A - F2K = 7 AND F3 = YES

F8

F5d [*] (Have they interfered with...) ...playing, hobbies, sports or other leisure activities? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY F2A - F2K = 7 AND F3 = YES

F5e [*] Have these problems put a burden on you or the family as a whole? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

[*] How long (has this fear/the most severe of these fears) been present? (1) (2) (3)

less than a month At least one month but less than 6 months Six months or more

IF: F7A = DEFINITELY OR SDQ EMOTION SCORE > 3

F9 [*] When (CHILD’S NAME) comes up against (PHOBIC STIMULUS) or thinks s/he is about to come up against it, does s/he become anxious or upset? RUNNING PROMPT (5) (6) (7)

No A little A Lot

IF: F9 = A LOT

F9a

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[*] Does this happen almost every time s/he comes up against (PHOBIC STIMULUS)?

burden on you or the family as a whole... RUNNING PROMPT

(1) (2)

(5) (6) (7) (8)

Yes No

IF: F9 = ALOT

not at all only a little quite a lot or a great deal?

F10 [*] How often does this fear of (PHOBIC STIMULUS) result in his/her becoming upset like this ... IN THE RELEVANT SEASON IF A SEASONAL STIMULUS E.G. WASPS

every now and then most weeks most days many times a day?

IF: F7A = DEFINITELY OR SDQ EMOTION

SCORE

>3

F11 [*] Does his/her fear lead to (CHILD’S NAME) avoiding (PHOBIC STIMULUS) ... SHOW CARD 11 RUNNING PROMPT (5) (6) (7)

No A little or a lot ?

[*] Overall, does (CHILD’S NAME) particularly fear or avoid social situations which involve a lot of people or meeting new people, or doing things in front of other people? (1) (2)

Yes No

Can I just check, has s/he been particularly afraid of any of the following social situations over the last month?

F11a

IF: F13

[*] How much does this avoidance interfere with his/her everyday life? SHOW CARD 11 RUNNING PROMPT No A little or a lot ?

F11b

OR

SDQ EMOTION

SCORE

3+

F14a [*] (Can I just check, has s/he been particularly afraid of) . . . meeting new people? SHOW CARD 11 (5) (6) (7)

IF: F7A = DEFINITELY OR SDQ EMOTION SCORE > 3

IF: F13

No A little A Lot OR

SDQ EMOTION

SCORE

3+

F14b

[*] Does s/he recognize that this fear is excessive or unreasonable? SHOW CARD 12

[*] (Can I just check, has s/he been particularly afraid of) . . .meeting a lot of people, such as at a party? SHOW CARD 11

(5) (6) (7)

(5) (6) (7)

No Perhaps Definitely

IF : F7 = 1-7 AND: F7A = DEFINITELY OR SDQ EMOTION

SCORE

>3

F11c

IF: F13

No A little A Lot OR

SDQ EMOTION

SCORE

3+

F14c

[*] Is s/he upset that s/he has this fear? SHOW CARD 12

[*] (Can I just check, has s/he been particularly afraid of) ...eating in front of others? SHOW CARD 11

(5) (6) (7)

(5) (6) (7)

No Perhaps Definitely

IF: F7 = 1-7 AND: F7A = DEFINITELY OR SDQ EMOTION SCORE > 3

F12 [*] Has (CHILD’S) fear of (PHOBIC STIMULUS) put a

158

F13

F14Intr

IF: F11 = ALOT

(5) (6) (7)

F13intr I am interested in whether (CHILD’S NAME) is particularly afraid of social situations, that is being with a lot of people, or meeting new people, or having to do things in front of other people. This is as compared with other children of his/her age, and is not counting the occasional ‘off day’ or ordinary shyness.

RUNNING PROMPT (1) (2) (3) (4)

Social Phobia

Mental health of children and adolescents in Great Britain

IF: F13

No A little A Lot OR

SDQ EMOTION

SCORE

3+

F14d [*] (Can I just check, has s/he been particularly afraid of)

Appendix E: Survey documents . . .speaking in class? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F13

OR

SDQ EMOTION

E

[*] Do you think his/her dislike of social situations is because s/he is afraid s/he will act in a way that will be embarrassing or show him/her up? SHOW CARD 12

SCORE

3+

(5) (6) (7)

No Perhaps Definitely

F14e [*] (Can I just check, has s/he been particularly afraid of) . . .reading out loud in front of others? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F13

OR

SDQ EMOTION

F18a [*] Is his/her dislike of social situations related to specific problems with speech, reading or writing? SHOW CARD 12

SCORE

3+

F14f [*] (Can I just check, has s/he been particularly afraid of) . . .writing in front of others? SHOW CARD 11 (5) (6) (7)

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A -F14 F)=7 AND F15=2 AND: ANY (F14D-F14F=6 OR 7)

No A little A Lot

IF: F13 OR SDQ EMOTION SCORE 3+ AND: SEPARATION ANXIETY AND (F14A - F14F)=7

(5) (6) (7)

No Perhaps Definitely

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A -F14 F)=7 AND F15=2

F19 [*] How long has this fear of social situations been present? (1) (2) (3)

Less than a month At least one month but less than six months Six months or more

F15

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

[*] Is (CHILD’S NAME) frightened of these social situations mainly because s/he is worried about being separated from (ATTACHMENT FIGURES) OR are (CHILD’S) fears of social situations still very obvious even when s/he is with them?

F20

(1) (2)

mainly related to his/her fear about being apart from attachment figures marked even when attachment figure present

What age did it begin at.. RUNNING PROMPT (1) (2)

under six years or six years or above?

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A -F14 F)=7 AND F15=2

F21

F16

[*] When (CHILD’S NAME) is in one of the social situations s/he fears, or thinks s/he is about to come up against,does s/he become anxious or upset? RUNNING PROMPT

[*] Is (CHILD’S NAME) just afraid with adults, or is s/he also afraid in situations that involve a lot of children, or meeting new children? (1) (2) (3)

Just with adults Just with children Also with children

(5) (6) (7)

No A little or a lot

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A -F14 F)=7 AND F15=2

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2 IF: F21 = ALOT

F17

F22

[*] Outside of these social situations, is (CHILD’S NAME) able to get on well enough with the adults and children s/he knows best?

[*] How often does his/her fear of social situations result in his/her becoming upset like this RUNNING PROMPT

(1) (2)

(1) (2) (3) (4)

Yes No

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A -F14 F)=7 AND F15=2

F18

many times a day most days most weeks or every now and then?

IF: F13 OR SDQ E MOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

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F23

(1) (2)

[*] Does his/her fear lead to (CHILD’S NAME) avoiding social situations... RUNNING PROMPT (5) (6) (7)

No A little or a lot

IF: SOCSPCHK = SOCFSEP IF: F23 = ALOT

F23a [*] How much does this avoidance interfere with his/her daily life? SHOW CARD 11

Yes No

F26 [*] Over the last month has (CHILD’S NAME) been very afraid of, or tried to avoid, the things on this card? SHOW CARD 13 CODE ALL THAT APPLY SET [4] OF (1) Crowds (2) Public places (3) Travelling alone (if s/he ever does) (4) Being far from home (9) None of the above

IF: F26 = 1 - 4 (5) (6) (7)

No A little A Lot

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

F23b [*] Does s/he recognize that this fear is excessive or unreasonable? SHOW CARD 12 (5) (6) (7)

No Perhaps Definitely

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

F23c [*] Is s/he upset about having this fear? SHOW CARD 12 (5) (6) (7)

No Perhaps Definitely

F27 [*] Do you think this fear or avoidance of (SITUATION) is because s/he is afraid that if s/he had a panic attack or something like that, s/he would find it difficult or embarassing to get away, or would not be able to get the help s/he needs? (1) (2)

Yes No

Post Traumatic Stress Disorder (PTSD) E1 The next section is about events or situations that are exceptionally stressful, and that would really upset almost anyone. For example being caught in a burning house, being abused, being in a serious car crash or seeing you being mugged at gunpoint. [*] During (CHILD’S) lifetime has anything like this happened to him/her? (1) (2)

Yes No

IF: F13 OR SDQ EMOTION SCORE 3+ AND: (F14A - F14F)=7 AND F15=2

IF: E1 = Y ES

F24

E2

[*] Have (CHILD’S) fears put a burden on you or the family as a whole RUNNING PROMPT

What was it, please describe? OPEN

IF: E1 = Y ES (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

E4

Panic attacks and agoraphobia

(1) (2)

INTERVIEWER CODE : DO YOU REGARD THIS AS AN EXCEPTIONALLY STRESSFUL OR TRAUMATIC EVENT? Yes No

F25Intr Many children have times when they get very anxious or worked up about silly little things, but some children get severe panics that come out of the blue - they just don’t seem to have any trigger at all.

IF: E1 = Y ES AND: E4 = YES

E3 [*] At the time, was (CHILD’S NAME) very distressed or did his/her behaviour change dramatically?

F25 [*] Over the last month has (CHILD’S NAME) had a panic attack when s/he suddenly became very panicky for no reason at all,without even a little thing to set him/her off?

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(1) (2)

Yes No

Appendix E: Survey documents

IF: E1 = YES AND: E4 = YES

E

him/her of the event? SHOW CARD 11

E5 At present, is it affecting (CHILD’S) behaviour, feelings or concentration? (1) (2)

Yes No

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21a [*] (Over the last month, has CHILD) . . ‘relived’ the event with vivid memories (flashbacks) of it? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES IF: E4 = YES IF: E5 = YES

E21b [*] (Over the last month, has CHILD ...) .. had repeated distressing dreams of the event? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21c [*] (Over the last month, has CHILD ...) .. got upset if anything happened which reminded him/ her of it? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21d [*] (Over the last month, has CHILD ...) .. tried to avoid thinking or talking about anything to do with the event? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21e [*] (Over the last month, has CHILD ...) .. tried to avoid activities places or people that remind

(5) (6) (7)

No A little A Lot

IF: E1 = Y ES AND: E4 = YES AND: E5 = YES

E21f [*] (Over the last month, has CHILD ...) .. blocked out important details of the event from his/her memory? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = Y ES AND: E4 = YES AND: E5 = YES

E21g [*] (Over the last month, has CHILD ...) .. shown much less interest in activities s/he used to enjoy? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = Y ES AND: E4 = YES AND: E5 = YES

E21h [*] (Over the last month, has CHILD ...) .. felt cut off or distant from others? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = Y ES AND: E4 = YES AND: E5 = YES

E21i [*] (Over the last month, has CHILD ...) .. expressed a smaller range of feelings than in the past? (e.g. no longer able to express loving feelings) SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = Y ES AND: E4 = YES AND: E5 = YES

E21j [*] (Over the last month, has (CHILD’S NAME) . . ) .. felt less confidence in the future? SHOW CARD 11

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(5) (6) (7)

No A little A Lot

[*] You have told me about how (DEFINITE SYMPTOMS) How long after the event did these problems begin?

IF: E1 = YES AND: E4 = YES AND: E5 = YES

(1) (2)

E21k

IF: ANYE21 - E21O = 7

within six months more than six months after the event

E23 [*] (Over the last month, has CHILD ...) .. had problems sleeping? SHOW CARD 11 (5) (6) (7)

No A little A Lot

How long has s/he been having these problems? (1) (2) (3)

Less than a month At least one month but less than three months Three months or more

IF: ANYE21 - E21O = 7

E24 IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21l [*] (Over the last month, has CHILD ...) .. felt irritable or angry? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21m [*] (Over the last month, has CHILD ...) .. had difficulty concentrating? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

[*] How much have these problems upset or distressed your child... RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: ANYE21 - E21O = 7

E25a [*] Have they interfered with... how well s/he gets on with you and the rest of the family? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANYE21 - E21O = 7

E25b [*] (Have they interfered with...) .. making and keeping friends? SHOW CARD 8

E21n [*] (Over the last month, has CHILD ...) .. always been on the alert for possible dangers? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: E1 = YES AND: E4 = YES AND: E5 = YES

E21o [*] (Over the last month, has CHILD ...) .. jumped at little noises or easily startled in other ways? SHOW CARD 11

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANYE21 - E21O = 7

E25c [*] (Have they interfered with...) .. learning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANYE21 - E21O = 7 (5) (6) (7)

No A little A Lot

IF: ANYE21 - E21O = 7

E25d [*] (Have they interfered with...) .. playing, hobbies, sports or other leisure activities? SHOW CARD 8

E22 (5)

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not at all

Appendix E: Survey documents

(6) (7) (8)

only a little quite a lot a great deal

IF: ANYE21 - E21O = 7

E26 [*] Have these problems put a burden on you or the family as a whole. . RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

E

Other special measures to avoid dirt, germs or poisons? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION

SCORE

>3

F29c [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all) Checking: doors, locks, oven, gas taps, electric switches? SHOW CARD 11

Compulsions and obsessions F28Intr Many young people have some habits or superstitions, such as not stepping on the cracks in the pavement, or having to go through a special goodnight ritual, or needing to wear lucky clothes or have a lucky mascot for exams or football/netball matches. It is also common for children to go through phases when they seem obsessed by one particular subject or activity. I want to ask whether (CHILD’S NAME) has rituals or obsessions that go beyond this.

F28 [*] Overall, does (CHILD’S NAME) have rituals or obsessions that upset him/her, waste a lot of his/her time or interfere with his/her ability to get on with everyday life? (1) (2)

Yes No

(5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION

SCORE

>3

F29d [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all) Repeating actions:like going in and out through a door many times in a row, getting up and down from a chair, or anything like this? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION

SCORE

>3

F29e

F29Intr

[*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all)

Can I just check, over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all?

Touching things or people in particular ways? SHOW CARD 11

IF: F28=YES OR SDQ EMOTION SCORE >3

IF: F28=YES OR SDQ EMOTION SCORE >3

F29a [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all) Excessive cleaning; handwashing, baths, showers, toothbrushing etc. ? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION SCORE >3

F29b [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all)

(5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION

SCORE

>3

F29f [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he has already done them or doesn’t need to do them at all) Arranging things so they are just so, or exactly symmetrical? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION

SCORE

>3

F29g [*] (Over the last month has s/he been doing any of the following things over and over again even though s/he

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has already done them or doesn’t need to do them at all)

[*] Does s/he try not to do them or think about them?

Counting to particular lucky numbers or avoiding unlucky numbers? SHOW CARD 11

(5) (6) (7)

(5) (6) (7)

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

No A little A Lot

IF: F28=YES OR SDQ EMOTION

No Perhaps Definitely

F36 SCORE

>3

F31a

[*] Does s/he become upset because s/he has to do or think about these things?

[*] Over the last month, has (CHILD’S NAME) been particularly concerned about ... Dirt, germs or poisons? SHOW CARD 11

(5) (6) (7) (8)

(5) (6) (7)

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

No A little A Lot

IF: F28=YES OR SDQ EMOTION

No,enjoys it Neutral, neither enjoys it or becomes upset Sometimes/somewhat upset Upset a great deal

F37 SCORE

>3

F31b [*] (Over the last month, has (CHILD’S NAME) been particularly concerned about) ... something terrible happening to him/her self or others - illnesses,accidents, fires etc.? SHOW CARD 11

[*] Do these (acts/thoughts) use up at least an hour a day on average? (1) (2)

Yes No

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F38a (5) (6) (7)

No A little A Lot

IF: F28=YES OR SDQ EMOTION SCORE >3 AND CHILD HAS SEPARATION ANXIETY AND F31B = ALOT

F32 [*] Is this just part of his/her general concern about separation from (SEPARATION ANIXETY) or is this a serious additional problem in its own right? (1) (2)

mainly related to separation anxiety a problem in it’s own right

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F33

[*] Have these acts/thoughts interfered with ... .. how well s/he gets on with you and the rest of the family? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F38b [*] (Have these acts/thoughts interfered with ...) ... making and keeping friends? SHOW CARD 8

[*] You have just told me about (CHILD’S) habits and obsessions. Have they been present on most days for a period of at least two weeks?

(5) (6) (7) (8)

(1) (2)

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

Yes No

not at all only a little quite a lot a great deal

F38c IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F34 [*] Does s/he recognise that these (acts/thoughts) are excessive or unreasonable? (5) (6) (7)

No Perhaps Definitely

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F35

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Mental health of children and adolescents in Great Britain

[*] (Have these acts/thoughts interfered with ...) ...learning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F38d

Appendix E: Survey documents

[*] (Have these acts/thoughts interfered with ...) ...playing, hobbies, sports or other leisure activities? SHOW CARD 8

IF: F39 = Y ES AND: F39A=6

(5) (6) (7) (8)

[*] (Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about:) Disasters: Burglaries, muggings, fires, bombs etc.

not at all only a little quite a lot a great deal

IF: F28=YES OR SDQ EMOTION SCORE >3 AND: F29A- F29G = 7 OR F31A - F31B = 7 OR F32 = 2

F38e

OR

7 OR SDQ EMOTION

SCORE

>3

F40c

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] Have these problems put a burden on you or the family as a whole? SHOW CARD 8

IF: F39 = Y ES AND: F39A=6

(5) (6) (7) (8)

[*] (Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about:) His/her own health

not at all only a little quite a lot a great deal

Generalised anxiety

E

OR

7 OR SDQ EMOTION

SCORE

>3

F40d

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

F39 [*] Does (CHILD’S NAME) ever worry?

IF: F39 = Y ES AND: F39A=6

OR

7 OR SDQ EMOTION

SCORE

>3

F40e (1) (2)

Yes No

IF: F39 = YES

F39a [*] From now on I am going to concentrate on general worrying (that is apart from his/her (SPECIFIC ANXIETIES) that you have already told me about). Over the last six months, has s/he worried so much about so many things that it has really upset him/her or interfered with his/her life?

[*] (Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about:) Bad things happening to others: family friends, pets, the world.. (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F39 = Y ES AND: F39A=6

OR

7 OR SDQ EMOTION

SCORE

>3

F40f (5) (6) (7)

No Perhaps Definitely

IF: F39 = YES AND: F39A=6 OR 7 OR SDQ EMOTION SCORE > 3

F40a [*] Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about: Past behaviour: Did I do that wrong? Have I upset someone? Have they forgiven me?

[*] (Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about:) The future: e.g. getting a job, boy/ girlfriend, moving out (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F39 = Y ES AND: F39A=6

OR

7 OR SDQ EMOTION

SCORE

>3

F40g (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: F39 = YES AND: F39A=6 OR 7 OR SDQ EMOTION SCORE > 3

F40b

[*] Has s/he worried about anything else? (1) (2)

Yes No

IF: F39 = Y ES AND: F39A=6 OR 7 OR SDQ EMOTION AND: F40G = YES

SCORE

>3

[*] (Over the last 6 months, and by comparison with other children of the same age, has (CHILD’S NAME) worried about:) School work,homework or examinations

F40ga

(5) (6)

IF: F39 = Y ES AND: F39A=6 OR 7 OR SDQ EMOTION SCORE > 3 AND: F40G = YES

(7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] What else has s/he worried about?

F40gb

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[*] How much does s/he worry about this

IF: (GENWCHK = YES) AND (F42 = YES)

F46 (5) (6) (7)

IF:TWO

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age OF

F40A - F40GB = 7

GenWCHK

[*] Does worrying lead to difficulties in concentrating or his/her mind going blank? (1) (2)

Yes No

INTERVIEWER CHECK: Are there two or more specific worries (SPECIFIC WORRIES) over and above those which have already been mentioned in earlier sections?

IF: (GENWCHK = YES) AND (F42 = YES) IF: F46 = Y ES

(1) (2)

[*] Has this been true for more days than not in the last six months?

Yes No

IF: G ENWCHK = YES

F42

F46a

(1) (2)

Yes No

[*] Over the last six months has s/he worried excessively on more days than not?

IF: (GENWCHK = YES) AND (F42 = YES)

(1) (2)

[*] Does worrying make him/her irritable?

Yes No

IF: (GENWCHK = YES) AND (F42 = YES)

F47

(1) (2)

Yes No

F43 [*] Does s/he find it difficult to control the worry?

IF: (GENWCHK = YES) AND (F42 = YES) IF: F47 = Y ES

F47a (1) (2)

Yes No

[*] Has this been true for more days than not in the last six months?

IF: (GENWCHK = YES) AND (F42 = YES)

F44

(1) (2)

[*] Does worrying lead to him /her being restless, feeling keyed up, tense or on edge, or being unable to relax?

Yes No

IF: (GENWCHK = YES) AND (F42 = YES)

F48 (1) (2)

Yes No

IF: (GENWCHK = YES) AND (F42 = YES) AND: F44 = YES

[*] Does worrying lead to muscle tension? (1) (2)

Yes No

F44a [*] Has this been true for more days than not in the last six months? (1) (2)

Yes No

IF: (GENWCHK = YES) AND (F42 = YES)

F45

IF: (GENWCHK = YES) AND (F42 = YES) IF: F48 = Y ES

F48a [*] Has this been true for more days than not in the last six months? (1) (2)

Yes No

[*] Does worrying lead to him/her feeling tired or ‘worn out’ more easily?

IF: (GENWCHK = YES) AND (F42 = YES)

(1) (2)

[*] Does worrying interfere with his/her sleep, leading to difficulty in falling or staying asleep, or to restless,unsatisfying sleep?

Yes No

IF: (GENWCHK = YES) AND (F42 = YES) AND: F45 = YES

F49

F45a

(1) (2)

Yes No

[*] Has this been true for more days than not in the last six months?

IF: (GENWCHK = YES) AND (F42 = YES) IF: F49 = Y ES

F49a (1) (2)

166

Yes No

Mental health of children and adolescents in Great Britain

[*] Has this been true for more days than not in the last six months?

Appendix E: Survey documents

(1) (2)

Yes No

E

[*] SHOW CARD 8 Have these worries put a burden on you or the family as a whole...

IF: (GENWCHK = YES) AND (F42 = YES)

F50

RUNNING PROMPT

[*] Overall, how upset and distressed is (CHILD’S NAME) as a result of all his/her various worries ... RUNNING PROMPT

(5) (6) (7) (8)

(5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: (GENWCHK = YES) AND (F42 = YES)

F51Intr I now want to ask you about the extent to which these worries have interfered with his/her day to day life.

IF: (GENWCHK = YES) AND (F42 = YES)

F51a [*] Have they interfered with ...How well s/he gets on with you and the rest of the family? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: (GENWCHK = YES) AND (F42 = YES)

F51b [*] (Have they interfered with ...) making and keeping friends? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: (GENWCHK = YES) AND (F42 = YES)

F51c

not at all only a little quite a lot a great deal

IF: (GENWCHK = YES) AND (F42 = YES)

F51d [*] (Have they interfered with ...) playing, hobbies, sports or other leisure activities? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: (GENWCHK = YES) AND (F42 = YES)

F52

Depression DepIntr This next section of the interview is about (CHILD’S) mood.

G1 [*] In the past month, have there been times when (CHILD’S NAME) has been very sad, miserable, unhappy or tearful? (1) (2)

Yes No

IF: G1 = YES

G3 [*] Was there a period when s/he was really miserable nearly every day? (1) (2)

Yes No

IF: G1 = YES

G4 [*] During this period, was s/he really miserable for most of the day? (i.e.for more hours than not) (1) (2)

Yes No

IF: G1 = YES

[*] (Have they interfered with ...) learning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

G5 [*] During this period, could s/he be cheered up... RUNNING PROMPT (1) (2) (3)

easily with difficulty/only briefly or not at all?

IF: G1 = YES

G6 [*] Can you tell me how long that period lasted? (1) (2)

less than two weeks two weeks or more

G8 [*] In the past month, have there been times when (CHILD’S NAME) has been very grumpy or irritable in a way that was out of character for him/her? (1)

Yes

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(2)

No

IF: G8 = Y ES

(2)

two weeks or more

G10

IF: G15 = Y ES AND: G4=YES AND G3 =YES OR: G10=YES OR G11=YES

[*] Was there a period when s/he was really irritable nearly everyday?

G20

(1) (2)

[*] Was this loss of interest present during the same period when s/he was really miserable/irritable for most of the time?

Yes No

IF: G8 = Y ES

G11

(1) (2)

[*] During this period, was s/he really irritable for most of the day?

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

(1) (2)

Yes No

IF: G8 = Y ES

G12 [*] Was the irritability improved by particular activities, friends coming around or anything else... RUNNING PROMPT (1) (2) (3)

easily with difficulty/only briefly or not at all?

IF: G8 = Y ES

G13

Yes No OR

G21a [*] During that time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) did s/he lack energy and seem tired all the time? (1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

OR

G21ba [*] During this time when s/he was was s/he eating much more or much less than normal? (1) (2)

Yes No

[*] Can you tell me how long that period lasted? (1) (2)

less than two weeks two weeks or more

G15 [*] In the past month, has there been a time when (CHILD’S NAME) lost interest in everything, or nearly everything, s/he normally enjoys doing? (1) (2)

Yes No

IF: G15 = Y ES

G17

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

OR

G21b [*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) . . . did s/he either lose or gain a lot of weight? (1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

OR

G21c

[*] Was there a period when s/he was lacking in interest nearly every day?

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) . . . did s/he find it hard to get to sleep?

(1) (2)

(1) (2)

Yes No

IF: G15 = Y ES

G18

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

OR

G21d [*] During this period, was s/he lacking in interest for most of each day? (i.e.for more hours than not) (1) (2)

Yes No

IF: G15 = Y ES

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) . . .did s/he sleep too much? (1) (2)

Yes No

G19 [*] Can you tell me how long this loss of interest lasted?

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

G21e (1)

168

less than two weeks

Mental health of children and adolescents in Great Britain

OR

Appendix E: Survey documents

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) . . . was s/he agitated or restless much of the time? (1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

E

. . . did s/he ever talk about harming himself/herself or killing himself/herself? (1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

G22

G21f [*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST)? .. did s/he feel worthless or unnecessarily guilty much of the time? (1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

[*] You have told me about (CHILD’S NAME) (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST). Overall, how upset and distressed is (CHILD’S NAME) as a result of this. RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

G21g

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST)) .. did s/he find it unusually hard to concentrate or to think things out?

G23Intr

(1) (2)

Yes No

I also want to ask you about the extent to (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST) has interfered with his/her day to day life.

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

G23a

G21h

[*] Has this interfered with ... how well s/he gets on with you and the rest of your family? SHOW CARD 8

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST)) . . . did s/he think about death a lot? (1) (2)

Yes No

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

G21k

G23b

[*] Over the whole of his/her lifetime has s/he ever tried to harm himself/herself or kill himself/herself?

[*] (Has this interfered with ...) making and keeping friends? SHOW CARD 8

(1) (2)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES AND: G21K = YES

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

G21j

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST)) . . . did s/he ever try to harm himself/herself or kill himself/herself?

G23c

(1) (2)

(5) (6) (7) (8)

Yes No

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

[*] (Has this interfered with ...) learning or class work? SHOW CARD 8 not at all only a little quite a lot a great deal

G21i

IF: G3 AND G4=YES OR G10 AND G11=YES OR G17=YES

[*] (During this time when s/he was (feeling DEPRESSED/IRRITABLE/A LACK OF INTEREST))

G23d

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Appendix E: Survey documents [*] (Has this interfered with ...) playing, hobbies, sports or other leisure activities? SHOW CARD 8

(1) (2)

Yes No

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ (5) (6) (7) (8)

not at all only a little quite a lot a great deal

H2Intr

IF: G3 AND G4=YES OR G10 AND G11=YES G17=YES

OR

G24

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

[*] Has (CHILD’S) (DEPRESSED/IRRITABLE/A LACK OF INTEREST) put a burden on you or the family as a whole... RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: G3 AND G4=NO OR G10 AND G11=NO G17=NO

Yes No

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

H2b [*] (Over the last 6 months, and compared with other children of his/her age..) Is it hard for him/her to stay sitting down for long? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

OR

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

G26

H2c

Over the past month, has s/he ever tried to harm or hurt himself/herself? (1) (2)

[*] Over the last 6 months, and compared with other children of is/her age... Does s/he often fidget? SHOW CARD 9

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ OR

Over the past month, has s/he talked about deliberately harming or hurting himself/herself?

IF: G3 AND G4=NO OR G10 AND G11=NO G17=NO

H2a

(5) (6) (7)

G25

(1) (2)

I would now like to go through some more detailed questions about how (CHILD’S NAME) has usually been over the last six months? I will start with questions about how active s/he has been

Yes No

IF: G3 AND G4=NO OR G10 AND G11=NO G17=NO

OR

G27

[*] (Over the last 6 months, and compared with other children of his/her age..) Does s/he run or climb about when s/he shouldn’t? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ Over the whole of his/her lifetime, has s/he ever tried to harm or hurt himself/herself? (1) (2)

Yes No

Attention and activity AttnIntr This section of the interview is about concentration and activity. I am going to ask you about (CHILD’S) activity and concentration over the past six months. Nearly all children are overactive or lose concentration at times,but what I would like to know is how (CHILD’S NAME) compares with other children of his/her age.? I am interested in how s/he is usually - not in the occasional ‘off day’.

H2d [*] (Over the last 6 months, and compared with other children of his/her age..) Does s/he find it hard to play or take part in other leisure activities without making a noise? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H2e [*] (Over the last 6 months, and compared with other children of his/her age..) If s/he is rushing about, does s/ he find it hard to calm down when someone asks him/ her to? SHOW CARD 9

H1 [*] Allowing for his/her age, do you think that (CHILD’S NAME) definitely has some problems with overactivity or poor concentration?

170

Mental health of children and adolescents in Great Britain

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

Appendix E: Survey documents IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H3Intr The next few questions are about impulsiveness Over the past six months and compared with other children of his/her age. SHOW CARD 9

E

children of his/her age.) Does s/he often make careless mistakes or fail to pay attention to what s/he is supposed to be doing? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H3a

H4b [*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often blurt out an answer before s/he had heard the question properly? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often seem to lose interest in what s/he is doing? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H3b

H4c

[*] (Over the past 6 months and compared with other children of his/her age.) Is it hard for him/her to wait his/ her turn? SHOW CARD 9

[*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often not listen to what people are saying to him/her? SHOW CARD 9

(5) (6)

(5) (6) (7)

(7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H4d

H3c [*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often butt in on other people’s conversations or games? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often not finish a job properly? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H4e IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H3d [*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often go on talking even if s/he has been asked to stop or no one is listening? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H4Intr The next set of questions are about attention. Over the past 6 months and compared with other children his/her age...

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

[*] (Over the past 6 months and compared with other children of his/her age.) Is it often hard for him/her to get himself/herself organised to do something? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H4f [*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often try to get out of things s/he would have to think about,such as homework? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

H4a IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ [*] (Over the past 6 months and compared with other

H4g

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[*] (Over the past 6 months and compared with other children of his/her age.) Does s/he often lose things s/he needs for school or games? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] You have told me about (CHILD’S) difficulties with some aspects of activity and concentration. Have they been there for much of his/her life? (1) (2)

Yes No

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H 2E) OR (H3A-H3D) OR (H4A-H 4I) OR (H5A-H5C) = 7

H4h

H8

[*] (Over the past 6 months and compared with other children of his/her age.) Is s/he easily distracted? SHOW CARD 9

[*] What age did they start at? IF ‘ALWAYS’ OR SINCE BIRTH, ENTER 00 ENTER AGE

(5) (6) (7)

0..15

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) (H5A-H5C) = 7

H4i

H9

[*] (Over the past 6 months and compared with other children of his/her age.) Is s/he often forgetful? SHOW CARD 9

[*] Thinking still of (CHILD’S) difficulties with activity and attention, how much do you think they have upset or distressed him/her SHOW CARD 8 RUNNING PROMPT

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H5a

(5) (6) (7) (8)

OR

not at all only a little quite a lot or a great deal?

[*] Could you tell me if (CHILD’S) teacher has complained, over the past 6 months of him/her being fidgety,restless or overactive SHOW CARD 11

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) OR (H5A-H5C) = 7

(5) (6) (7)

I also want to ask you about the extent to which these difficulties have interfered with his/her day to day life. SHOW CARD 8

No A little A Lot

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+

H5b [*] (Could you tell me if (CHILD’S) teacher has complained over the last six months of problems with...) Poor concentration or being easily distracted? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

H10Intr

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF:TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) OR (H5A-H5C) = 7

H10a [*] Have they interfered with ... how well s/he gets on with you and the rest of the family? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

H5c [*] (Could you tell me if (CHILD’S) teacher has complained over the last six months of problems with...) Acting without thinking about what s/he was doing, frequently butting in, or not waiting his/her turn? SHOW CARD 11 (5) (6) (7)

No A little A Lot

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A- H4I) OR (H5A-H5C) = 7

H7

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Mental health of children and adolescents in Great Britain

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H 2E) OR (H3A-H3D) OR (H4A-H 4I) OR (H5A-H5C) = 7

H10b [*] (Have they interfered with ...) .. making and keeping friends? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: H1=Y ES OR SDQ HYPERACTIVITY SCORE = 6+

Appendix E: Survey documents

IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) OR (H5A-H5C) = 7

H10c [*] (Have they interfered with ...) .. learning or class work? SHOW CARD 8

Some children are awkward or annoying with just one person - perhaps with yourself or just one brother or sister. Other children are troublesome with a range of adults or children. The following questions are about how (CHILD’S NAME) is in general, and not just with one person.

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT (5) (6) (7) (8)

E

SCORE

3+

I2a

not at all only a little quite a lot a great deal

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) OR (H5A-H5C) = 7

[*] Over the last six months and compared with other children of the same age. Has s/he often had severe temper outbursts? SHOW CARD 9

H10d

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

[*] (Have they interfered with ...) .. playing, hobbies, sports or other leisure activities? SHOW CARD 8

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

(5) (6) (7) (8)

[*] (Over the last six months and compared with other children of the same age.) Has s/he often argued with grown-ups? SHOW CARD 9

SCORE

3+

I2b

not at all only a little quite a lot a great deal

IF: H1=YES OR SDQ HYPERACTIVITY SCORE = 6+ IF: TWO OF ( H2A-H2E) OR (H3A-H3D) OR (H4A-H4I) OR (H5A-H5C) = 7

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

H11 IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

(5) (6) (7) (8)

SCORE

3+

I2c

[*] Have these problems put a burden on you or the family as a whole? RUNNING PROMPT

[*] (Over the last six months and compared with other children of the same age.) Has s/he often taken no notice of rules, or refused to do as s/he is told? SHOW CARD 9

not at all only a little quite a lot or a great deal?

(5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

Awkward and troublesome behaviour IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

AwkIntr

I2d

This next section of the interview is about behaviour. All children can be awkward and difficult at times, but once again what I would like to know is how (CHILD’S NAME) compares with other children of the same age.

[*] (Over the last six months and compared with other children of the same age.) Has s/he often seemed to do things to annoy other people on purpose? SHOW CARD 9

I’m going to ask you first about (CHILD’S) awkward behaviour over the past six months, things like, not doing what s/he is told, being irritable, having temper outbursts, or deliberately annoying other people.

(5) (6) (7)

I am interested in how s/he is usually, and not just on the occasional ‘off days’.

I2e

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

[*] Overall, how do you think (CHILD’S NAME) compares with other children of his/her age as far as this sort of awkward behaviour is concerned, is s/he..... RUNNING PROMPT

I2Intr

(5) (6) (7)

less troublesome than average about average or more troublesome than average

IF: I1=3 (MORE TROUBLESOME) OR SDQ CONDUCT

SCORE

3+

[*] (Over the last six months and compared with other children of the same age.) Has s/he often blamed others for his/her own mistakes or bad behaviour? SHOW CARD 9

I1

(1) (2) (3)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

I2f SCORE

3+

[*] (Over the last six months and compared with other children of the same age.) Was s/he often touchy and easily annoyed?

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SHOW CARD 9

0..15

(5) (6)

IF: I2 A - I2I = 7

(7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

I2g

I6Intr I also want to ask you about the extent to which it has interfered with ... SHOW CARD 8

IF: I2A - I2I = 7 [*] (Over the last six months and compared with other children of the same age.) Was s/he often angry and resentful? SHOW CARD 9 (5) (6) (7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

I2h

(7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

I2i

(7)

No more than other children of the same age A little more than other children of the same age A lot more than other children of the same age

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT

SCORE

3+

I3

No A little A Lot

IF: I2A - I2I = 7

I4 [*] You have told me about (CHILD’S) awkward behaviour. Has it been there for much of his/her life? (1) (2)

Yes No

IF: I2A - I2I = 7

I5 What age did it start at?

174

not at all only a little quite a lot a great deal

I6b [*] (Has it interfered with...) ...making and keeping friends? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

I6c [*] (Has it interfered with...) ...learning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: I2 A - I2I = 7

I6d

Could you also tell me if (CHILD’S) teacher has complained over the last six months of problems with this same kind of awkward behaviour or disruptiveness in class? SHOW CARD 11 (5) (6) (7)

(5) (6) (7) (8)

IF: I2 A - I2I = 7

[*] (Over the last six months and compared with other children of the same age.) Has s/he often tried to get his/her own back on people? SHOW CARD 9 (5) (6)

[*] (Has it interfered with...) how well s/he gets on with you and the rest of the family? SHOW CARD 8

IF: I2 A - I2I = 7

[*] (Over the last six months and compared with other children of the same age.) Was s/he often spiteful? SHOW CARD 9 (5) (6)

I6a

Mental health of children and adolescents in Great Britain

[*] (Has it interfered with...) ... playing, hobbies, sports or other leisure activities? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: I2 A - I2I = 7

I7 [*] Have these problems put a burden on you or the family as a whole? RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: I1=3 ( MORE TROUBLESOME) OR SDQ CONDUCT

I8Intr

SCORE=3+

Appendix E: Survey documents

I’m now going to ask about behaviour that sometimes gets children into trouble, including dangerous, aggressive or antisocial behaviour. Please answer according to how s/he has been over the last year - I’m switching to the past 12 months for this set of questions. As before, I am interested in how s/he is usually, and not just in occasional ‘off days’.

IF: I1=3 (MORE TROUBLESOME) OR SDQ

CONDUCT SCORE=3+

s/he was supposed to? SHOW CARD 12 (5) (6) (7)

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+ AND: I8D = DEF

I8a

I8da

[*] Has s/he often told lies in order to get things or favours from others, or to get out of having to do things s/he is supposed to do? SHOW CARD 12

[*] Has this been going on for the last 6 months?

(5) (6) (7)

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME) OR SDQ AND: I8A = DEF

CONDUCT SCORE=3+

[*] Has this been going on for the last 6 months? Yes No

IF: I1=3 (MORE TROUBLESOME) OR SDQ

(1) (2)

Yes No

I8e

I8aa

(1) (2)

CONDUCT SCORE=3+

[*] Has s/he stolen from the house, or from other people’s houses, from shops or school? (Do not include things of trivial value) SHOW CARD 12 (5) (6) (7)

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+ IF: I8E = DEF

I8b

I8ea

[*] Has s/he often started fights? (other than with brothers or sisters) SHOW CARD 12

[*] Has this been going on for the last 6 months?

(5) (6) (7)

(1) (2)

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME) OR SDQ AND: I8B = DEF

I8f CONDUCT SCORE=3+

[*] Has this been going on for the last 6 months? Yes No

IF: I1=3 (MORE TROUBLESOME) OR SDQ

Yes No

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+

I8ba

(1) (2)

CONDUCT SCORE=3+

[*] Has s/he run away from home more than once or ever stayed away all night without your permission? SHOW CARD 12 (5) (6) (7)

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+ IF: I8F = DEF

I8c

I8fa

[*] Has s/he often bullied or threatened people? SHOW CARD 12

[*] Has this been going on for the last 6 months?

(5) (6) (7)

E

(1) (2)

No Perhaps Definitely

Yes No

IF: I1=3 (MORE TROUBLESOME ) OR SDQ CONDUCT SCORE=3+

I8g IF: I1=3 (MORE TROUBLESOME) OR SDQ AND: I8C = DEF

CONDUCT SCORE=3+

[*] Has s/he often played truant (‘bunked off’) from school? SHOW CARD 12

I8ca [*] Has this been going on for the last 6 months? (1) (2)

(5) (6) (7)

Yes No

IF: I1=3 (MORE TROUBLESOME) OR SDQ

CONDUCT SCORE=3+

I8d

No Perhaps Definitely

IF: I1=3 (MORE TROUBLESOME) OR SDQ CONDUCT SCORE=3+ 1 IF: I8G = DEF

I8ga [*] Has s/he often stayed out after dark much later than

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[*] Has this been going on for the last 6 months?

I10ca

(1) (2)

[*] Has this happened in the past six months?

Yes No

IF: CHILD = 13+ YEARS AND I8G = DEF

(1) (2)

Yes No

I9 IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)) [*] Did s/he start playing truant (‘bunking off’) from school before s/he was 13? (1) (2)

Yes No

I10d [*] Has s/he deliberately started a fire? (has to be with the intention of causing severe damage. Do not include campfires, burning individual matches or pieces of paper)

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

I10Intr

(1) (2)

May I now ask you about a list of less common but potentially more serious behaviours. I have to ask everyone all these questions even when they are not likely to apply. Have any of the following happened even once in the past year?

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10D = YES

I10da Has this happened in the past six months?

SHOW CARD 8

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

(1) (2)

Yes No

I10a IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) Has s/he used a weapon or anything that could seriously hurt someone? (1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10 A = YES

I10aa

I10e Has s/he deliberately destroyed someone else’s property? (Exclude setting fire to things or very minor acts, eg. destroying sister’s drawing. Include acts such as smashing car windows or school vandalism) (1) (2)

Yes No

Has this happened in the past six months?

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10E = YES

(1) (2)

I10ea

Yes No

Has this happened in the past six months?

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

I10b [*] Has s/he really hurt someone or been physically cruel to them? (e.g. ties up, cuts or burns victim)? (1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10 B = YES

[*] Has this happened in the past six months? Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

I10f Has s/he been involved in stealing from someone in the street? (1) (2)

I10ba

(1) (2)

(1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10F = YES

I10fa Has this happened in the past six months?

I10c [*] Has s/he been really cruel on purpose to animals and birds?

(1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) (1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10 C = YES

I10g Has s/he tried to force someone to have sexual activity against their will? (1)

176

Mental health of children and adolescents in Great Britain

Yes

Appendix E: Survey documents

(2)

No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10G = YES

I10ga Has this happened in the past six months? (1) (2)

Yes No

I13c (Have this interfered with...) earning or class work? SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

IF: ANY (I8A-I8G=7) OR ANY (I10AA - I10HA =YES)

I10h

I13d

Has s/he broken into a house, any other building, or a car?

(Have this interfered with...) playing, hobbies, sports or other leisure activities? SHOW CARD 8

(1) (2)

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7) IF: I10H = YES

E

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

I10ha IF: ANY (I8A-I8G=7) OR ANY (I10AA - I10HA =YES) Has this happened in the past six months?

I14

(1) (2)

Have these problems put a burden on you or the family as a whole RUNNING PROMPT

Yes No

IF: ANY (I2A-I2I=7) OR ANY(I8A - I8G=7)

I11 Could you also tell me if (CHILD’S) teacher has complained over the last six momths of problems with any of these same kinds of behaviour? (1) (2)

I13Intr

Less common disorders LessIntr This next section is about a variety of different aspects of (CHILD’S) behaviour and development.

You have told me about (CHILD’S) troublesome behaviour. I also want to ask you about the extent to which this behaviour has interfered with his/her day to day life

IF: ANY (I8 A-I8G=7) OR ANY (I10AA - I10HA=YES)

I13a Have this interfered with... how well s/he gets on with you and the rest of the family ? SHOW CARD 8 not at all only a little quite a lot a great deal

IF: ANY (I8 A-I8G=7) OR ANY (I10AA - I10HA=YES)

I13b (Have this interfered with...) making and keeping friends SHOW CARD 8 (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

Yes No

IF: ANY (I8 A-I8G=7) OR ANY (I10AA - I10HA=YES)

(5) (6) (7) (8)

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY (I8 A-I8G=7) OR ANY (I10AA - I10HA=YES)

I15a [*] In his/her first three years of life, was there anything that seriously worried you about... the way his/her speech developed? (1) (2)

Yes No

I15b [*] (In his/her first three years of life, was there anything that seriously worried you about...) how s/he got on with other people? (1) (2)

Yes No

I15c [*] (In his/her first three years of life, was there anything that seriously worried you about...) any odd rituals or unusual habits that were very hard to interrupt? (1) (2)

Yes No

IF: ((I15A = YES) OR (I15B = YES)) OR (I15C = YES)

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I15aa [*] Has this/Have all of these now cleared up completely? (1) (2)

some continuing problems completely cleared up

INTERVIEWER: Please try and cover all areas of difficulty, but it is a good idea to let the parent choose which order to cover them in, starting with the area that concerns them most. Use the suggested prompts written below and on the prompt card.

I16 [*] Coming back to the present, does s/he have any tics or twitches that s/he can’t seem to control? (1) (2)

Yes No

1. 2. 3. 4. 5. 6.

I17

Description of the problem? How often does the problem occur? How severe is the problem at its worst? How long has it been going on for? Is the problem interfering with the child’s quality of life? If so, how? WHERE APPROPRIATE,record what the family think the problem is due to, and what they have done about it.

[*] Have you been concerned about him/her being too thin or dieting too much?

Anxiety

(1) (2)

Does (CHILD’S NAME) experience any of the following symptoms when he/she feels anxious, nervous or tense ? INDIVIDUAL PROMPT

Yes No

I18 [*] Apart from the things you have already told me about, are there any other aspects of (CHILD’S) psychological development that really concern you? (1) (2)

Yes No

I19 [*] Apart from the things you have already told me about, are there any other aspects of (CHILD’S) psychological development that really concern his/her teachers? (1) (2) (3)

Yes No Don’t know

SET [7] OF (1) Heart racing or pounding? (2) Hands sweating or shaking? (3) Feeling dizzy? (4) Difficulty getting his/her breath? (5) Butterflies in stomach? (6) Dry mouth? (7) Nausea or feeling as though s/he wanted to be sick? (8) OR are you not aware of him/her having any of the above?

Use of services for significant problem(s) IF: SIGNIFICANT PROBLEM

HAS BEEN IDENTIFIED (I.E . CHILD HAS

SYMPTOMS AND THESE ARE CAUSING AN IMPACT OR BURDEN) IN ONE OR MORE AREA.

Family

Significant problems IF: SIGNIFICANT

PROBLEM HAS BEEN IDENTIFIED (I.E . CHILD HAS

SYMPTOMS AND THESE ARE CAUSING AN IMPACT OR BURDEN) IN ONE OR MORE AREA.

Intro

TypNow INTERVIEWER: if you prefer to take notes by hand rather than typing the details during the interview just type ‘later’ in the response box - but please remember to come back and complete the question befor transmission. WILL YOU BE TYPING IN THE ANSWERS NOW OR LATER Now Later

SigProb LIST OF PROBLEMS

178

(1) (2)

Yes No

Profess

You have told me about (LIST OF SIGNIFICANT PROBLEMS) I’d now like to hear a bit more about these difficulties in your own words.

(1) (2)

Have you spoken to family or friends about any of the difficulties we have just been talking about?

Mental health of children and adolescents in Great Britain

Have you spoken to a professional about them? (1) (2)

Yes No

IF: PROFESS = YES

ProfWho Which of these areas did the professional come from? SHOW CARD 14 CODE ALL THAT APPLY SET [6] OF (1) Primary healthcare (eg. GP, health visitor) (2) Specialist healthcare (eg. Paediatrician, child guidance) (3) Social services (eg. social worker) (4) Education (eg. teacher, educational psychologist, school counsellor) (5) Alternative therapist

Appendix E: Survey documents

(6)

Other

(3) (4)

E

or has it made no difference? SPONTANEOUS: No other children

IF: PROFESS = YES

Treat

J6

What sort of help, advice or treatment did they give? PLEASE ENTER A BRIEF DESCRIPTION

[*] Has (CHILD’S) difficulties caused any problems with other members of your family (including family members in other households)?

Impact IF: SIGNIFICANT PROBLEM HAS

BEEN IDENTIFIED (I. E. CHILD HAS

SYMPTOMS AND THESE ARE CAUSING AN IMPACT OR BURDEN) IN

(1) (2)

Yes No

J7

ONE OR MORE AREA.

[*] Has (CHILD’S) difficulties caused any problems with your relationship with your friends?

J2Intr I now want to ask you about the impact of some of (CHILD’S) difficulties that you have just been telling me about.

(1) (2)

Yes No

J8 IF: PARENT HAS A PARTNER LIVING AT HOME WITH THEM.

J2a [*] (Sorry if these questions do not apply to you - but we have to ask everyone them....) Has (CHILD’S) difficulties made your relationship with your partner RUNNING PROMPT (1) (2) (3)

Stronger more strained or has it made no difference?

IF: J2 = NO

Thinking about your own leisure and social activities, has (CHILD’S) difficulties disrupted these.. RUNNING PROMPT SHOW CARD 15 (5) (6) (7)

to a great extent to some extent or not at all?

J9 [*] Have these difficulties kept you from doing things socially with (CHILD’S NAME)

J3 [*] Do you believe that (CHILD’S) difficulties put a strain on your previous relationship and was part of the reason that relationship broke up... RUNNING PROMPT SHOW CARD 15a (1) (2) (3) (4) (5)

to a great extent to some extent or not at all? SPONTANEOUS: No previous relationship SPONTANEOUS: Problems started since relationship broke up

RUNNING PROMPT SHOW CARD 15 (5) (6) (7)

to a great extent to some extent or not at all?

J10 [*] Are you embarrassed about his/her difficulties? (1) (2)

Yes No

J11 J4 [*] Have (CHILD’S) difficulties made your relationship with your other children (including step-children and any who no longer live at home)..... RUNNING PROMPT (1) (2) (3) (4)

Stronger More difficult or has it made no difference? SPONTANEOUS: No other children

IF: J4 < NOO TH

J5 [*] Have (CHILD’S) difficulties made his/her relationship with your other children (including step-children and any who no longer live at home)..... RUNNING PROMPT (1) (2)

Stronger More difficult

[*] Have you felt others disapprove of you or avoid you because of his/her difficulties? (1) (2)

Yes No

J12a [*] I now want to ask you how (CHILD’S) problems have affected you. Would you say they have made you... Worried? SHOW CARD 15 (5) (6) (7)

to a great extent to some extent or not at all

J12b

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[*] (Would you say they have made you...) depressed? SHOW CARD 15

have faced during his/her life.

(5) (6) (7)

Since (CHILD’S NAME) was born have you had a separation due to marital difficulties or broken off a steady relationship?

to a great extent to some extent or not at all

J12c

K1

(1) (2)

Yes No

[*] (Would you say they have made you...) tired? SHOW CARD 15

K2

(5) (6) (7)

Since (CHILD’S NAME) was born have you (or your partner) had a major financial crisis, such as losing the equivalent of 3 months income?

to a great extent to some extent or not at all

J12d

(1) (2)

[*] (Would you say they have made you...) or physically ill? SHOW CARD 15 (5) (6) (7)

to a great extent to some extent or not at all

IF: (J12A-J12D=5 OR 6)

Yes No

K3 Since (CHILD’S NAME) was born have you (or your partner) had a problem with the police involving a court appearance? (1) (2)

Yes No

J13 K4 Have you been to see a doctor because you felt (worried/ill/depressed/tired) coping with (CHILD’S NAME)

At any stage in his/her life has s/he ever had serious illness which required a stay in hospital

(1) (2)

(1) (2)

Yes No

Yes No

IF: (J12A-J12D=5 OR 6) AND: J13 = YES

K5

J14 Were you prescribed any medicine for this?

(At any stage in his/her life)...... Has s/he ever been in a serious accident or badly hurt in an accident?

(1) (2)

(1) (2)

Yes No

IF: (J12A-J12D=5 OR 6)

Yes No

K6

J15 [*] Did it make you drink more alcohol?

Now turning to things that have happened to (CHILD’S NAME) At any stage in his/her life has a parent, brother or sister of his/hers died?

(1) (2) (3)

(1) (2)

Yes No Don’t drink

IF: (J12A-J12D=5 OR 6)

IF: K6 = Y ES

J16

K6a

[*] Did it make you smoke more?

ASK OR RECORD How many have died? 0..5

(1) (2) (3)

Yes No Don’t smoke

Stressful life events

180

Yes No

K7 At any stage in his/her life has a close friend of his/her died?

StrsIntr

(1) (2)

I would now like to ask about things that may have happened or problems that you or (CHILD’S NAME) may

IF: K7 = Y ES

Mental health of children and adolescents in Great Britain

Yes No

Appendix E: Survey documents

E

Has (CHILD’S NAME) had to visit an Accident and Emergency department in the last 12 months?

K7a ASK OR RECORD How many of his/her close friends have died? 0...5

(1) (2)

K8

IF: ACCEM = YES

Yes No

AEVis

In the PAST YEAR has a grandparent of his/her died? (1) (2)

Yes No

IF: K8 = YES

K8a ASK OR RECORD How many of (CHILD’S) grandparents have died? 0..5

How many seperate visits has (CHILD’S NAME) made to an Accident and Emergency department in those 12 months? (1) (2) (3) (4)

Once Twice Three Four or more

InPat

In the PAST YEAR has a pet of his/hers died?

Has (CHILD’S NAME) been in hospital as an in-patient, overnight or longer, for treatment or tests in the past 12 months?

(1) (2)

(1) (2)

K9

Yes No

IF: K9 = YES

Yes No

IF: IN PAT = YES

K9a

InPatVis

ASK OR RECORD How many of his/her pets have died? 0..5

How many separate stays has (CHILD’S NAME) been in hospital as an in-patient in those 12 months

IF: CHILD = 13+ YEARS

K10 In the PAST YEAR has (CHILD’S NAME) broken off a steady relationship with a girl/boy friend? (1) (2)

Yes No

Use of services - general GPChk In the past 12 months has (CHILD’S NAME) or have you or any member of your household talked to a GP or a family doctor for any reason at all, on his/her behalf apart from immunisation, child surveillance or development tests? INCLUDE ASTHMA CLINIC (1) (2)

Yes No

IF: GPCHK = YES

GPVis About how many times has (CHILD’S NAME) seen the GP in those 12 months? (1) (2) (3) (4)

Once Twice Three Four or more

AccEm

(1) (2) (3) (4)

Once Twice Three Four or more

HospClin (Apart from seeing your own doctor/when (CHILD’S NAME) stayed in hospital or seeing an optician or dentist) In the past 12 months, has (CHILD’S NAME) been to a hospital or clinic or anywhere else for treatment or check-ups? (1) (2)

Yes No

IF: HOSPCLIN = YES

OutIn In the past 12 months, on how many separate occasions has (CHILD’S NAME) been for out-patient or day patient visits in the past year? (1) (2) (3) (4)

Once Twice Three Four or more

VisHome Here is a list of people who visit children and their families in their homes to give them help and support when they need it. Have any of these people visited you to talk about behavioural or emotional problems of (CHILD’S NAME) in the past year? SHOW CARD 16 (1) (2)

Yes No

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Strengths

SpecSch Does (CHILD’S NAME) attend a special school or a special unit of an ordinary school? (1) (2)

Yes No

IF: SPECSCH = YES

PIntro I have been asking you a lot of questions about difficulties and problems. I now want to ask you about your child’s good points or strengths.

Perslty

BehEm Is this for ... INDIVIDUAL PROMPT behavioural and emotional problems? (1) (2)

Yes No

IF: SPECSCH = YES

LearnD

[*] In terms of what sort of person (CHILD’S NAME) is, what would you say are the best things about him/her? OPEN

PersNo INTERVIEWER: Did the parent mention any qualities? (1) (2)

Yes No

learning difficulties?

Quality (1) (2)

Yes No

IF: SPECSCH = YES

[*] Can you tell me some things which (CHILD’S NAME) does which really please you?

SpecOth

OPEN

or some other reason?

QualNo

(1) (2)

INTERVIEWER: Did the parent mention any things that really please them about (CHILD’S NAME)

Yes No

IF: SPECSCH = YES IF: SPECO TH = YES

OthReas

(1) (2)

Yes No

RewardA What is the other reason? STRING[60]

Police In the past 12 months has (CHILD’S NAME) ever been in trouble with the police? (1) (2)

Yes No

IF: POLICE = YES

PolNum In the past 12 months, on how many occasions has (CHILD’S NAME) been in trouble with the police? ENTER NO. OF OCCASIONS 0..99

SocSer In the past 12 months has (CHILD’S NAME) or have you or any member of your household talked to a social worker or someone from social services/ for any reason at all, on his/her behalf? (1) (2)

Yes No

[*] How often do you reward good behaviour or doing something well by... giving encouragement or praise? SHOW CARD 17 (1) (2) (3) (4)

RewardB [*] (How often do you reward good behaviour or doing something well by...) giving (CHILD’S NAME) treats, such as extra pocket money, staying up late or a special outing? SHOW CARD 17 (1) (2) (3) (4)

Mental health of children and adolescents in Great Britain

Never Seldom Sometimes Frequently

RewardC [*] (How often do you reward good behaviour or doing something well by...) giving (CHILD’S NAME) favourite things? SHOW CARD 17 (1) (2) (3) (4)

182

Never Seldom Sometimes Frequently

Never Seldom Sometimes Frequently

Appendix E: Survey documents

PunishA

SHOW CARD 17

[*] All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by... sending him/her to his/her room? SHOW CARD 17

(1) (2) (3) (4)

(1) (2) (3) (4)

Never Seldom Sometimes Frequently

PunishB [*] (All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by...) ...’grounding’/keeping him/her in? SHOW CARD 17 (1) (2) (3) (4) (5)

Never Seldom Sometimes Frequently SPONTANEOUS: Too young to go out on his/ her own

PunishC [*] (All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by...) ... shouting or yelling at him/her? SHOW CARD 17 (1) (2) (3) (4)

Never Seldom Sometimes Frequently

SchLeft At what age did you finish your continuous full-time education at school or college? NEVER WENT TO SCHOOL=01 STILL AT SCHOOL/EDUCATIONAL COLLEGE=99 0..99

AnyQuals Have you got any qualifications of any sort? (1) (2)

Yes No

IF: ANYQ UALS = YES

HiQuals Please look at this card and tell me whether you have passed any of the qualifications listed. Look down the list and tell me the first one you come to that you have passed SHOW CARD 18 (1) (2)

(3)

(4)

[*] (All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by...) ... smacking him/her with your hand? SHOW CARD 17

(5)

Never Seldom Sometimes Frequently

Never Seldom Sometimes Frequently

Education level (interviewed parent)

PunishD

(1) (2) (3) (4)

(6) (7) (8)

Degree level qualification Teaching qualification or HNC/HND,BEC/TEC Higher, BTEC Higher ‘A’Levels/SCE Higher or ONC/OND/BEC/TEC not higher or City & Guilds Advanced Final Level ‘O’Level passes (Grade A-C if after 1975) or City & Guilds Craft/Ord level or GCSE (Grades A-C) CSE Grades 2-5 GCE ‘O’level (Grades D & E if after 1975) GCSE (Grades D,E,F,G) NVQs CSE ungraded Other qualifications (specify) No qualifications

PunishE

IF: ANYQ UALS = YES IF: HIQUALS = OTHER

[*] (All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by...) .... hitting him/her with a strap or something else? SHOW CARD 17

OthQuals

(1) (2) (3) (4)

Never Seldom Sometimes Frequently

PunishF [*] (All children are naughty at sometime. How often do you punish (CHILD’S NAME) when s/he misbehaves or does something wrong by...) ... shaking him/her?

E

What other qualification do you have? INTERVIEW CHECK THAT THIS QUALIFICATION CANNOT BE CODED AT (HIQUALS) - IF NOT PLEASE ENTER A SHORT DESCRIPTION OR TITLE

Employment status (interviewed parent) IF: ALL INTERVIEWED ADULTS

Wrking Did you do any paid work in the 7 days ending Sunday the (DATE), either as an employee or as self-employed?

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Appendix E: Survey documents (1) (2)

Yes No

AND: L OOKED = NO OR STARTJ = NO

YInAct

IF: W RKING = NO AND: MEN AGED 16-64 AND WOMEN AGED 16-62

SchemeET Were you on a government scheme for employment training? (1) (2)

Yes No

What was the main reason you did not seek any work in the last 4 weeks/would not be able to start in the next 2 weeks? (1) (2) (3) (4) (5) (6)

Student Looking after the family/home Temporarily sick or injured Long-term sick or disabled Retired from paid work None of these

IF: W RKING = NO AND: S CHEMEET = NO

IF: UNEMPLOYED

JbAway

Everwk

Did you have a job or business that you were away from?

Have you ever had a paid job, apart from casual or holiday work?

(1) (2) (3)

(1) (2)

Yes No Waiting to take up a new job/business already obtained

IF: W RKING = NO AND: S CHEMEET = NO AND: J BAWAY = NO OR JBAWAY = WAITING

OwnBus Did you do any unpaid work in that week for any business that you own?

OR ECONOMICALLY INACTIVE

Yes No

IF: UNEMPLOYED OR ECONOMICALLY INACTIVE AND: EVERWK = YES

DtJbL When did you leave your last PAID job? FOR DAY NOT GIVEN....ENTER 15 FOR DAY FOR MONTH NOT GIVEN....ENTER 6 FOR MONTH

IF:ALL

ECONOMICALLY INACTIVE EXCEPT THOSE UNEMPLOYED

WHO HAVE NEVER WORKED AND ARE NOT WAITING TO TAKE UP A

(1) (2)

Yes No

JOB

IF: W RKING = NO AND: S CHEMEET = NO AND: J BAWAY = NO OR JBAWAY = WAITING AND: OWNBUS = NO

RelBus ...or that a relative owns? (1) (2)

Yes No

IF: NOT

IN EMPLOYMENT I.E .

IndD CURRENT OR LAST JOB What did the firm/organisation you worked for mainly make or do (at the place where you worked)? DESCRIBE FULLY - PROBE MANUFACTURING or PROCESSING or DISTRIBUTING ETC. AND MAIN GOODS PRODUCED, MATERIALS USED, WHOLESALE or RETAIL ETC.

OccT NO TO ALL

QUESTIONS ABOVE ON

JOBTITLE

CURRENT OR LAST JOB

WORK

Looked Thinking of the 4 weeks ending Sunday the (DATE), were you looking for any kind of paid work or government training scheme at any time in those 4 weeks? (1) (2)

IN EMPLOYMENT I.E .

OccD CURRENT OR LAST JOB What did you mainly do in your job?

Yes No

IF: NOT

What was your (main) job (in the week ending Sunday XX) ?

NO TO ALL

QUESTIONS ABOVE ON

CHECK SPECIAL QUALIFICATIONS/TRAINING NEEDED TO DO THE JOB

WORK

AND: L OOKED = YES

Stat

StartJ If a job or a place on a government scheme had been available in the week ending Sunday the (DATE), would you have been able to start within 2 weeks? (1) (2)

Yes No

IF: NOT

IN EMPLOYMENT I.E .

(1) (2)

Employee Self-employed

IF: STAT = EMP NO TO ALL

QUESTIONS ABOVE ON

WORK

184

Were you working as an employee or were you selfemployed?

Mental health of children and adolescents in Great Britain

Manage Did you have any managerial duties, or were you

Appendix E: Survey documents

supervising any other employees? ASK OR RECORD

(9) (10)

(1) (2) (3)

CareBen

Manager Foreman/supervisor Not manager/supervisor

IF: STAT = EMP

EmpNo How many employees were there at the place where you worked? (1) (2)

1-24 25 or more

IF: STAT = SELFEMP

E

Disability working allowance None of these

And looking at this card, are you at present receiving any of the state benefits shown on this card - either in your own name, or on behalf of someone else in the household? SHOW CARD 20 CODE ALL THAT APPLY SET [3] OF (1) Care component of disability living allowance (2) Mobility allowance of disability living allowance (3) Attendance Allowance (4) None of these

Solo IncBen Were you working on your own or did you have employees? (1) (2)

on own/with partner(s) but no employees with employees

IF: STAT = SELFEMP IF: SOLO = WITHEMP

SENo How many people did you employ at the place where you worked? (1) (2)

1-24 25 or more

Now looking at this card, are you at present receiving any of these benefits in your own right, that is where you are the named recipient? SHOW CARD 21 CODE ALL THAT APPLY SET [6] OF (1) Jobseekers Allowance (2) Income support (3) Family credit (not received in a lump sum) (4) Incapacity allowance (5) Statutory sick pay (6) Industrial injury disablement benefit (7) None of these

IF: QSELECT.ADLTSEX =

FtPtWk

FEMALE

Matern In your (main) job were you working: (1) (2)

full time or part time?

Partner’s employment status The employment status section is repeated for interviewed parent’s partner (where applicable).

State benefits Benefits Looking at the card, are you at present receiving any of these state benefits in your own right, that is, were you the named recipient? SHOW CARD 19 CODE ALL THAT APPLY SET [9] OF (1) Child Benefit (2) One Parent Benefit (3) Guardian’s Allowance (4) Invalid Care Allowance (5) Retirement pension (National Insurance) or old person’s pension (6) Widow’s pension or allowance (National Insurance) (7) War disablement pension (8) Severe disablement allowance (and related allowances)

Are you receiving either of the things shown on this card, in your own right? SHOW CARD 22 CODE ALL THAT APPLY SET [2] OF (1) Maternity Allowance (2) Statutory Maternity Pay from your employer or former employer (3) None of these

Other In the last 6 months have you received any of the things shown on this card, in your own right? SHOW CARD 23 CODE ALL THAT APPLY SET [5] OF (1) Family credit, paid in a lump sum (2) A grant from the Social Fund for funeral expenses (3) Grant from the Social Fund for maternity expenses (4) A Community Care grant from the Social Fund (5) Any National Insurance or State benefit not mentioned earlier (6) None of these

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Income IncKind (In addition to these) This card shows a number of (other) possible sources of income. Can you tell me which different kinds of income you personally receive? CODE ALL THAT APPLY SHOW CARD 24 SET [7] OF (1) Earned income/salary (2) Income from self-employment (3) Pension from a former employer (4) Interest from savings, building society, investment dividends from shares etc. (5) Other kinds of regular allowances from outside the household (e.g. alimony, annuity, educational grant) (6) Any other source (7) None of these (9) Refused

IF: O THER IN I NCKIND

IncOther

ENTER GROUP NO. OR CODE 23 FOR REFUSAL SHOW CARD 25

PARENT SELF-COMPLETION QUESTIONNAIRE SCIntr I would now like to you to take the computer and answer the next set of questions yourself.

PCGSc INTERVIEWER: RESPONDENTS SHOULD SELFCOMPLETE. OFFER TO READ THE QUESTIONS FROM THE PRINTED SCRIPT BUT THE RESPONDENTS SHOULD STILL TYPE THE ANSWERS INTO THE LAPTOP THEMSELVES IF AT ALL POSSIBLE

What is this other source of income?

(1) (2) (3)

IF: I NCKIND = 1-7

SCTest

GrossInc Could you please look at this card and tell me which group represents your own personal gross income from all sources mentioned? By gross income, I mean income from all sources before deductions for income tax, National Insurance etc. ENTER GROUP NO. OR CODE 23 FOR REFUSAL SHOW CARD 25 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23)

Less than 1000 1,000 to 1,999 2,000 to 2,999 3,000 to 3,999 4,000 to 4,999 5,000 to 5,999 6,000 to 6,999 7,000 to 7,999 8,000 to 8,999 9,000 to 9,999 10,000 to 10,999 11,000 to 11,999 12,000 to 12,999 13,000 to 13,999 14,000 to 14,999 15,000 to 17,499 17,500 to 19,999 20,000 to 24,999 25,000 to 29,999 30,000 to 39,999 40,000 or more No source of income Refused

IF: I NCKIND = 1-7

HHldInc INCOME SECTION - PARENT INTERVIEW Could you look at this card again and tell me which group represents your household’s gross income from all sources mentioned.

186

ASK OR RECORD IF SINGLE PERSON HOUSEHOLD RECORD GROUP NO.AT INDIVIDUAL INCOME.

Mental health of children and adolescents in Great Britain

Complete self-completion by respondent Questions read from script by the interviewer Section read and entered by interviewer

This question is just to help you to get used to answering the questions in this section. I like using computers PRESS 1 for STRONGLY AGREE PRESS 2 for AGREE PRESS 3 for DISAGREE PRESS 4 for STRONGLY DISAGREE (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

HthIntr We would like to know how your health has been in general, over the past few weeks. Please answer ALL the questions by entering the number next to the answer which describes how you have been feeling recently THE QUESTION WILL ALWAYS APPEAR AT THE TOP OF THE SCREEN PRESS TO MOVE ON TO THE FIRST QUESTION

GH1 Have you recently been able to concentrate on whatever you’re doing? ENTER THE NUMBER NEXT TO YOUR ANSWER (1) (2) (3) (4)

Better than usual Same as usual Less than usual Much less than usual

GH2 Have you recently lost much sleep over worry? (1)

Not at all

Appendix E: Survey documents

(2) (3) (4)

No more than usual Rather more than usual Much more than usual

GH3 Have you recently felt that you are playing a useful part in things? (1) (2) (3) (4)

More so than usual Same as usual Less so than usual Much less useful

GH4 Have you recently felt capable of making decisions about things? (1) (2) (3) (4)

More so than usual Same as usual Less so than usual Much less capable

GH5 Have you recently felt constantly under strain? (1) (2) (3) (4)

Not at all No more than usual Rather more than usual Much more than usual

GH6 Have you recently felt you couldn’t overcome your difficulties? (1) (2) (3) (4)

Not at all No more than usual Rather more than usual Much more than usual

E

GH10 Have you recently been losing confidence in yourself? (1) (2) (3) (4)

Not at all No more than usual Rather more than usual Much more than usual

GH11 Have you recently been thinking of yourself as a worthless person? (1) (2) (3) (4)

Not at all No more than usual Rather more than usual Much more than usual

GH12 Have you recently been feeling reasonably happy, all things considered? (1) (2) (3) (4)

More so than usual Same as usual Less so than usual Much lessthan usual

FamIntr We would like to know how your family gets on together. Please answer ALL the next set of questions by pressing 1 for STRONGLY AGREE 2 for AGREE 3 for DISAGREE 4 for STRONGLY DISAGREE THE QUESTION WILL ALWAYS APPEAR AT THE TOP OF THE SCREEN PRESS TO MOVE TO THE NEXT QUESTION

GH7 FF1 Have you recently been able to enjoy your normal dayto-day activities? (1) (2) (3) (4)

More so than usual Same as usual Less so than usual Much lessthan usual

Planning family activities is difficult because we misunderstand each other (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

GH8 FF2 Have you recently been able to face up to your problems?

In times of crisis we can turn to each other for support

(1) (2) (3) (4)

(1) (2) (3) (4)

More so than usual Same as usual Less able than usual Much less able

Strongly agree Agree Disagree Strongly disagree

GH9

FF3

Have you recently been feeling unhappy and depressed?

We cannot talk to each other about the sadness we feel

(1) (2) (3) (4)

Not at all No more than usual Rather more than usual Much more than usual

(1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

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Appendix E: Survey documents FF4

FF12

Individuals are accepted for what they are

We confide in each other

(1) (2) (3) (4)

(1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

Strongly agree Agree Disagree Strongly disagree

FF5

SCExit

We avoid discussing our fears and concerns

Thank you. that is the end of this section. Please pass the computer back to the interviewer INTERVIEWER:

(1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

FF6

IF: PCGS C = SCACCEPT

PHowCmp INTERVIEWER: Did the parent complete the whole of this section as a self-completion?

We can express feelings to each other (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

(1) (2)

Yes No

ParEnd THIS IS THE END OF THE PARENT INTERVIEW

FF7 There is lots of bad feeling in the family (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

FF8 We feel accepted for what we are (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

ChldNow INTERVIEWER: Do you want to interview the child now? (1) (2)

Yes No

Friendships CA1

FF9

Do you have any friends?

Making decisions is a problem for our family

(1) (2)

(1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

FF10 We are able to make decisions on how to solve problems (1) (2) (3) (4)

Strongly agree Agree Disagree Strongly disagree

We don’t get along well together (1) (2) (3) (4)

Yes No

IF: CA1 = YES

CA2 [*] How much time do you spend together... RUNNING PROMPT (1) (2) (3) (4)

all of your spare time some of your spare time a little of your spare time or not at all?

IF: CA1 = YES

CA4 [*] How often do friends come to your house.. RUNNING PROMPT

FF11

188

CHILD INTERVIEW (Face to face interview with 11-15 year olds)

Strongly agree Agree Disagree Strongly disagree

Mental health of children and adolescents in Great Britain

(1) (2) (3) (4)

all or most of the time some of the time or a little time or not at all?

Appendix E: Survey documents IF: CA1 = YES

CA5 [*] How often do you go to your friend’s home.. RUNNING PROMPT (1) (2) (3) (4)

all or most of the time some of the time a little time or not at all?

IF: CA1 = YES

(5) (6) (7)

E

Not true Somewhat true Certainly true

CB6 [*] I get a lot of headaches,stomach aches or sickness SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CA6 CB7 [*] Can you confide in any of your friends such as sharing a secret or telling them private things? SHOW CARD 1

[*] I usually share with others(food, games, pens etc.) SHOW CARD 2

(1) (2) (3)

(5) (6) (7)

Definitely Sometimes Not at all

IF: CA1 = YES

Not true Somewhat true Certainly true

CB8

CA10 [*] (Can I just check) Do you have a ‘best’ friend or a special friend? (1) (2)

Yes No

[*] I get very angry and often lose my temper SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CA15

CB9

Over the past 12 months have you belonged to any teams, clubs or other groups with an adult in charge? INCLUDE CLUBS SUCH AS SCOUTS/GUIDES OR SCHOOL CLUBS

[*] I am usually on my own, I generally play alone or keep to myself SHOW CARD 2

(1) (2)

Yes No

Strengths and difficulties IntrSDQ

(5) (6) (7)

Not true Somewhat true Certainly true

CB10 [*] I usually do as I am told SHOW CARD 2

The next section is about your personality and behaviour this is to give us an overall view of your strengths and difficulties - we will be coming back to specific areas in more detail later in the interview.

(5) (6) (7)

SectnB

CB11

For each item that I am going to read out can you please tell me whether it is ‘not true’, ‘somewhat true’ or ‘certainly true’ for you SHOW CARD 2

[*] I worry a lot SHOW CARD 2

CB4 [*] I try to be nice to other people, I care about their feelings SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CB5 [*] I am restless, I cannot stay still for long SHOW CARD 2

(5) (6) (7)

Not true Somewhat true Certainly true

Not true Somewhat true Certainly true

CB12 [*] I am helpful if someone is hurt, upset or feeling ill SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CB13 [*] I am constantly fidgeting or squirming

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SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

[*] I am often accused of lying or cheating SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CB14 CB22 [*] I have at least one good friend SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CB15 [*] I fight a lot. I can make other people do what I want SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

[*] Other children or young people pick on me or bully me SHOW CARD 2 (5) (6) (7)

CB23 [*] I often volunteer to help others (parents, teachers, other children) SHOW CARD 2

CB16

(5) (6) (7)

[*] I am often unhappy, down-hearted or tearful SHOW CARD 2

CB24

(5) (6) (7)

Not true Somewhat true Certainly true

Not true Somewhat true Certainly true

Not true Somewhat true Certainly true

[*] I think before I do things SHOW CARD 2

CB17

(5) (6) (7)

[*] Other people my age generally like me SHOW CARD 2

CB25

(5) (6) (7)

[*] I take things that are not mine from home, school or elsewhere SHOW CARD 2

Not true Somewhat true Certainly true

CB18 [*] I am easily distracted, I find it difficult to concentrate SHOW CARD 2

(5) (6) (7)

Not true Somewhat true Certainly true

Not true Somewhat true Certainly true

CB26 (5) (6) (7)

Not true Somewhat true Certainly true

[*] I get on better with adults than with people of my own age SHOW CARD 2

CB19 [*] I am nervous in new situations.I easily lose my confidence SHOW CARD 2

(5) (6) (7)

Not true Somewhat true Certainly true

CB27 (5) (6) (7)

Not true Somewhat true Certainly true

CB20 [*] I am kind to younger children SHOW CARD 2

[*] I have many fears,I am easily scared SHOW CARD 2 (5) (6) (7)

Not true Somewhat true Certainly true

CB28 (5) (6) (7)

Not true Somewhat true Certainly true

CB21

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[*] I finish the work I’m doing, my attention is good SHOW CARD 2 (5)

Not true

Appendix E: Survey documents

(6) (7)

Somewhat true Certainly true

(6) (7) (8)

E

only a little quite a lot a great deal

CB29 IF: CB29 = 7 [*] Overall, do you think that you have difficulties in one or more of the following areas: emotions,concentration, behaviour or getting on with other people? SHOW CARD 3 (5) (6) (7) (8)

No Yes: minor difficulties Yes: definite difficulties Yes: severe difficulties

IF: CB29 = 7 OR 8

OR

8

Cb30c [*] (Do the difficulties interfere with your everyday life in terms of your) ... leisure activities? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

Cb29a IF: CB29 = 7

OR

8

[*] How long have these difficulties been present?

Cb31

(1) (2) (3) (4)

[*] Do the difficulties make it harder for those around you such as your family, friends and teachers? SHOW CARD 4

Less than a month One to five months Six to eleven months A year or more

IF: CB29 = 7 OR 8

Cb29b

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

[*] Do the difficulties upset or distress you.. RUNNING PROMPT SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: CB29 = 7 OR 8

CB30 [*] Do the difficulties interfere with your everyday life in terms of your ...home life? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CB29 = 7 OR 8

Cb30a [*] (Do the difficulties interfere with your everyday life in terms of your) ... friendships? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CB29 = 7 OR 8

Cb30b [*] (Do the difficulties interfere with your everyday life in terms of your) ... classroom learning? SHOW CARD 4 (5)

not at all

Separation anxiety CIntroF Most (TEENAGERS/YOUNG PEOPLE are particularly attached to one person or a few key people, looking to them for security, and turning to them when distressed. They can be mum and dad, grandparents, favourite teachers, neighbours etc.

FigNamC [*] Who are you particularly attached to? (INTERVIEWER PLEASE NOTE: Though children and teenagers can be particularly attached to other people of the same age for eg. sisters, brothers or friends aim to identify ADULT attachment figures). - RECORD THE NAME (OR A UNIQUE IDENTIFIER) FOR EACH PERSON

CF1a1 [*] Who are the three most important to you RECORD BY ENTERING THE NUMBER OF THE ATTACHMENT FIGURE CHOOSE 3 ONLY - IF THREE OR LESS ENTER ALL ATTACHMENT FIGURES

AtHomeC Do any of these people live at home with you? ASK OR RECORD (1) (2)

Yes No

IF: ATHOMEC = YES

HomeC Which of the people live at home with you? RECORD BY ENTERING THE NUMBER OF THE

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ATTACHMENT FIGURE ASK OR RECORD

worried about sleeping alone? IF DNA USE CODE ‘5’ (No more) SHOW CARD 5

CF2intr This section of the interview is about how much you worry about being separated from (ATTACHMENT FIGURES). Most (TEENAGERS/YOUNG PEOPLE) have some worries of this sort, but what I would like to know about is how you compare with others of your own age. I am interested in how you are usually - not in the occasional ‘off day’.

CF2 [*] Overall, in the past month, have you been particularly worried about being separated from your (ATTACHMENT FIGURES)? (1) (2)

Yes No

(5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=Y ES OR SDQ(CHILD ) EMOTION SCORE = 6+ IF: ATHOMEC = YES

CF2e [*] (Thinking about the past month and comparing yourself with other people of your age..) have you often come out of your bedroom at night to check on, or to sleep near (ATTACHMENT FIGURES AT HOME) IF DNA USE CODE ‘5’ (No more) SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=YES OR SDQ(CHILD ) EMOTION SCORE = 6+

CF2a

IF: CF2=Y ES OR SDQ(CHILD ) EMOTION SCORE = 6+

[*] Thinking about the past month and comparing yourself with other people of your age have you often been worried about something unpleasant happening to (ATTACHMENT FIGURES), or about losing them? SHOW CARD 5

[*] (Thinking about the past month and comparing yourself with other people of your age..) have you worried about sleeping in a strange place? SHOW CARD 5

(5) (6) (7)

(5) (6) (7)

CF2f

No more than other children of my age A little more than other children of my age A lot more than other children of my age

No more than other children of my age A little more than other children of my age A lot more than other children of my age

CF2b

IF: CF2=Y ES OR SDQ(CHILD ) EMOTION SCORE = 6+ IF: ATHOMEC = YES

[*] (Thinking about the past month and comparing yourself with other people of your age..) have you often worried that you might be taken away from (ATTACHMENT FIGURES) for example, by being kidnapped, taken to hospital or killed? SHOW CARD 5

[*] (Thinking about the past month and comparing yourself with other people of your age..) have you been particularly afraid of being alone if (HomeC[1],HomeC[2], HomeC[3]) pop out for a moment? SHOW CARD 5

(5) (6) (7)

(5) (6) (7)

IF: CF2=YES OR SDQ(CHILD ) EMOTION SCORE = 6+

CF2h

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=YES OR SDQ(CHILD ) EMOTION SCORE = 6+ IF: ATHOMEC = YES

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=Y ES OR SDQ(CHILD ) EMOTION SCORE = 6+

CF2i

CF2c [*] (Thinking about the past month and comparing yourself with other people of your age..) have you often not wanted to go to school in case something nasty happened to (ATTACHMENT FIGURES AT HOME) while you were at school? (DO NOT INCLUDE RELUCTANCE TO GO TO SCHOOL FOR OTHER REASONS, EG. FEAR OF BULLYING OR EXAMS) SHOW CARD 5

[*] (Thinking about the past month and comparing yourself with other people of your age..) have you had repeated nightmares or bad dreams about being separated from (ATTACHMENT FIGURES)? SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=Y ES OR SDQ(CHILD ) EMOTION SCORE = 6+ (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF2=YES OR SDQ(CHILD ) EMOTION SCORE = 6+

CF2d [*] (Thinking about the past month and comparing yourself with other people of your age..) have you

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CF2j [*] (Thinking about the past month and comparing yourself with other people of your age..) have you had headaches, stomach aches or felt sick when you had to leave (ATTACHMENT FIGURES) or when you knew it was about to happen? SHOW CARD 5

Appendix E: Survey documents

(5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

(5) (6) (7) (8)

E

not at all only a little quite a lot a great deal

IF: CF2=YES OR SDQ (CHILD ) EMOTION SCORE = 6+

CF2k

IF: ANY(CF2A - CF2 K = 7)

CF5c [*] (Thinking about the past month and comparing yourself with other people of your age..) has being apart or the thought of being apart from (ATTACHMENT FIGURES) led to worry, crying, angry outbursts,clinginess or misery? SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

[*] (Have they interfered with...) ...learning or class work? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY(CF2A - CF2 K = 7) IF: ANY(CF2A - CF2 K = 7)

CF5d

CF3 [*] You have told me about your worries about separations. Have you had these for at least a month? (1) (2)

Yes No

IF: ANY(CF2A - CF2 K = 7)

[*] (Have they interfered with...) ...playing, hobbies, sports or other leisure activities? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

CF3a IF: ANY(CF2A - CF2 K = 7) Were you like this by the age of 6?

CF5e

(1) (2)

[*] Have these worries about separation made it harder for those around you (family, friends or teachers) ? SHOW CARD 4

Yes No

IF: ANY(CF2A - CF2 K = 7)

CF4 [*] Thinking still of your worries about separation, how much have they have upset or distressed you RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

Specific phobia CF6Intr

I also want to ask you about the extent to which these worries have interfered with your day to day life.

This section of the interview is about any particular things or situations that you are particularly scared of, even though they aren’t really a danger to you. I am interested in how you are usually - not in the occasional ‘off day’. I shall ask you first about particular fears, but will ask later about social fears.

IF: ANY(CF2A - CF2 K = 7)

CF7

IF: ANY(CF2A - CF2 K = 7)

CF5Intr

CF5a [*] Have they interfered with... How well you get on with the rest of the family? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ANY(CF2A - CF2 K = 7)

CF5b [*] (Have they interfered with...) ....making and keeping friends? SHOW CARD 4

[*] Are you PARTICULARLY scared about any of the things or situations on this list? CODE ALL THAT APPLY SHOW CARD 6 SET [7] OF (1) ANIMALS: Insects, spiders, wasps, bees, mice, snakes, birds or any other animal (2) Storms, thunder, heights or water (3) Blood-injection-Injury Set off by the sight of blood or injury or by an injection (4) Dentists or Doctors (5) The dark (6) Other specific situations: for example: lifts, tunnels, flying, driving, trains, buses, small enclosed spaces (7) Any other specific fear (specify)

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(9)

[*] Does your fear lead to you avoiding (PHOBIC STIMULUS)... RUNNING PROMPT

Not particularly scared of anything

IF: ANYOTH IN CF7

CF7Oth

(5) (6) (7)

What are these other fears?

IF: CF7 = 1 - 7

CF7a [*] Is this fear/are these fears a real nuisance to you, or to anyone else? (5) (6) (7)

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ ( CHILD) EMOTION SCORE = 6+) AND: CF11 = ALOT

CF11a [*] How much does this avoidance interfere with your everyday life? RUNNING PROMPT

No Perhaps Definitely

CF8

(5) (6) (7)

[*] How long has this fear (the most severe of these fears) been present?

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ ( CHILD) EMOTION SCORE = 6+)

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ (CHILD) EMOTION

(1) (2) (3)

SCORE

= 6+)

less than a month At least one month but less than 6 months Six months or more

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ (CHILD) EMOTION

No A little A Lot

CF11b [*] Thinking about it now, do you think your fear is excessive or unreasonable? SHOW CARD 7

CF9

(5) (6) (7)

[*] When you come up against (PHOBIC STIMULUS), or think you are about to come up against it, do you become anxious or upset? RUNNING PROMPT

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ ( CHILD) EMOTION SCORE = 6+)

(5) (6) (7)

SCORE

= 6+)

SCORE

= 6+)

[*] Does this happen almost every time you come up against (PHOBIC STIMULUS)? Yes No

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ (CHILD) EMOTION AND: CF9 = AL OT

SCORE

= 6+)

CF10 [*] How often does this fear of (PHOBIC STIMULUS) result in you becoming upset like this ... IN THE RELEVANT SEASON IF A SEASONAL STIMULUS EG. WASPS RUNNING PROMPT (1) (2) (3) (4)

many times a day most days most weeks or every now and then?

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ (CHILD) EMOTION

CF11

Mental health of children and adolescents in Great Britain

CF11c

(5) (6) (7)

No Perhaps Definitely

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ ( CHILD) EMOTION SCORE = 6+)

CF9a

(1) (2)

No Perhaps Definitely

[*] Are you upset about having this fear? SHOW CARD 7

No A little A Lot

IF: CF7 = 1 - 7 AND: (CF7A = 7) OR (SDQ (CHILD) EMOTION AND: CF9 = AL OT

194

No A little A Lot

SCORE

= 6+)

CF12 [*] Lastly, has your fear of (PHOBIC STIMULUS) made it harder for those around you (family, friends,teachers etc.) ... RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

Social phobia CF13intr I am interested in whether you are particularly afraid of social situations, that is being with a lot of people, meeting new people or having to do things in front of other people. This is as compared with other (TEENAGERS/YOUNG PEOPLE) of you own age, and is not counting the occasional ‘off day’ or ordinary shyness.

Appendix E: Survey documents

CF13 [*] Overall, do you particularly fear or avoid social situations which involve a lot of people, meeting new people or doing things in front of other people? (1) (2)

Yes No

E

[*] (Can I just check, have you been particularly afraid of) . . .writing in front of others? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: SEPARATION ANXIETY AND ANY (CF14A - CF14F)=7

CF14Intr

CF15

Can I just check, have you been particularly afraid of any of the following social situations over the last month?

[*] Are your fears of social situations mainly related to you worries about being separated from (ATTACHMENT FIGURES) OR are you still afraid of social situations even when you are with them?

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

CF14a

(1)

[*] Can I just check, have you been particularly afraid of . . . meeting new people? SHOW CARD 7

(2)

(5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

mainly related to his/her fear of being apart from attachment figures marked even when attachment figure present

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14 F)=7 AND CF15=2

CF16 [*] Are you just afraid with adults, or are you also afraid in situations that involve a lot of (TEENAGERS/YOUNG PEOPLE), or meeting new people of your age?

CF14b [*] (Can I just check, have you been particularly afraid of . . .) meeting a lot of people, such as at a party? SHOW CARD 7

(1) (2) (3)

(5) (6) (7)

I IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+ AND: ANY (CF14A - CF14 F)=7 AND CF15=2

No A little A Lot

Just with adults just with children With both children and adults

CF17

CF14c

[*] Outside of these social situations, are you able to get on well enough with the adults and (TEENAGERS/ YOUNG PEOPLE) you know best?

[*] (Can I just check, have you been particularly afraid of) . . .eating in front of others? SHOW CARD 7

(1) (2)

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

(5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

CF14d [*] (Can I just check, have you been particularly afraid of) . . .speaking in class? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

Yes No

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14 F)=7 AND CF15=2

CF18 [*] Is the main reason you dislike social situations because you are afraid you will act in a way that will be embarrassing or show you up? (5) (6) (7)

No Perhaps Definitely

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14 F)=7 AND CF15=2 AND: ANY (CF14D-CF14 F=6 OR 7)

CF18a

CF14e [*] (Can I just check, have you been particularly afraid of) . . .reading out loud in front of others? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (C HILD) EMOTION SCORE 6+

[*] Do you dislike social situations because of specific problems with speaking, reading or writing? (5) (6) (7)

No Perhaps Definitely

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14 F)=7 AND CF15=2

CF19

CF14f

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[*] How long has this fear of social situations been present? (1) (2) (3)

Less than a month At least one month but less than six months Six months or more

(1) (2) (3) (4)

many times a day most days most weeks or every now and then?

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14F)=7 AND CF15=2

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2

CF23

CF20

[*] Does your fear lead to you avoiding social situations... SHOW CARD 7

[*] What age did it begin at.. RUNNING PROMPT (1) (2)

under six years or six years or above?

(5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14F)=7 AND CF15=2 IF: CF23 = ALOT

CFblush

CF23a

[*] When you are in one of the social situations you dislike, do you normally... blush (go red) or shake (tremble)?

[*] How much does this avoidance interfere with your everyday life? SHOW CARD 7

(1) (2)

(5) (6) (7)

Yes No

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2

CFSick

No A little A Lot

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14F)=7 AND CF15=2

CF23b [*] (When you are in one of the social situations you dislike, do you normally...) feel afraid that you are going to be sick (throw up)? (1) (2)

Yes No

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2

[*] Thinking about it now, do you think that your fears is excessive or unreasonable? SHOW CARD 8 (5) (6) (7)

No Perhaps Definitely

CFShort

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14F)=7 AND CF15=2

[*] (When you are in one of the social situations you dislike, do you normally...) need to rush off to the toilet or worry that you might be caught short?

CF23c

(1) (2)

(5) (6) (7)

Yes No

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2

CF21

[*] Are you upset about having this fear? SHOW CARD 8 No Perhaps Definitely

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14A - CF14F)=7 AND CF15=2

CF24 [*] When you are in one of the social situations you fear, or when you think you are about to be in one, do your become anxious or upset? (5) (6) (7)

No A little A Lot

IF: CF13 OR SDQ (CHILD) E MOTION SCORE 6+ AND: ANY (CF14 A - CF14F)=7 AND CF15=2 IF: CF21 = ALOT

CF22 [*] How often does this happen RUNNING PROMPT

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[*] Has your fear of social situations made it harder for those around you (family, friends or teachers) RUNNING PROMPT SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

Appendix E: Survey documents

Panic attacks and agoraphobia CF25Intr Many (TEENAGERS/YOUNG PEOPLE) have times when they get very anxious or worked up about silly little things, but some get severe panics that come out of the blue - they just don’t seem to have any trigger at all.

IF: CF25 = YES

CFMouth [*] (When you are feeling panicky, do you also feel...) that your mouth is dry? (1) (2)

Yes No

IF: CF25 = YES

CF25

CFBreath

[*] In the last month have you had a panic attack when you suddenly became very panicky for no reason at all, without even a little thing to set you off?

[*] (When you are feeling panicky, do you also feel...) that it is hard to get your breath or that you are suffocating?

(1) (2)

(1) (2)

Yes No

IF: CF25 = YES

Yes No

IF: CF25 = YES

CFStart

CFChoke

[*] Can I just check.. Do your panics start very suddenly?

[*] (When you are feeling panicky, do you also feel...) that you are choking?

(1) (2)

(1) (2)

Yes No

IF: CF25 = YES

Yes No

IF: CF25 = YES

CFPeak

CFPain

[*] Do they reach a peak within a few minutes (up to 10)?

[*] (When you are feeling panicky, do you also feel...) pain or an uncomfortable feeling in your chest?

(1) (2)

(1) (2)

Yes No

IF: CF25 = YES

Yes No

IF: CF25 = YES

CFHowLng

CFsick

[*] Do they last at least a few minutes?

[*] (When you are feeling panicky, do you also feel...) that you want to be sick (throw up) or that your stomach is turning over?

(1) (2)

Yes No

IF: CF25 = YES

CHeart [*] When you are feeling panicky, do you also feel... your heart racing, fluttering or pounding away? (1) (2)

Yes No

IF: CF25 = YES

CFSweat [*] (When you are feeling panicky, do you also feel...) sweaty? (1) (2)

Yes No

IF: CF25 = YES

CFTremb [*] (When you are feeling panicky, do you also feel...) trembly or shaky? (1) (2)

Yes No

E

(1) (2)

Yes No

IF: CF25 = YES

CFDizz [*] (When you are feeling panicky, do you also feel...) dizzy, unsteady, faint or light-headed? (1) (2)

Yes No

IF: CF25 = YES

CFunreal [*] (When you are feeling panicky, do you also feel...) as though things around you were unreal or you were not really there? (1) (2)

Yes No

IF: CF25 = YES

CFCrazy [*] (When you are feeling panicky, do you also feel...) afraid that you might lose control, go crazy or pass out?

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(1) (2)

Yes No

(1) (2)

Yes No

IF: CF25 = YES

IF: CE1 = YES

CFDie

CE1a

[*] (When you are feeling panicky, do you also feel...) afraid you might die?

What was it, please describe?

IF: CE1 = YES (1) (2)

Yes No

IF: CF25 = YES

CE1c DO YOU REGARD THIS AS AN EXCEPTIONALLY STRESSFUL OR TRAUMATIC EVENT?

CFCold INTERVIEWER CODE [*] (When you are feeling panicky, do you also feel...) hot or cold all over? (1) (2)

Yes No

IF: CF25 = YES

(1) (2)

Yes No

IF: CE1 = YES IF: CE1C=YES

CE1b

CFNumb [*] (When you are feeling panicky, do you also feel...) numbness or tingling feelings in your body? (1) (2)

Yes No

[*] At the time, were you very upset or badly affected by it in someway? (1) (2)

Yes No

IF: CE1 = YES IF: CE1C = YES

CF26

CE2 [*] In the last month have you been very afraid of, or tried to avoid, the things on this card? CODE ALL THAT APPLY SHOW CARD 9 SET [4] OF (1) Crowds (2) public places (3) Travelling alone (if you ever do) (4) Being far from home (9) None of the above

IF: CF26=1-4

CF27 [*] Is this fear or avoidance of (SITUATION) mostly because you are afraid that if you had a panic attack or something like that (such as dizziness or diarrhoea), you would find it difficult or embarassing to get away, or would not be able to get the help you need? (1) (2)

Yes No

Post Traumatic Stress Disorder CE1 The next section is about events or situations that are exceptionally stressful, and that would really upset almost anyone. For example, being caught in a burning house, being abused, being in a serious car crash or seeing a member of your family or friends being mugged at gun point. [*] During your lifetime has anything like this happened to you?

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[*] At present, is it affecting your behaviour, feelings or concentration? (1) (2)

Yes No

IF: CE1 = YES AND: CE2 = YES

CE2a [*] Over the last month, have you . . . . ‘relived’ the event with vivid memories (flashbacks) of it? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

CE2b [*] (Over the last month, have you. .) .. had a lot of upsetting dreams of the event? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

CE2c [*] (Over the last month, have you. .) .. got upset if anything happened which reminded you of it? SHOW CARD 7

Appendix E: Survey documents

(5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

[*] (Over the last month, have you. .) .. expressed a smaller range of feelings than in the past, e.g. no longer able to express loving feelings? SHOW CARD 7

CE2d

(5) (6) (7)

[*] (Over the last month, have you. .) .. tried to avoid thinking or talking about anything to do with the event? SHOW CARD 7

IF: CE1 = YES AND: CE2 = Y ES

(5) (6) (7)

[*] (Over the last month, have you. .) .. felt less confidence in the future? SHOW CARD 7

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

CE2e [*] (Over the last month, have you. .) .. tried to avoid activities places or people that remind you of the event? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

E

No A little A Lot

CE2j

(5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = Y ES

CE2k [*] (Over the last month, have you. .) .. had problems sleeping? SHOW CARD 7 (5) (6) (7)

No A little A Lot

CE2f [*] (Over the last month, have you. .) .. blocked out important details of the event from your memory? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

IF: CE1 = YES AND: CE2 = Y ES

CE2l [*] (Over the last month, have you. .) .. felt irritable or angry? SHOW CARD 7 (5) (6) (7)

No A little A Lot

CE2g

IF: CE1 = YES AND: CE2 = Y ES

[*] (Over the last month, have you. .) .. shown much less interest in activities you used to enjoy? SHOW CARD 7

CE2m

(5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = YES

CE2h

[*] (Over the last month, have you. .) .. had difficulty concentrating? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = Y ES

CE2n [*] (Over the last month, have you. .) .. felt cut off or distant from others? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES IF: CE2 = YES

CE2i

[*] (Over the last month, have you. .) .. always been on the alert for possible dangers? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = Y ES

CE2o

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[*] (Over the last month, have you. .) .. jumped at little noises or easily startled in other ways? SHOW CARD 7

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A -CE2O)=7

CE6c (5) (6) (7)

No A little A Lot

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A-CE2 O)=7

CE3 [*] You have told me about (TRAUMATIC EVENT) How long after the event did these problems begin? (1) (2)

within six months More than six months after the event

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A-CE2 O)=7

[*] (Have they interfered with...) .. learning or class work? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A -CE2O)=7

CE6d [*] (Have they interfered with...) .. playing, hobbies, sports or other leisure activities? SHOW CARD 4

CE4 [*] How long have you been having these problems? (1) (2) (3)

Less than a month At least one month but less than three months Three months or more

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A-CE2 O)=7

CE5 [*] How much have these problems upset or distressed you... RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A -CE2O)=7

CE7 [*] Have these problems made it harder for those around you (family, friends and teachers etc.). . RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

Compulsions and obsessions IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A-CE2 O)=7

CE6a [*] Have they interfered with... how well you get on with the rest of your family? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CE1 = YES AND: CE2 = Y ES AND: ANY (CE2A-CE2 O)=7

CE6b [*] (Have they interfered with...) .. making and keeping friends? SHOW CARD 4 (5) (6) (7) (8)

200

not at all only a little quite a lot a great deal

Mental health of children and adolescents in Great Britain

CF28Intr Many young people have some habits or superstitions, such as not stepping on the cracks in the pavement, or having to go through a special goodnight ritual, or having to wear lucky clothes or have a lucky mascot for exams or football/netball matches. It is also common for young people to go through phases when they seem obsessed by one particular subject or activity. I want to ask whether you have rituals or obsessions that go beyond this.

CF28 [*] Overall, do you have rituals or obsessions that upset you, waste a lot of time, or interfere with your ability to get on with everyday life? (1) (2)

Yes No

IF: CF28=YES OR SDQ ( CHILD) EMOTION

SCORE

= 6+

CF29Intr Can I just check, over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all?

Appendix E: Survey documents

IF: CF28=YES OR SDQ (CHILD) E MOTION SCORE = 6+

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+

CF29a

CF29f

[*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all)

[*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all)

Excessive cleaning; handwashing, baths, showers, toothbrushing etc.? SHOW CARD 7

Arranging things so they are just so, or exactly symmetrical? SHOW CARD 7

(5) (6) (7)

(5) (6) (7)

No A little A Lot

No A little A Lot

IF: CF28=YES OR SDQ (CHILD) E MOTION SCORE = 6+

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+

CF29b

CF29g

[*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all)

[*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all)

Other special measures to avoid dirt, germs or poisons? SHOW CARD 7

Counting to particular lucky numbers or avoiding unlucky numbers? SHOW CARD 7

(5) (6) (7)

No A little A Lot

(5) (6) (7)

E

No A little A Lot

IF: CF28=YES OR SDQ (CHILD) E MOTION SCORE = 6+

CF29c

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+

CF31a [*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all) Checking: doors, locks, oven, gas taps, electric switches? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF28=YES OR SDQ (CHILD) E MOTION SCORE = 6+

CF29d [*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all) Repeating actions: going in and out of the door many times in a row, or getting up/down from a chair or anything like this? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF28=YES OR SDQ (CHILD) E MOTION SCORE = 6+

CF29e [*] (Over the last month have you been doing any of the following things over and over again even though you have already done them or don’t need to do them at all) Touching things or people in particular ways? SHOW CARD 7

[*] Over the last month, have you been thinking over and over again about dirt, germs or poisons? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+

CF31b [*] (Over the last month, have you been thinking over and over again about any of the following) ... Something terrible happening to yourself or others illnesses,accidents, fires etc.? SHOW CARD 7 (5) (6) (7)

No A little A Lot

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+ AND: SEPARATION ANXIETY AND F31B = ALOT

CF32 [*] Is this just part of your general concern about being separated from (ATTACHMENT FIGURES) or is this a serious additional problem in its own right? (1) (2)

part of separation anxiety a problem in it’s own right

IF: CF28=YES OR SDQ (CHILD ) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF33 (5) (6) (7)

No A little A Lot

[*] You have just told me about your habits and obsessions. Have they been present on most days for a period of at least two weeks?

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(1) (2)

Yes No

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF34 [*] Does you think that these (acts/thoughts) are excessive or unreasonable? (5) (6) (7)

No Sometimes Definitely

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF38c [*] (Have these acts/thoughts interfered with ...) ...learning or class work? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

CF35 [*] Do you try not to do them or think about them? (5) (6) (7)

No Perhaps Definitely

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF36 [*] Do you become upset because you have to do or think these things? (5) (6) (7) (8)

No, I enjoy them Neutral,I neither enjoy them nor become upset Sometimes/somewhat upset Upset a great deal

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF37 [*] Do these (acts/thoughts) use up at least an hour a day on average? (1) (2)

CF38d [*] (Have these acts/thoughts interfered with ...) ...playing, hobbies, sports or other leisure activities? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF38e [*] Have these acts/thoughts made it harder for those around you (family, friends or teachers etc.)? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

Yes No

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF38a [*] Have these acts/thoughts interfered with ... .. how well s/he gets on with the rest of your family? SHOW CARD 4 (5) (6) (7) (8)

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

not at all only a little quite a lot a great deal

IF: CF28=YES OR SDQ ( CHILD) EMOTION SCORE = 6+ AND: PROBLEM IS NOT PART OF SEPARATION ANXIETY (CF32=2)

CF38b

Generalised anxiety GenAInt What I want to ask about next is worries. Nearly all (TEENAGERS/YOUNG PEOPLE) have some worries, and these are naturally worse on some days than others, but some (TEENAGERS/YOUNG PEOPLE) have so many worries for so much of the time that it makes them really upset or interferes with their lives.

CF40 [*] What I am asking about now is general worrying (apart from your SPECIFIC ANXIETIES) Do you ever worry? (1) (2)

Yes No

IF: CF40 = YES [*] (Have these acts/thoughts interfered with ...) ... making and keeping friends? SHOW CARD 4

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Mental health of children and adolescents in Great Britain

CF40a [*] Over the last six months, have you worried so much

Appendix E: Survey documents

about so many things that it has really upset you or interfered with your life? (5) (6) (7)

No Perhaps Definitely

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41a

E

worried about:) Bad things happening to others: family, friends, pets, the world.. SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41f [*] Thinking of the last 6 months and by comparing yourself with other people of your age, have you worried about: Past behaviour: Did I do that wrong? Have I upset someone? Have they forgiven me? SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41b

[*] (Thinking of the last 6 months and by comparing yourself with other people of your age, have you worried about:) The future: e.g. getting a job, boy/girlfriend, moving out SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41g [*] (Thinking of the last 6 months and by comparing yourself with other people of your age, have you worried about:) School work,homework or examinations SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

[*] Do you worry about anything else? (1) (2)

Yes No

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+ IF: CF41G = YES

CF41ga

CF41c

[*] What else do you worry about?

[*] (Thinking of the last 6 months and by comparing yourself with other people of your age, have you worried about:) Disasters: Burglaries, muggings, fires, bombs etc. SHOW CARD 5

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+ IF: CF41G = YES

(5) (6) (7)

[*] How much do you worry about this? SHOW CARD 5

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41d

CF41gb

(5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: TWO

OF CF41A-CF41GB=7

CF42DV [*] (Thinking of the last 6 months and by comparing yourself with other people of your age, have you worried about:) Your own health SHOW CARD 5 (5) (6) (7)

No more than other children of my age A little more than other children of my age A lot more than other children of my age

IF: CF40 = YES AND: CF40A=6 OR 7 OR SDQ (CHILDS) EMOTION SCORE=6+

CF41e [*] (Thinking of the last 6 months and by comparing yourself with other people of your age, have you

INTERVIEWER CHECK: Are there two or more specific worries (SPECIFIC WORRIES) over and above those which have already been mentioned in earlier sections? (1) (2)

Yes No

IF: CF40 = YES IF: CF42DV = YES

CF43 [*] Over the last six months have you been really worried on more days than not? (1) (2)

Yes No

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IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF44

CF48

[*] Do you find it difficult to control the worry?

[*] Does worrying make you feel irritable?

(1) (2)

(1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF45

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF48 = Y ES

CF48a [*] Does worrying lead to you being restless, feeling keyed up, tense or on edge, or being unable to relax? (1) (2)

Yes No

[*] Has this been true for more days than not in the last six months? (1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF45 = YES

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF45a

CF49

[*] Has this been true for more days than not in the last six months?

[*] Does worrying lead to you feeling tense in your whole body?

(1) (2)

(1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF46

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF49 = Y ES

CF49a [*] Does worrying lead to you feeling tired or ‘worn out’ more easily? (1) (2)

Yes No

(1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF46 = YES

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF46a

CF50

[*] Has this been true for more days than not in the last six months?

[*] Does worrying interfere with your sleep, making it difficult to fall or stay asleep, or making your sleep restless and unsatisfying?

(1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES

CF47 [*] Does worrying lead to difficulties in concentrating or or your mind going blank? (1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF47 = YES

CF47a [*] Has this been true for more days than not in the last six months? (1) (2)

204

[*] Has this been true for more days than not in the last six months?

Yes No

Mental health of children and adolescents in Great Britain

(1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF50 = Y ES

CF50a [*] Has this been true for more days than not in the last six months? (1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF50 = Y ES

CF51 [*] Overall, how much do your various worries upset and distress you ... RUNNING PROMPT

Appendix E: Survey documents

(5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF50 = YES

CF52Intr I now want to ask you about the extent to which these worries have interfered with your day to day life.

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES AND: CF50 = YES

CF52a

CF53 [*] Have your worries made it harder for those around you (family, friends or teachers etc) RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

Depression CDepInt This next section of the interview is about your mood.

[*] Have they interfered with ... how well you get on with the rest of your family? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

CG1 [*] In the past month, have there been times when you have been very sad, miserable, unhappy or tearful? (1) (2)

Yes No

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF50 = YES

IF: CG1 = YES

CF52b

[*] Over this month was there a period when you were really miserable nearly every day?

[*] (Have they interfered with ...) making and keeping friends? SHOW CARD 4

(1) (2)

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF50 = YES

CF52c [*] (Have they interfered with ...) learning or class work? SHOW CARD 4 (5) (6) (7) (8)

E

not at all only a little quite a lot a great deal

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF50 = YES

CG3

Yes No

IF: CG1 = YES

CG4 [*] During the time when you were really miserable were you really miserable for most of the day? (i.e. more hours than not) (1) (2)

Yes No

IF: CG1 = YES

CG5 [*] When you were miserable, could you be cheered up... RUNNING PROMPT (1) (2) (3)

easily with difficulty/only briefly or not at all?

IF: CG1 = YES

CG6

CF52d [*] Can you tell me how long that period lasted? [*] (Have they interfered with ...) playing, hobbies, sports or other leisure activities? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: CF40 = YES AND: CF42DV=YES AND CF43=YES IF: CF50 = YES

(1) (2)

less than two weeks two weeks or more

CG8 [*] In the past month, have there been times when you have been grumpy or irritable in a way that was out of character for you? (1) (2)

Yes No

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IF: CG8 = YES

CG10

IF: CG15 = YES IF: (CG3 OR CG4=YES) OR (CG10 OR CG11=YES)

CG20 [*] Over this month, was there a period when you were really irritable nearly every day? (1) (2)

Yes No

IF: CG8 = YES

[*] Was this loss of interest present during the same period when you were really miserable/irritable for most of the time? (1) (2)

Yes No

CG11 [*] During the time when you were grumpy or irritable, were you like this for most of the day? (i.e. more hours than not) (1) (2)

Yes No

IF: CG8 = YES

CG12

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

OR

CG4 = YES))

CG21a [*] (During that time when you were (IRRITABLE/ DEPRESSED/LACKING INTEREST)...) did you lack energy and seem tired all the time? (1) (2)

Yes No

[*] Was the irritability improved by particular activities, friends coming around or anything else... RUNNING PROMPT

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

(1) (2) (3)

[*] .... were you eating much more or much less than normal?

easily with difficulty/only briefly or not at all?

IF: CG8 = YES

OR

CG4 = YES))

CG21b

(1) (2)

Yes No

CG13 [*] Can you tell me how long that period lasted?

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

OR

CG4 = YES))

CG21ba (1) (2)

less than two weeks two weeks or more

CG15

[*] ...did you either lose or gain a lot of weight? (1) (2)

[*] In the past month, has there been a time when you lost interest in everything, or nearly everything, you normally enjoy doing?

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

OR

CG4 = YES))

CG21c (1) (2)

Yes No

IF: CG15 = YES

[*] ... did you find it hard to get to sleep?

CG17

(1) (2)

Yes No

[*] Over this month, was there a period when you were lacking in interest nearly every day?

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

OR

CG4 = YES))

OR

CG4 = YES))

CG21d (1) (2)

Yes No

IF: CG15 = YES

CG18

[*] ... did you sleep too much? (1) (2)

Yes No

[*] During these days when you lost interest in things, were you like this for most of each day? (i.e. more hours than not)

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

(1) (2)

[*] ...were you agitated or restless much of the time?

Yes No

IF: CG15 = YES

CG21e

(1) (2)

Yes No

CG19 [*] Can you tell me how long this loss of interest lasted?

IF: ((CG10 OR CG11=YES) OR (CG3 OR (CG17 = YES)

CG21f (1) (2)

206

less than two weeks two weeks or more

Mental health of children and adolescents in Great Britain

OR

CG4 = YES))

Appendix E: Survey documents

[*] ... did you feel worthless or unnecessarily guilty for much of the time? (1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES)

CG21g

E

CG23Intr I also want to ask you about the extent to which (IRRITABLE/DEPRESSED/ A LACK OF INTEREST) has interfered with your day to day life. SHOWCARD 4

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG23a [*] ....did you find it unusually hard to concentrate or to think things out? (1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG21h

[*] Has this interfered with ... how well you get on with the rest of your family? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

[*] ... did you think about death a lot?

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

(1) (2)

CG23b

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

[*] (Has this interfered with ...) making and keeping friends? SHOW CARD 4

CG21k [*] Over the whole of your lifetime have you ever tried to harm yourself or kill yourself? (1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES)) IF: CG21K = YES

CG21j (During that time when you were (IRRITABLE/DEPRESSED/LACKING INTEREST) did you ever try to harm yourself or kill yourself? (1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

(5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG23c [*] (Has this interfered with ...) learning or class work? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG23d

CG21i [*] .... did you ever talk about harming yourself or killing yourself? (1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

[*] (Has this interfered with ...) playing, hobbies, sports or other leisure activities? SHOW CARD 4 (5) (6) (7) (8)

not at all only a little quite a lot a great deal

CG22

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

[*] .... Overall, how upset and distressed are you as a result of this. RUNNING PROMPT

CG24

(5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

[*] Has feeling (DEPRESSED/IRRITABLE/A LACK OF INTEREST) made it harder for those around you (family, friends, teachers etc... RUNNING PROMPT (5) (6) (7) (8)

not at all only a little quite a lot or a great deal?

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IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

Awkward and troublesome behaviour

CG25

CI1

[*] Over the past month have you thought about harming or hurting yourself?

This next section is about behaviour that sometimes gets young people into trouble with parents, teachers or other adults. Do your teachers complain about you being awkward or troublesome? SHOW CARD 7

(1) (2)

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG26

(5) (6) (7)

No A little A Lot

[*] Over the past month, have you ever tried to harm or hurt yourself?

CI2

(1) (2)

Do your family complain about you being awkward or troublesome? SHOW CARD 7

Yes No

IF: ((CG10 OR CG11=YES) OR (CG3 OR CG4 = YES)) OR (CG17 = YES))

CG27

(5) (6) (7)

No A little A Lot

[*] Over the whole of your lifetime, have you ever tried to harm or hurt yourself?

CI3

(1) (2)

And what do you think, do you think you are awkward or troublesome? SHOW CARD 7

Yes No

Attention and activity

(5) (6) (7)

No A little A Lot

AttnInt

Less common disorders

This section of the interview is about concentration and activity.

LessInt

CH1 [*] Do your teachers complain about you having problems with overactivity or poor concentration? SHOW CARD 7 (5) (6) (7)

No A little A Lot

[*] Do your family complain about you having problems with overactivity or poor concentration? SHOW CARD 7 No A little A Lot

CH3 [*] And what do you think? Do you think you have definite problems with overactivity or poor concentration? SHOW CARD 7 (5) (6) (7)

CI4 Do you have any tics or twitches that you can’t seem to control? (1) (2)

CH2

(5) (6) (7)

This next section is about a variety of different aspects of behaviour and development.

No A little A Lot

CI5 Do you have dyslexia or reading difficulties? (1) (2)

Mental health of children and adolescents in Great Britain

Yes No

CI6 Have other people been concerned that you have been dieting too much? (1) (2)

Yes No

CI7 Have you had any out-of-ordinary experiences - such as seeing or hearing things, or having unusual ideas that have worried or frightened you? (1) (2)

208

Yes No

Yes No

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Significant problem(s) IF: SIGNIFICANT

PROBLEM HAS BEEN IDENTIFIED (I.E . CHILD HAS

SYMPTOMS AND THESE ARE CAUSING AN IMPACT OR BURDEN) IN

E

CPerslty [*] In terms of what sort of person you are, what would you say are the best things about you?

ONE OR MORE AREA.

CSigInt

OPEN

You have told me about (LIST OF PROBLEMS) I’d now like to hear a bit more about these in your own words.

CPersNo INTERVIEWER: Did the child mention any qualities?

CTypNow INTERVIEWER: if you prefer to take notes by hand rather than typing the details during the interview just type ‘later’ in the response boxes - but please remember to come back and complete the question before transmission. WILL YOU BE TYPING IN THE ANSWERS NOW OR LATER (1) (2)

CQuality [*] Can you tell me some things you have done that you are really proud of? They could be related to school, sport, music, friends, charity or anything else

INTERVIEWER: Did the child mention any things they are proud of?

LIST OF PROBLEMS INTERVIEWER: Please try and cover all areas of difficulty, but it is a good idea to let the young person choose which order to cover them in, starting with the area that concerns them most. Use the suggested prompts written below and on the prompt card.

6.

Yes No

CQualNo

Now Later

CSigPrb

1. 2. 3. 4. 5.

(1) (2)

Description of the problem? How often does the problem occur? How severe is the problem at its worst? How long has it been going on for? Is the problem interfering with the child’s quality of life? If so, how? WHERE APPROPRIATE,record what the child thinks the problem is due to, and what s/he has done about it.

CAnxity Do you experience any of the following when you feel anxious, nervous or tense INDIVIDUAL PROMPT SET [7] OF (1) Heart racing or pounding? (2) Hands sweating or shaking? (3) Feeling dizzy? (4) Difficulty getting my breath? (5) Butterflies in stomach? (6) Dry mouth? (7) Nausea or feeling as though I wanted to be sick? (8) or none of the above?

Strengths

(1) (2)

Yes No

EndFTF THIS IS THE END OF THE CHILD’S FACE TO FACE INTERVIEW PLEASE CONTINUE WITH THE CHILD’S SELFCOMPLETION

CHILD SELF-COMPLETION CSCIntr I would now like you to take the computer and answer the next set of questions yourself

ChldSc INTERVIEWER: RESPONDENTS SHOULD SELFCOMPLETE. ENCOURAGE THE CHILD TO COMPLETE THIS SECTION THEMSELVES IF ABSOLUTELY NECESSARY ADMINISTER AS AN INTERVIEW (1) (2)

Complete self-completion by respondent Section read and entered by interviewer

Confid Take your time to read each question carefully in turn and answer it as best you can. REMEMBER THAT WE ARE ONLY INTERESTED IN YOUR OPINION. THIS IS NOT A TEST

SCTest

SIntro

This question is just to help you to get used to answering the questions in this section.

I have been asking you a lot of questions about difficulties and problems. I now want to ask you about your good points or strengths.

Do you like using computers? PRESS 1 for No PRESS 2 for Just a bit PRESS 3 for

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Definitely THEN

IF: C3D1 = YES

C3D8 (1) (2) (3)

No Just a bit Definitely

Chronic fatigue syndrome (M.E)

(1) (2) (3)

No A bit A lot

C3D1

IF: C3D1 = YES

Over the last month have you been feeling much more tired and worn out than usual? PRESS 1 for No PRESS 2 for Yes THEN

Do you suffer from pains in you knees, elbows, wrists or other joints?

(1) (2)

(1) (2) (3)

C3D9

No Yes

IF: C3D1 = YES

No A bit A lot

C3D2

IF: C3D1 = YES

Why do you think this is? TYPE IN YOUR ANSWER AND THE

Do you suffer from headaches?

C3D10

C3D3

(1) (2) (3)

How long have you been feeling tired and worn out like this?

IF: C3D1 = YES

IF: C3D1 = YES

(1) (2) (3) (4) (5)

less than 3 months 3-5 months 6 months to 5 years Over 5 years All my life

IF: C3D1 = YES

C3D4

No A bit A lot

C3D11 Do you suffer from problems getting to sleep or staying asleep? (1) (2) (3)

No A bit A lot

IF: C3D1 = YES

Do you feel better after resting?

C3D12

(1) (2) (3)

Do you suffer from feeling sick/wanting to throw up?

Not at all only a bit Definitely better

IF: C3D1 = YES

C3D5

(1) (2) (3)

No A bit A lot

IF: C3D1 = YES

Does exercise really wipe you out for the next day?

C3D13

(1) (2)

Do you suffer from dizziness or poor balance?

No Yes

C3D6

(1) (2) (3)

Do you suffer from sore throats?

IF: C3D1 = YES

IF: C3D1 = YES

(1) (2) (3)

No A bit A lot

IF: C3D1 = YES

C3D7 Do you suffer from painful glands (lumps) in your neck or armpits? (1) (2) (3)

210

Do you suffer from painful muscles?

No A bit A lot

Mental health of children and adolescents in Great Britain

No A bit A lot

C3D14 You have told me about feeling more tired and worn-out than usual. Overall, how much has this upset or distressed you? (1) (2) (3) (4)

Not at all only a little quite a lot a great deal

IF: C3D1 = YES

C3D15

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Has feeling tired and worn-out interfered with ... How well you get on with the rest of your family? (1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: C3D1 = YES

C3D16 (Has feeling tired and worn-out interfered with ... ) making and keeping friends? (1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: C3D1 = YES

E

ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

C3A4b Have you often started fights in the past year? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU (1) (2) (3)

No perhaps Definitely

IF: C3A4B = DEF

C3A4ba Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

C3D17 (Has feeling tired and worn-out interfered with ... ) learning or class work?

(1) (2)

No Yes

C3A4c (1) (2) (3) (4)

not at all only a little quite a lot a great deal

During the past year, have you often bullied or threatened people? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU

IF: C3D1 = YES

C3D18 (Has feeling tired and worn-out interfered with ... ) playing, hobbies, sports or other leisure activities?

(1) (2) (3)

No perhaps Definitely

IF: C3A4C = DEF (1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: C3D1 = YES

C3D19 Has feeling tired and worn-out made it harder for those around you (family, friends or teachers etc) RUNNING PROMPT (1) (2) (3) (4)

not at all only a little quite a lot or a great deal?

C3A4ca Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

C3A4d Thinking of the past year, have you often stayed out later than you were supposed to? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU (1) (2) (3)

No perhaps Definitely

Awkward and troublesome behaviour IF: C3A4D = DEF

C3A4a

C3A4da

Thinking of the last year, have you often told lies to get things or favours from others, or to get out of having to do things you are supposed to do? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU

Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

(1) (2) (3)

C3A4e

No perhaps Definitely

IF: C3A4A = DEF

C3A4aa

(1) (2)

No Yes

Have you stolen valuable things from your house or other people’s houses. shops or school in the past year? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU

Has this been going on for the last 6 months?

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(1) (2) (3)

No perhaps Definitely

ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

IF: C3A4E = DEF

C3A4ea Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

C3A4f

C3A6aa Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

Have you run away from home more than once or ever stayed away all night without permission in the past year? ENTER THE NUMBER OF THE ANSWER WHICH APPLIES TO YOU (1) (2) (3)

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+ IF: C3A6A = YES

No perhaps Definitely

IF: C3A4F = DEF

C3A4fa

No Yes

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+

C3A6b In the past year, have you really hurt someone or been physically cruel to them, for example, tied up, cut or burned someone? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+ IF: C3A6B = YES

(1) (2)

C3A6ba

No Yes

C3A4g

Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

Thinking of the past year, have you often played truant (‘bunked off’) from school?

(1) (2)

(1) (2) (3)

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+)

No perhaps Definitely

IF: C3A4G = DEF

C3A4ga Has this been going on for the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

No Yes

C3A6c Have you been really cruel to animals or birds on purpose in the past year (eg. tied them up, cut or burnt them)? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

IF: C3A4G = DEF AND: CHILD 13+ YEARS OLDS

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+ IF: C3A6C = YES

C3A5

C3A6ca

Did you start playing truant (‘bunking off’) from school before you were 13 years old? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

(1) (2)

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+

(1) (2)

No Yes

IF: ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+

C3A6d

C3A6a The next few questions are about some other behaviours that sometimes get people into trouble. We have to ask everyone these questions even when they are not likely to apply. In the past year, have you ever used a weapon against another person (e.g. a bat, brick, broken bottle, knife, gun)?

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Have you deliberately started a fire in the past year? (DO NOT INCLUDE BURNING INDIVIDUAL MATCHES OR PIECES OF PAPER, CAMP FIRES ETC.) ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

Appendix E: Survey documents

IF: (C3A4DV >= 1) OR (QC1INT.QC1SDQ.SCONDUCT > 3) IF: C3A6D = YES

Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

C3A6da

(1) (2)

Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

IF: (C3A4DV >= 1) OR (QC1INT.QC1SDQ.SCONDUCT > 3)

C3A6e

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) C ONDUCT = 4+

C3A6h Have you broken into a house, any other building or a car in the past year? (1) (2)

Thinking of the past year, have you deliberately destroyed someone else’s property? (eg. smashing car windows or destroying school property ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

E

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) C ONDUCT = 4+ AND: C3A6H = YES

C3A6ha (1) (2)

No Yes

Has this happened in the last 6 months?

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+ IF: C3A6E = YES

(1) (2)

C3A6ea

C3A7

Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

Have you ever been in trouble with the police?

(1) (2)

No Yes

(1) (2)

No Yes

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) C ONDUCT = 4+ IF: C3A7 = YES

C3A6f

C3A7a

Have you been involved in stealing from someone in the street? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

Please type in why you were in trouble with the police.

(1) (2)

You have told me about some behaviours that have got you into trouble. How far have these interfered with how well you get on with the rest of your family?

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+ IF: C3A6F = YES

C3A6fa Has this happened in the last 6 months? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+

C3A8a

(1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: (ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+) OR (C3A7 = YES)

C3A8b You have told me about some behaviours that have got you into trouble. How far have these interfered with making and keeping friends?

C3A6g During the past year have you tried to force someone into sexual activity against their will? ENTER 1 FOR ‘NO’ AND 2 FOR ‘YES’

(1) (2) (3) (4)

(1) (2)

IF:( ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD ) CONDUCT = 4+) OR (C3A7 = YES)

No Yes

not at all only a little quite a lot a great deal

C3A8c IF: ANY(C3A3A-C3A3G=DEF) OR SDQ (CHILD) CONDUCT = 4+ IF: C3A6G = YES

C3A6ga

You have told me about some behaviours that have got you into trouble. How far have these interfered with learning or class work?

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(1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: (ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD) C ONDUCT = 4+) OR (C3A7 = YES)

C3A8d You have told me about some behaviours that have got you into trouble. How far have these interfered with playing, hobbies, sports or other leisure activities? (1) (2) (3) (4)

not at all only a little quite a lot a great deal

IF: (ANY(C3A3A-C3A3 G=DEF ) OR SDQ (CHILD) C ONDUCT = 4+) OR (C3A7 = YES)

C3A9 Have your behaviour made it harder for those around you (family, friends or teachers etc.)? (1) (2) (3) (4)

not at all only a little quite a lot a great deal

Moods and feelings MoodIntr

C3C4 (In the past two weeks) I was very restless? TYPE 1 for ‘Mostly true’ 2 for ‘Sometimes true’ OR 3 for ‘Not True’. (1) (2) (3)

Mostly true Sometimes true Not true

C3C5 (In the past two weeks) I felt I was no good any more? TYPE 1 for ‘Mostly true’ 2 for ‘Sometimes true’ OR 3 for ‘Not True’. (1) (2) (3)

Mostly true Sometimes true Not true

C3C6 (In the past two weeks) I cried a lot? (1) (2) (3)

Mostly true Sometimes true Not true

C3C7 (In the past two weeks) I found it hard to think properly or concentrate?

These next few questions are about how you might have been acting or feeling recently. For each statement please say whether it was true most of the time, sometimes true or not true about you.

(1) (2) (3)

C3C1

C3C8

(In the past two weeks) I felt miserable or unhappy? TYPE 1 for ‘Mostly true’ 2 for ‘Sometimes true’ OR 3 for ‘Not True’.

(In the past two weeks) I hated myself?

(1) (2) (3)

Mostly true Sometimes true Not true

C3C2

Mostly true Sometimes true Not true

C3C9 (In the past two weeks) I was a bad person?

(In the past two weeks) I didn’t enjoy anything at all? TYPE 1 for ‘Mostly true’ 2 for ‘Sometimes true’ OR 3 for ‘Not True’. (1) (2) (3)

(1) (2) (3)

Mostly true Sometimes true Not true

Mostly true Sometimes true Not true

(1) (2) (3)

Mostly true Sometimes true Not true

C3C10 (In the past two weeks) I felt lonely?

C3C3 (In the past two weeks) I felt so tired I just sat around and did nothing? TYPE 1 for ‘Mostly true’ 2 for ‘Sometimes true’ OR 3 for ‘Not True’. (1) (2) (3)

214

Mostly true Sometimes true Not true

Mental health of children and adolescents in Great Britain

(1) (2) (3)

Mostly true Sometimes true Not true

C3C11 (In the past two weeks) I thought nobody really loved me?

Appendix E: Survey documents

(1) (2) (3)

Mostly true Sometimes true Not true

(In the past two weeks) I thought I could never be as good as other young people? Mostly true Sometimes true Not true

C3C13

PLEASE TYPE IN YOUR ANSWER

C3B1b Were you trying to get practical advice or did you just need someone to talk things over with? (1) (2) (3)

Practical advice Talk things over Both,practical advice and to talk things over

IF: C3B1 = NO

(In the past two weeks) I did everything wrong? (1) (2) (3)

Who else did you ask for help?

IF: C3B1 = YES AND: C3B1A=1-9 OR C3B1 OTH = YES

C3C12

(1) (2) (3)

Mostly true Sometimes true Not true

C3C14 What word best describes how you have felt in the past 2 weeks?

Help from others C3B1

C3B2 If you ever felt so unhappy or worried that you needed to ask for help, who would you talk to? ENTER ‘10’ IF YOU WOULD NOT ASK ANY OF THESE PEOPLE FOR HELP SET [10] OF (1) Mother (2) Father (3) Brother or Sister (4) Special friend (5) School Teacher (6) School Nurse (7) Doctor (8) Social worker (9) Telephone helpline (10) None of these

Have you ever felt so unhappy or worried that you have asked people for help? PRESS 1 for NO, 2 for YES

IF: C3B1 = NO

(1) (2)

Is there anyone else you would ask for help? PRESS 1 for NO, 2 for YES

No Yes

IF: C3B1 = YES

C3B2Oth

C3B1a

(1) (2)

Who did you ask for help? ENTER ‘10’ IF YOU DID NOT ASK ANY OF THESE PEOPLE FOR HELP

IF: C3B1 = NO IF: C3B2OTH = YES

SET [10] OF (1) Mother (2) Father (3) Brother or Sister (4) Special friend (5) School Teacher (6) School Nurse (7) Doctor (8) Social worker (9) Telephone helpline (10) None of these

Who else would you ask for help?

IF: C3B1 = YES

C3B1oth

No Yes

C3B2Spec

PLEASE TYPE IN YOUR ANSWER

IF: C3B1 = NO IF: (C3B2=1-8 )OR (C3B2OTH = YES)

C3B2a What sort of help would you expect to get? (1) (2) (3)

Practical advice Talk things over Both,practical advice and to talk things over

Did you ask anyone else for help? PRESS 1 for NO, 2 for YES (1) (2)

E

No Yes

IF: C3B1 = YES AND: C3B1OTH = YES

C3B1Spec

Smoking C3E1 Do you smoke cigarettes at all these days? TYPE 1 FOR ‘NO’ AND 2 FOR ‘YES’ (1) (2)

No Yes

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C3E2 Now read all the following statements carefully and type in the number next to the one which best describes you. (1) (2) (3) (4) (5) (6)

I have never smoked I have only tried smoking once I used to smoke cigarettes but I never smoke now I sometimes smoke cigarettes now, but I don’t smoke as many as one a week I usually smoke between 1 - 6 cigarettes a week I usually smoke more than 6 cigarettes a week

IF: C3E2 = NEVER

C3E3 Just to check, read the statements below carefully and type in the number next to the one which best describes you. (1) (2) (3)

I have never tried smoking a cigarette, not even a puff or two I did once have a puff or two of a cigarette, but I never smoke now I do sometimes smoke cigarettes

IF: C3E3 = 3

(3) (4) (5) (6) (7)

Some other time during the last week One week, but less than two weeks ago Two weeks, but less than four weeks ago One month, but less than six months ago Six months ago or more

Drug use CanIntr The next set of questions are about drugs The first few questions are about marijuana and hashish. Marijuana is also called cannabis, hash, dope, grass, ganja, kif. Marijuana is usually smoked either in cigarettes, called joints, or in a pipe.

C3C1 Have you ever had a chance to try marijuana or hashish? Having a ‘chance to try’ means that cannabis was available to you if you wanted to use it or not? PRESS 1 for NO, 2 for YES, (1) (2)

No Yes

C3E3a

C3c2

About how many cigarettes a day do you usually smoke? IF YOU SMOKE LESS THAN 1, ENTER 0

Have you ever, even once, used cannabis? PRESS 1 for NO, 2 for YES, 3 for DON’T KNOW

0..98

(1) (2) (3)

Drinking

No Yes Never heard of cannabis/don’t know

IF: C3 C2 = YES

C3c3

C3F1 Have you ever had a proper alcoholic drink - a whole drink not just a sip ? PLEASE DO NOT INCLUDE DRINKS LABELLED LOW ALCOHOL

Have you ever used cannabis more than 5 times in your life? PRESS 1 FOR NO, 2 FOR YES (1) (2)

No Yes

PRESS 1 for ‘NO’ or 2 for ‘YES’ THEN PRESS ENTER

IF: C3 C2 = YES (1) (2)

No Yes

IF: C3F1 = YES

C3F2

C3C4 About how old were you the first time you used cannabis, even once? 0..15

How often do you usually have an alcoholic drink?

IF: C3 C2 = YES (1) (2) (3) (4) (5) (6) (7)

Almost every day About twice a week About once a week About once a fortnight About once a month Only a few times a year I never drink alcohol

IF: C3F1 = YES

C3F3

C3C5 About how often have you used cannabis in the past year? (1) (2) (3) (4) (5) (6)

About daily 2 or 3 times a week about once a week about once a month only a once or twice in past year not at all in past year

When did you last have an alcoholic drink?

IF: C3 C2 = YES (1) (2)

216

Today Yesterday

Mental health of children and adolescents in Great Britain

C3C6

Appendix E: Survey documents

Have you ever been concerned or worried about using cannabis? (1) (2)

No Yes

IF: C3C2 = YES

E

C3G4a Have you ever used ectasy more than 5 times in your life? (1) (2)

No Yes

C3C7 IF: C3G2 = YES Has using cannabis ever made you feel ill?

C3G5

(1) (2)

Have you ever used AMPHETAMINES (SPEED)

No Yes

C3C8

(1) (2) (3)

Have you ever felt you wanted to cut down or stop using cannabis?

IF: C3G2 = YES IF: C3G5 = YES

IF: C3C2 = YES

No Yes Never heard of amphetamines/don’t know

C3G5a (1) (2)

No Yes

Have you ever used amphetamines (speed) more than 5 times in your life?

IF: C3C2 = YES

C3C9

(1) (2)

Has anyone expressed concern about you using cannabis - for example a friend or relative or teacher

No Yes

IF: C3G2 = YES

C3G6 (1) (2)

No Yes

C3G2

Have you ever used LSD (ACID)?

Have you ever used any other drug?

(1) (2) (3)

(1) (2)

IF: C3G2 = YES IF: C3G6 = YES

No Yes

No Yes Never heard of LSD/don’t know

C3G6a IF: C3G2 = YES

C3G3

Have you ever used LSD (Acid) more than 5 times in your life?

Have you ever used inhalants (these are liquids or sprays that people sniff or inhale to get high or make them feel good such as solvents, sprays, glue or amylnitrate)?

(1) (2)

No Yes

IF: C3G2 = YES (1) (2) (3)

No Yes Never heard of inhalants/don’t know

IF: C3G2 = YES IF: C3G3 = YES

C3G3a Have you ever used inhalants more than 5 times in your life? (1) (2)

No Yes

IF: C3G2 = YES

C3G7 Have you ever used TRANQUILISERS (VALIUM,TEMAZAPAN)? (1) (2) (3)

No Yes Never heard of tranquilisers/don’t know

IF: C3G2 = YES IF: C3G7 = YES

C3G7a Have you ever used Tranquilisers (valium, temazapan) more than 5 times in your life?

C3G4 Have you ever used ECSTASY? (1) (2) (3)

No Yes Never heard of ecstasy/don’t know

IF: C3G2 = YES IF: C3G4 = YES

(1) (2)

No Yes

IF: C3G2 = YES

C3G8 Have you ever used COCAINE (CRACK)?

Mental health of children and adolescents in Great Britain

217

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(1) (2) (3)

No Yes Never heard of cocaine/don’t know

IF: C3G2 = YES IF: C3G8 = YES

C3G8a Have you ever used cocaine (crack) more than 5 times in your life? (1) (2)

No Yes

TO THE BALL AND SAYING: That was a good try, but this is the ‘ball’. Now try again. Put your finger on the ‘ball’. HELP AS NECESSARY UNTIL A CORRECT RESPONSE IS MADE. Good let’s try another one. Put your finger on the ‘dog’.

Starting test:: Fine, now I am going to show you some pictures. Each time I will say something, and you will point to the best picture of it. When we go further along, you may not be sure which one to point to, but I want you to look carefully at all the pictures anyway, and choose the one you think is right. Point to....

IF: C3G2 = YES

C3G9

* British Ability Scales (BAS-II)

Have you ever used HEROIN (METHADONE)?

* Word reading scale

(1) (2) (3)

Here is a card with a lot of words. Let’s see how many you can read. Read them out loud to me. INTERVIEWER: POINT TO THE FIRST WORD FOR THE CHILD.

No Yes Never heard of heroin/don’t know

IF: C3G2 = YES IF: C3G9 = YES

* Spelling sheet

C3G9a Have you ever used Heroin (methadone) more than 5 times in your life? (1) (2)

No Yes

CSCExit Thank you. That is the end of this section. Now please pass the computer back to the interviewer.

CHowCmp INTERVIEWER: Did the child complete the whole of this section as a self-completion? (1) (2)

Yes No

Dyslexia test DysTest INTERVIEWER: Will you be completing the dyslexia test with this child? (1) (2)

Yes No

* British Picture Vocabulary Scale (BPVS-II)

Introduction: I want you to look at some pictures with me. See all the pictures on this page. POINT TO EACH OF THE PICTURES IN TRAINING PLATE A. THEN SAY: I will say something; the I want you to put your finger on the ‘ball’. IF THE CHILD RESPONDS CORRECTLY PRESS TO CONTINUE WITH ANOTHER TRAINING PLATE. IF CHILD RESPONDS INCORRECTLY DEMONSTRATE THE CORRECT RESPONSE BY POINTING

218

Mental health of children and adolescents in Great Britain

GIVE THE CHILD THE SPELLING WORKSHEET AND A PENCIL AND ERASER. POINT TO THE LINE OF THE WORKSHEET CORRESPONDING TO THE CHILD’S STARTING ITEM AND SAY: I would like you to spell some words for me. Try as hard as you can to spell every word. Write the first one here. Get ready, listen.

N1392

D

IN CONFIDENCE

How to fill in this questionnaire 1.

Please read each question carefully.

2.

All questions can be answered by putting a tick in the box next to the answer that applies to the child.

Survey of Development and Well-being of Children and Adolescents

Not true

Somewhat true

Certainly true

For example Questionnaire for teachers of children aged 5 and above in primary or secondary schools

3.

Sometimes you are asked to write a number in a box. For example

Enter number of days

4

Stick Label Here

4.

It would help if you could answer all questions as best as you can even if you are not absolutely certain or you think the question seems a little odd.

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Mental health of children and adolescents in Great Britain

E

219

E

220 Above average

Average

Some difficulty

Marked difficulty

(a) Reading?

1

2

3

4

(b) Mathematics?

1

2

3

4

(c) Spelling

1

2

3

4

A2. Although “mental age” is a crude measure that cannot take account of a child being better in some areas than others, it would be helpful if you could answer the following question: In terms of overall intellectual and scholastic ability, roughly what age level is he or she at?

Enter age level

Go to Question A3

A3. During the last term, how many days overall has the child been absent? Enter number of days If don't know enter "99" If none enter "00"

A4.

Go to Question A4

Does the child have officially recognised special needs?

No .....................................................................................

0

Stage 1 (class teacher or form/year tutor has overall responsibility) ....................................

1

Stage 2 (SENCO takes the lead in co-ordinating provision and drawing up IEP) ............................

2

Stage 3(External specialist support enlisted) ...................

3

Stage 4(Statutory assessment by LEA) ............................

4

Stage 5(Statement issued by LEA) ..................................

5

A5. Are these special needs related to . . . . .

Go to Section B

Go to question A5

Yes

No

General learning difficulties? ..................................

1

2

Specific learning difficulties? .................................

1

2

Speech and language difficulties? ...........................

1

2

Emotional and behavioural difficulties? .................

1

2

Physical disability/sensory impairment? .................

1

2

Other (please specify) .............................................

1

2

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

A1. Compared with an average child of the same age, how does he or she fare in the following areas:

Section B

Strengths and Difficulties Questionnaire

For each item, please tick a box under one of the headings: Not True, Somewhat True or Certainly True.

For each item, please tick a box under one of the headings:

Not true

Not True, Somewhat True or Certainly True.

Somewhat true

Certainly true

Over the past six months:

Not true

Somewhat true

Certainly true

Over the past six months: B1. Considerate of other people's feelings ................................................. B2. Restless, overactive, cannot stay still for long .......................................... B3. Often complains of headaches, stomach aches or sickness .................... B4. Shares readily with other children (treats, toys, pencils etc) ....................... B5. Often has temper tantrums or hot tempers ...........................................

B7. Generally obedient, usually does what adults ask ............................. B8. Many worries, often seems worried ................................................. B9. Helpful if someone is hurt, upset or feeling ill ................................ B10. Constantly fidgeting or squirming .........................................

1

1

1

1

2

2

2

2

2

3

3

3

3

1

2

3

1

1

2

2

3

B12. Often fights with other children or bullies them ....................................

1

2

3

B13. Often unhapy, downhearted or tearful .............................................

1

2

3

B14. Generally liked by other children ...............................................

1

2

3

B15. Easily distracted, concentration wanders...............................................

1

2

3

B16. Nervous or clingy in new situations, easily loses confidence .......................

1

2

3

B17. Kind to younger children....................

1

2

3

B18. Often lies or cheats .............................

1

2

3

B19. Picked on or bullied by other children ...............................................

1

2

3

B20. Often volunteers to help others (parents, teachers, other children) ......

1

2

3

B21. Thinks things out before acting ..................................................

1

2

3

B22. Steals from home, school or elsewhere ............................................

1

2

3

B23. Gets on better with adults than with other children .............................

1

2

3

B24. Has many fears, easily scared .................................................

1

2

3

B25. Sees tasks through to the end, good attention span.............................

1

2

3

3

2

2

2

3

1

1

1

3

3

3

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Mental health of children and adolescents in Great Britain

B6. Rather solitary, tends to play alone .............................................

1

B11. Has at least one good friend ...............

E

221

E

222 Section C

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

B26. Overall, do you think that this child has difficulties in one or more of the following areas: emotions, concentration, behaviour or getting on with other people?

Emotions

For each item, please tick a box under one of the headings:

(a)

No ..........................................................

1

Yes: minor difficulties ..........................

2

Yes: definite difficulties ........................

3

Yes: severe difficulties ..........................

4

Go to Section C

Not true

1

1 - 5 months ..........................................

2

6 - 12 months ........................................

3

A year or more ......................................

4

Not at all B27. Do the difficulties upset or distress the child?..........................

1

Only a little

2

Quite a lot

3

A great deal

4

B28. Do the difficulties interfere with the child's everyday life in terms of his or her . . . peer relationships? ...................

Somewhat true

Certainly true

Go to Question B26(a)

How long have these difficulties been present? Less than a month .................................

Not True, Somewhat True or Certainly True.

C1. Excessive worries ..............................................

1

2

3

C2. Marked tension or inability to relax ..................

1

2

3

C3. Excessive concern about his/her own abilities, e.g. academic, sporting or social .......................

1

2

3

C4. Particularly anxious about speaking to class or reading aloud ...................................

1

2

3

C5. Reluctant to separate from family to come to school ..............................................

1

2

3

C6. Unhappy, sad or depressed ...............................

1

2

3

C7. Has lost interest in carrying out usual activities ............................................................

1

2

3

C8. Feels worthless or inferior ................................

1

2

3

C9. Concentration affected by worries or misery ...........................................................

1

2

3

Go to C11 C10. Other emotional difficulties eg. marked fears panic attacks, obsessions or compulsions ......... 1

2

3

C10a. Please descibe these briefly 1

2

3

4

B29. Do the difficulties put a burden on you or the class as a whole? .........

1

2

3

4

2

3

Go to C10a

4

classroom learning? .................

1

Please review your answers to questions C1 to C10 about worries, misery and so on. If you have ticked ‘CERTAINLY TRUE’ to any of the questions C1 to C10 - Please go to question C11. If not, go to Section D. Not at all C11. Do the difficulties upset or distress the child? .........................................

Only a little

1

2

Quite a lot

A great deal

3

Section D Attention, Activity and Impulsiveness D1. When s/he is doing something in class that s/he enjoys and is good at, whether reading or drawing or making a model or whatever, how long does s/he typically stay on that task?

Less than 2 minutes ..................

1

2 - 4 minutes .............................

2

5 - 9 minutes .............................

3

10 - 19 minutes .........................

4

20 minutes or more ...................

5

4

C12. Do the difficulties interfere with the child's everyday life in terms of his or her . . . peer relationships? ...................

1

2

3

4

classroom learning? .................

1

2

3

4

C13. Do the difficulties put a burden on you or the class as a whole? .........

1

2

3

4

Go to question D2

Yes

1

Go to Question C14a

No

2

Go to Section D

C14a. If there are serious concerns in this area, please say how long the child has had these problems, and what, if anything, might have triggered them.

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

C14. Do you have any further comments about this child’s emotional state?

E

223

E

224 Please review your answers to questions D2 to D20 on attention and activity.

Not true

Somewhat true

Certainly true

D2.

Makes careless mistakes..............................

1

2

3

D3.

Fails to pay attention ...................................

1

2

3

D4.

Loses interest in what s/he is doing .............

1

2

3

D5.

Doesn’t seem to listen .................................

1

2

3

D6.

Fails to finish things s/he starts ...................

1

2

3

D7.

Disorganised ................................................

1

2

3

D8.

Tries to avoid tasks that require thought .....

1

2

3

D9.

Loses things .................................................

1

2

3

D10. Easily distracted ..........................................

1

2

3

D11. Forgetful ......................................................

1

2

3

D12. Fidgets .........................................................

1

2

3

D13. Can’t stay seated when required to do so ....

1

2

3

D14. Runs or climbs about when s/he shouldn’t..

1

2

3

D15. Has difficulty playing quietly ......................

1

2

3

D16. Finds it hard to calm down when asked to do so ............................................................

1

2

3

D17. Interrupts, blurts out answers to questions ..

1

2

3

D18. Hard for him/her to wait their turn ..............

1

2

3

D19. Interrupts or butts in on others ....................

1

2

3

D20. Goes on talking if asked to stop ..................

1

2

3

If you have ticked ‘CERTAINLY TRUE’ to any of the questions D2 to D20 - Please go to question D21. If not, go to Section E. Not at all D21. Do the difficulties upset or distress the child? .........................................

Only a little

Quite a lot

A great deal

1

2

3

4

peer relationships? ...................

1

2

3

4

classroom learning? .................

1

2

3

4

D23. Do the difficulties put a burden on you or the class as a whole? .........

1

2

3

4

D22. Do the difficulties interfere with the child's everyday life in terms of his or her . . .

D24. Do you have any further comments about this child in relation to attention or activity and impulsiveness?

Yes

1

Go to Question D24a

No

2

Go to Section E

D24a. Please describe. If there are serious concerns in this area, please say how long the child has had these problems, and what, if anything, might have triggered them.

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

For each item, please tick a box under one of the headings: Not True, Somewhat true or Certainly true.

Section E

Awkward and Troublesome Behaviour

E18. Does (CHILD) steal? Not true .....................................

1

Somewhat true ..........................

2

Certainly true ............................

3

For each item, please tick a box under one of the headings:

Go to question E19

Not True, Somewhat true or Certainly true. Not true

Somewhat true

Certainly true

E18a. Please describe this briefly

E1.

Temper tantrums or hot tempers .................

1

2

3

E2.

Argues a lot with adults ...............................

1

2

3

E3.

Disobedient at school ..................................

1

2

3

E4.

Deliberately does things to annoy others ....

1

2

3

E5.

Blames others for own mistakes..................

Go to question E18a

1

2

E19. Does s/he destroy things belonging to others, vandalism? Not true .....................................

1

Somewhat true ..........................

2

Certainly true ............................

3

Go to question E20

3

E6.

Easily annoyed by others.............................

1

2

3

E7.

Angry and resentful .....................................

1

2

3

E8.

Spiteful ........................................................

1

2

3

E9.

Tries to get his/her own back ......................

1

2

3

1

2

3

E11. Starts fights ..................................................

1

2

3

E12. Bullies others ...............................................

1

2

3

E13. Plays truant ..................................................

1

2

3

E14. Uses weapons when fighting .......................

1

2

3

E19a. Please describe this briefly

E20. Does (CHILD) show unwanted sexualized behaviour towards others? Not true .....................................

1

Somewhat true ..........................

2

Certainly true ............................

3

Go to question E21

Go to question E20a

E20a. Please describe this behaviour

E21. Has (CHILD) been in trouble with the law? Not true .....................................

1

Somewhat true ..........................

2

Certainly true ............................

3

Go to next page

E15. Has been physically cruel, has really hurt someone ...............................................

1

2

3

E16. Deliberately cruel to animals.......................

1

2

3

E17. Sets fires deliberately ..................................

1

2

3

E21a. Please describe this briefly

Go to question E21a

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

E10. Lying or cheating ........................................

Go to question E19a

E

225

E

226 Section F

If you have ticked ‘CERTAINLY TRUE’ to any of the questions E1 to E21 - Please go to question E22. If not, go to Section F.

Not True, Somewhat true or Certainly true.

Other Concerns

For each item, please tick a box under one of the headings:

Not at all E22. Do the difficulties upset or distress the child? .........................................

Only a little

1

2

Quite a lot

A great deal

3

Not true F1.

Somewhat true

Certainly true

Tics, twitches, involuntary grunts or noises ...................................

1

2

3

F2. Diets to excess .....................................

1

2

3

4

F3. Do you have anyother concerns about the child's psychological development?

E23. Do the difficulties interfere with the child's everyday life in terms of his or her . . . peer relationships? ...................

1

2

3

4

classroom learning? .................

1

2

3

4

E24. Do the difficulties put a burden on you or the class as a whole? .........

1

2

3

4

Yes .........................

1

Go to question F3a

No ..........................

2

Go to question F4

F3a. Please describe this briefly

E25. Do you have any further comments about this child's awkwardness and troublesome behaviour? F4.

Yes No

1

Go to Question E25a

2

Go to Section F

E25a. Please describe. If there are serious concerns in this area, please say how long the child ha had these problems, and what, if anything, might have triggered them.

Do you have any further comments about (CHILD) in general?

F4a. Please describe

Yes

1

Go to Question F4a

No

2

Go to Section G

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

Please review your answers to questions E1 to E21 on awkward and troublesome behaviour.

Section G

Help from school

G1. During this school year, has s/he had any specific help for emotional or behavioural problems from teachers, educational psychologists, or other professionals working within the school setting.

Yes .........................

1

Go to question G1(a)

No ..........................

2

END

G1a. Please describe briefly what sort of help was provided, by whom, and for what:

Thank you very much for your help

ONS 1 Drummond Gate London SW1V 2QQ

Appendix E: Survey documents

Mental health of children and adolescents in Great Britain

Please return this questionnaire in the prepaid envelope provided as soon as possible

E

227

F

Appendix F: Glossary of terms

Appendix F

Glossary of terms Navigate through the Glossary by using its Bookmarks or select the HAND tool and click in a text column below to enlarge the view. Continue clicking the HAND tool to advance seamlessly throughout the listing.

ACORN classification ACORN is a geodemographic targeting classification, combining geographical and demographic characteristics to distinguish different types of people in different areas in Great Britain. (CACI Information Services, (1993), ACORN User Guide, CACI Limited 1994. All Rights Reserved. Source: ONS and GRO(S) (c) Crown Copyright 1991. All Rights Reserved) Although the ACORN classification has various levels, 6 categories, 17 groups and 54 types, for the purposes of this report, the highest level, i.e. the six broad categories have been chosen for comparative analysis. The ACORN User Guide gives the following description of each category. A. Thriving: wealthy achievers, suburban areas; affluent greys, rural communities; prosperous pensioners, retirement areas. B. Expanding: affluent executives, family areas; well-off workers, family areas. C. Rising: affluent urbanites, town and city areas, prosperous professionals, metropolitan areas; better off executives, inner city areas. D.Settling: comfortable middle agers, mature home owning areas; skilled workers, home owning areas. E. Aspiring: new home owners, mature communities; white collar workers, better-off multi-ethnic areas. F. Striving: older people, less prosperous areas; council estate residents, better off homes; council estate residents, high unemployment; council estate residents, greater hardship, people in multi-ethnic, low-income areas.

Burden of mental disorders The burden of the child’s problem is a

228

Mental health of children and adolescents in Great Britain

measure of the consequences of the symptoms in terms of whether they cause distress to the family by making the parents worried, depressed, tired or physically ill.

Case vignettes This case vignette approach for analysing survey data uses clinician ratings based on a review of all the information of each subject. This information includes not only the questionnaires and structured interviews but also any additional comments made by the interviewers, and the transcripts of informants’ comments to open-ended questions particularly those which ask about the child’s significant problems.

Educational level Educational level was based on the highest educational qualification obtained and was grouped as follows: Degree (or degree level qualification) Teaching qualification HNC/HND, BEC/TEC Higher, BTEC Higher City and Guilds Full Technological Certificate Nursing qualifications: (SRN,SCM,RGN,RM,RHV,Midwife) A-levels/SCE higher ONC/OND/BEC/TEC/not higher City and Guilds Advanced/Final level GCE O-level (grades A-C if after 1975) GCSE (grades A-C) CSE (grade 1) SCE Ordinary (bands A-C) Standard grade (levels 1-3) SLC Lower SUPE Lower or Ordinary

Appendix F: Glossary of terms

School certificate or Matric City and Guilds Craft/Ordinary level GCE O-level (grades D-E if after 1975) GCSE (grades D-G) CSE (grades 2-5) SCE Ordinary (bands D-E) Standard grade (levels 4-5) Clerical or commercial qualifications Apprenticeship Other qualifications CSE ungraded No qualifications

Ethnic Group Household members were classified into nine groups: White Black - Caribbean Black - African Black - Other Indian Pakistani Bangladeshi Chinese None of these For analysis purpose these nine groups were subsumed under 5 headings: White, Black, Indian, Pakistani and Bangladeshi and other

Household The standard definition used in most surveys carried out by ONS Social Survey Division, and comparable with the 1991 Census definition of a household, was used in this survey. A household is defined as a single person or group of people who have the accommodation as their only or main residence and who either share one meal a day or share the living accommodation. (See E McCrossan A Handbook for interviewers. HMSO: London 1985.)

Impact of mental disorders Impact refers to the consequences of the disorder for the child in terms of social

F

impairment and distress. Social impairment refers to the extent to which the disorder interferes with the child’s everyday life in terms of his or her home life, friendships, classroom learning or leisure activities.

Marital status Two questions were asked to obtain the marital status of the interviewed parent. The first asked: “Are you single, that is never married, married and living with your husband/wife, married and separated from your husband/wife, divorced or widowed?” The second question asked of everyone except those married and living with husband/wife was “May I just check, are you living with someone else as a couple?” The stability of the cohabitation was not assessed.

Mental disorders The questionnaires used in this survey were based on both the ICD10 and DSM-IV diagnostic research criteria, but this report uses the terms mental disorders as defined by the ICD-10: to imply a clinically recognisable set of symptoms or behaviour associated in most cases with considerable distress and substantial interference with personal functions.

Region When the survey was carried out there were 14 Regional Health Authorities in England. These were used in the sample design for stratification. Scotland and Wales were treated as two distinct areas. However, for analysis purposes, the postal sectors were allocated to Government Office Regions with Metropolitan counties (GOR2) 1. North East Met 2. North East Non Met 3. North West Met 4. North West Non Met 5. Merseyside 6. Yorks and Humberside Met 7. Yorks and Humberside Non Met 8. East Midlands 9. West Midlands Met 10.West Midlands Non Met

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F

Appendix F: Glossary of terms

11.Eastern Outer Met 12.Eastern Other 13.London Inner 14.London Outer 15.South East Outer Met 16.South East Other 17.South West 18.Wales 1 - Glamorgan, Gwent 19.Wales 2 - Clwydd, Gwenneyd, Dyfed, Powys 20.Scotland 1 - Highlands, Grampian, Tayside 21.Scotland 2 - Fife, Central, Lothian 22.Scotland 3 - Glasgow Met 23.Scotland 3 - Strathclyde Exc Glasgow 24.Scotland 4 - Borders, Dumfries, Galloway These 24 codes were collapsed into seven categories and in the tables the two areas of Scotland were grouped together: 1. 2. 3. 4. 5. 6. 7.

Inner London Outer London Metropolitan England Non-metropolitan England Wales Glasgow Met Other Scotland

Social class Based on the Registrar General’s Standard Occupational Classification, Volume 3 OPCS London: HMSO 1991, social class was ascribed on the basis of occupation and industry:

230

Descriptive definition

Social class

Professional Managerial and Technical Skilled occupations non-manual Skilled occupations manual Partly-skilled Unskilled occupations Armed Forces

I II III non-manual III manual IV V

Mental health of children and adolescents in Great Britain

Social class was not determined where informant (and spouse) had never worked, or was a full-time student or whose occupation was inadequately described.

Tenure Tenure was assessed by asking two standard questions: how the accommodation was occupied and who was the landlord. How accommodation was occupied • Own outright • Buying it with the help of a mortgage or loan • Pay part rent and part mortgage (shared ownership) • Rent it • Live here rent free (including rent free in relative’s or friend’s property) • Squatting Type of landlord • Local authority or Council or New Town development or Scottish Homes • A housing association or co-operative or charitable trust • Employer (Organisation) of a household member • Another organisation • Relative or friend (before living there) of a household member • Employer (individual( of a household member • Another individual private landlord Three types of tenure categories were created: Owners means bought without mortgage or loan or with a mortgage or loan which has been paid off. Includes co-ownership and shared ownership schemes. Social sector tenants means rented from local authorities, New Town corporations or commissions or Scottish Homes, and housing associations which include co-operatives and property owned by charitable trusts. Private renters includes rent from organisations (property company, employer or other organisation) and from individuals (relative, friend, employer or other individual.

Appendix F: Glossary of terms

Type of accommodation Four types of accommodation were created: Detached means a detached house or bungalow Semi-detached includes a semi-detached whole house or bungalow Terraced means a terraced or end of terraced whole house or bungalow Flat/maisonette includes a purpose built flat or maisonette in block, converted flat or maisonette in house, a room in a house or block, a bedsit.

Working status Working adults The two categories of working adults include persons who did any work for pay or profit in the week ending the last Sunday prior to interview, even if it was for as little as one hour, including Saturday jobs and casual work (e.g. babysitting, running a mail order club). Self-employed persons were considered to be working if they worked in their own business, professional practice, or farm for the purpose of making a profit, or even if the enterprise was failing to make a profit or just being set up. The unpaid ‘family worker’ (e.g., a wife doing her husband’s accounts or helping with the farm or business) was included as working if the work contributed directly to a business, farm or family practice owned or operated by a related member of the same household. (Although the individual concerned may have received no pay or profit, her contribution to the business profit counted as paid work). This only applied when the business was owned or operated by a member of the same household. Anyone on a Government scheme which was employer based was also ‘working last week’

F

waiting to take up a job that had already been obtained, those who were looking for work, and people who intended to look for work but prevented by temporary ill-health, sickness or injury. Economically inactive adults This category comprised five main categories of people: “Going to school or college” only applied to people who were under 50 years of age. The category included people following full time educational courses at school or at further education establishments (colleges, university etc). It included all school children (16 years and over). During vacations, students were still coded as “going to school or college”. If their return to college depends on passing a set of exams, you should code on the assumption that they will be passed. If however, they were having a break from full time education, i.e. they were taking a year out, they were not counted as being in full time education. “Permanently unable to work” only applied to those under state retirement age, i.e. to men aged 16 to 64 and to women aged 16 to 59. Include were people whose inability to work was due to health or emotional problems or disablement. “Retired” only applied to those who retired from their full-time occupation at approximately the retirement age for that occupation, and were not seeking further employment of any kind. “Looking after the home or family” covered anyone who was mainly involved in domestic duties, provided this person had not already been coded in an earlier category. “Doing something else” included anyone for whom the earlier categories were inappropriate.

Informants definitions dictated whether they felt they were working full time or part time Unemployed adults This category included those who were

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The mental health of children and adolescents in Great Britain

The mental health of children and adolescents in Great Britain The report of a survey carried out in 1999 by Social Survey Division of the Office for ...

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