SCHOOL SUCCES AND PSYCHIATRIC DISORDERS IN CHILD AND ADOLESCENT

ABSTRACT:

School evaluation by social dimensions is a recent and important theme in all the countries of the world. J. Gray (2004) considers that children’s progress evaluation needs to rely on cultural and social factors. Social problems that influence children’s school involvement are more and more complex and difficult to manage. Parents complain about peer groups that have bad infl uence on their children. Teachers complain about low interest of parents in school performance of children. Parents also complain about teachers’ low involvement in teaching. Drugs and alcohol use, as well as domestic violence place more and more children and adolescents at risk, especially for their educational advancement. In Romania, a comprehensive research on these issues is a new topic and in some situation the educational system need efficient and rapid intervention.

METHOD AND MATERIAL

The purpose of this study is to identify the groups who present high risk of vulnerability regarding the social dimensions, psychopathology and behavioral problems (alcohol and drugs abuse, skipping school, violence). The study assesses the adolescents with psychiatric diagnosis (a possible risk factor) by applying the SSP-Ro (School Success Profile –the adapted Romanian version).SSP is based on a systemic perspective. According to it, school success is ensured by the experience of various protective factors,at different systemic levels (family, community, peer groups, teaching staff, culture and values promoted in schools). Conversely,risk factors are also situated at various social levels.

We assessed 50 adolescents (32 girls-64% and 18 boys-36%), with ages between 11 (5th grade) and 17 (11th grade) who attendschool and are registered with psychiatric diagnosis in Pediatric Psychiatry Clinic from Cluj Napoca. They were split in three diagnosis categories: psychosis, neurosis and conduct disorders. Th ey filled the SSP questionnaire. Data were introduced in a database and analyzed with SPSS16 statistical program. Their scores were then compared with those of the national group (N=2465). For the study we used only the completed questionnaires.

RESULTS

We identify significant correlations between school performance and the parameters evaluated by the applied questionnaire (role of support received from parents, classmates and teachers; violence in families, schools, and community, drug and alcohol abuse, interethnic confl icts, impact of parental migration to work abroad, discrepancies rural / urban and rrom children vulnerability).Using Pearson correlation we find a strong correlation between school involvement and level of optimism (p=0,00519), avoiding school problems and academic level (p=0,00515), self esteem and health state (p=0,00450) and also between state of health and adjusting (p=0,00442).

CONCLUSIONS

School involvement, capacity of school problem avoidance and also the academic level (reported) are lower for the pupils with psychiatric diagnosis. SSP-RO as a diagnosis instrument for school success can contribute to increase knowledge of social factors that affect children performance and can be use as a school risk evaluation procedure, as an instrument for reducing negative factors that influence school performance (role of support received from parents, classmates and teachers; violence in families,schools, and community; other risk factors in the family; problems with alcohol and drugs; and interethnic conflicts), and as a procedure for school progress evaluation.

INTRODUCTION

Mental health has been for a long time an area ofless priority in our country. Unfortunately, the interestin mental health increased along with the prevalenceof mental illness to approximately 20% of the populationworldwide, and approximately 25% in Europeanpopulation. Th e latest statistics showed that a similarpercentage is recorded in Romania. Economic and social effects of information explosion, labor market competition and many other reasons producedMental health has been for a long time an area of visible damage to the state of health for most populess priority in our country. Unfortunately, the interest lation, in latest years. Mortality risk through suicide in mental health increased along with the prevalence as a consequence of depression, increased aggression,of mental illness to approximately 20% of the popula-and lack of social adjustment manifested in both child tion worldwide, and approximately 25% in European and adult, it is becoming a more clear alarm signal population. The latest statistics showed that a similar through the effects of psychiatric disorders in society.percentage is recorded in Romania. Economic and WHO (World Health Organisation) considers that the growth rate of mental disorders in countries in transition is far above the average of the continent.To these estimates must be added the mental health problems of the infant population, especially of teenagers.

World Health Organization Annual Report (2001) show that mental disorders are a major source of disability, 5 of top 10 positions in the hierarchy of diseases according to their capacity to generate disabilities belong to the psychiatric disorders. The prevalence of these diseases during the lifespan is approximately 33% which means that one in three people will have,at some point, a mental disorder diagnosed according to the internationally accepted criteria. Even if we do not have recent epidemiological studies in Romania (because they are very expensive), there is no reason to believe that we stand below this level. Moreover, there is sufficient evidence to suggest signifi cantly higher values in the last decade (compared to EU average),such as the general deterioration in the health state of the population, abuse and psychoactive substance dependency expansion, suicide rate increasing, super-saturation with the society stressors (economic decline, unemployment growing, lower living standards),aggressive and violent behavior expansion, etc.Th e importance of the problem is underlined by the fact that, unlike most somatic diseases, a mental illness present at a particular person is a source of impaired balance for the social micro group (family, professional) in which that person lives. In assessing the economic costs due to the mental disorder, it is estimated that the ratio between the global costs and direct costs (medical related) is approximately 9 / 1, which means that the social intervention should be mainly prophylactic. Primary prevention must be subject for educational, medical, social programs, etc. Ministry of Health consider as fundamental the placement ina priority position within the prevention module, of the programs and actions aiming the mental health of children and adolescents. In this context, some of the immediate objectives are: to introduce mental health programs for school children, to ensure harmonization of the educational program requirements with the students cognitive-emotional potential (fewer homeworks,without the actual exaggeration); to aime the school integration improvement, the reducing of the risk for conduct disorder, the early school abandon;increasing the share of health education in schools regarding the development of a healthy lifestyle and social skills training (fighting drug addiction, alcoholism, suicide, violence), provide sexual education; diversification of medical and educational intervention in and outside schools, to meet the special needs of certain categories of children and young people with high vulnerability (various forms of disability, social disadvantage, with increased risk of delinquency and social poor adjustement).

School difficulties, behavioral problems in school and inconstant attendance at classes can be a sign of mental health problems in children.To emphasize the importance / role of the measuring instruments who assess the factors that predict or influence the school success / failure, in 2006, Natasha Bowen conducted a research, that presented the psychometric properties of the ESSP (Elementary School Success Profi le), a research instrument that can be apply to the primary school children, unlike the SSP (School Success Profile) that applies to the middle school and high school children. Assuming that problems reside primarily in individual, she wanted to show that practitioners need tools to evaluate certain aspects of the social environment that influence the functioning of the individual.In this sense, she applied the ESSP to a number of 3rd, 4th and 5th grade children. Previously the children were interviewed to ensure understanding of the used terms. Most items in the original questionnaire was modified, considering the basic knowledge of child development, the feedback from children, as well as from experts in child development, especially after the cognitive testing of items with children. ESSP is a variant of SSP for students of lower age, commissioned by the practitioners who applied the SSP. SSP has strong psychometric qualities (Bowen, Rose and Bowen, 2005) and appears to be a intervention guide for promoting the academic success.

The study conducted by James K. Nash in 2002,aimed the ecological perspective on planned intervention, in order to promote academic success in adolescents at risk for school failure. He started from the perspective of ecological development, which emphasizes the importance of understanding the infl uence of the characteristic factors of the micro systems in which the teenagers function, on their behavior and development, the intervention purpose being to promote the optimal behavior, by improving person-environment relationships. The attention to factors outside the school environment can be very important for students at risk of school failure. This study investigates the influence of neighborhood on highschool and gymnasium adolescent educational behavior, with risk of school failure. Focus is on informal social control of neighborhood and the potential positive influence on the educational behavior. In addition,the study examines two neighborhood risk factors for school success: criminality and negative peer culture. The assumptions that this study took into account are: the neighborhood informal social control positively influence the school coherence; neighborhood criminality negatively influence the school coherence;neighborhood negative culture negatively infl uence the school coherence; school coherence is positively influenced by the educational behavior. 4772 adolescents at risk for school failure were included in the study, to which the SSP was applied (School Success Profile), SSP being a tool that focuses on the student perceptions of individual and contextual micro system, representing a phenomenological approach.This emphasizes the importance of the adolescent vision on his world. The conclusion of this research lies in the idea that a comprehensive approach, with dual focusing on individual and community, go in the same direction with the ecological approach that emphasizes the interaction between the individual and contextual factors and it is important for the school,mental health and child protection practitioners.

METHOD AND MATERIAL

Within the “Babes-Bolyai” University project “Social diagnosis of school performance by School Success Social Scale and design intervention methods validated by research”, coordinated by Prof. Dr.Maria Roth, which aims also to identify the high vulnerability groups in terms of social dimensions,psychopathology, respectively the founded behavioral disorders (alcohol and drugs abuse, truancy, violent behavior), we conducted a study that evaluate the answers of the adolescents with psychiatric disorders (possible risk factor) by applying the SSP-Ro (School Success Profile –the adapted Romanian version).

This study included a group of 50 children (32 girls-64% and 18 boys-36%), aged between 11 (5th grade) and 17 years (11th grade) who attend school and are registered in Child and Adolescent Psychiatry Clinic from Cluj-Napoca, with psychiatric diagnoses.They were split in three diagnosis categories: psychosis, neurosis and conduct disorders. Th ey fi lled the SSP questionnaire. Their scores were then compared with those of the national group (N=2465).

SSP is based on a systemic perspective. According to it, school success is ensured by the existence of numerous protective factors at different systemic levels (family, neighborhood, friends, teachers, school culture and values, etc., and the relations between these systems) and threatened by a number of risk factors (Fraser, 2000, Woolley, Michael E., Grogan, Kayla,Andrew, 2006).

For the study we used only the completed questionnaires.

For data analysis was used SPSS 16.0 statistical program, assessing the frequency of the psychiatric disorders for the children and adolescents included in the study, the frequency of responses to questions concerning certain aspects of school success and psychiatric disorders in the described categories.To get a clearer picture on the social factors that can infl uence school success in children with psychiatric diagnosis,we used the t test for independent samples.

RESULTS AND DISCUSSION

The national group demographics are described in table 1.

Table 1. Demographic data of the national sample (N=2465)

The frequency of the psychiatric disorder type for the questioned children appears in the frequency table below (table 2).
We chose several variables to observe the school performance, as an important element in evaluating school success (“How many grades under 5 have had in the last semester ?” – Table 3), school truancy (“I ditched at least one hour” – table 4); indiscipline (“I was undisciplined” –table 5) and regarding the health of the child (“You could not sleep, though it was nothing to bother you” – table 6, “You had energy for nothing “ –table 7).

Table 2. Frequency of psychiatric disorders type for the questioned children

Table 3. How many grades under 5 you had last semester?

Table 4. I ditched at least one hour

Table 5. I was undisciplined

Table 6. Could not sleep at night, although there was nothing to bother you.

Table 7. You did not have energy for anything

Taking into account several dimensions that interested us: school envolvement (includes items like: It’s fun to go to school.; I like learning new things at school.; I find it interesting to go to school.), avoiding problems at school (includes items like: I was undisciplined.; A teacher made comments about my absences or behavior in class., etc..) academic level (What grades you obtained at the studied disciplines in the previous school year ?; How many grades under 5 did you have in the last semester ?; Compared with your classmates, your grades are ?), state of health (You did not have energy for anything.; You had headaches.; you were nervous, agitated., etc.), self esteem (I feel good as I am.; I have many qualities.; etc.), adaptation (Often I think to run away from home.; I often feel lost or confused., etc..) and optimism (When I think of my future I feel very peaceful.; I know that I’ll succeed in the future.; I’m sure I’ll finish the high school., etc.) and using Pearson correlation, we can say that there is a strong correlation between school envolvement and optimism (p = 0.00519), between avoiding problems at school and academic level (p = 0.00515), an average correlation between self-esteem and state of health (p = 0.00450) and between health and adaptation(p = 0.00442) (see Table 8).

Table 8. Correlations

To get a clearer picture on the social factors that can influence school success in children with psychiatric diagnosis,we used the t test for independent samples. Significant differences were recorded in nearly all the analyzed factors, in each case the situation being in disadvantage for the children with psychiatric diagnosis,(table 9).

Table 9. Comparison between children with and without formal recorded psychiatric diagnosis on the social factors of academic success (N = 2465 national group and 50 with psychiatric diagnosis). Statistically signifi cant differences are shown at p <0.05.

The results are similar to those in the literature. Eggert, Thompson, Randall and Pike identifi ed in 2002, an increased the risk for depression, drug abuse, suicidal behavior in children who have left school.ADHD, oppositional-defiant disorder and conduct disorder affects more than 10% of the children, and this leads to school adjustment problems. Anxiety disorders, depression, substance abuse contribute to school avoidance and underestimation of school performance. Also, studies on young people with psychotic disorders showed that there were school difficulties in their childhood. Poor school functioning was argued by studies in schizophrenia or schizoaff ective disorders. Language disorders, learning disorders are also involved in lowering the academic success of the children. Literature provides evidence of clear connections, bidirectional between psychiatric disorders and school performance. Therefore, it is important to recognize early in the school these markers of psychosocial stress and poor social functioning in order to prevent the increase of mental health disorders.

CONCLUSIONS

The school engagement, ability to avoid problems at school and academic level (reported) are lower in the group of students with psychiatric diagnosis.

Whereas educational performance, school success / failure are parts of the school system, but are intertwined with the health and development of the individual, it is important to focus attention on reducing the behaviors at risk. Thus is necessary to understand the behavior of individuals, followed by the development of specifi c instruments.

SSP-RO as a diagnosis instrument for school success can contribute to increase knowledge of social factors that affect children school performance.

It is necessary to assess and improve through psychosocial interventions the acute social problems (reduction of students oppositional and aggressive behaviors in schools and communities, increase social skills and problem solving skills).

Through social diagnosis of the family, community, institutional and peer-group problems thatinfluence the academic performance, it can be stimulated the quality of education locally, regionallyand nationally by developing a methodology for social intervention, specific for school social support,whose resources are now insufficiently known andrecognized in Romania.

Note: The project is part of Program 4 – Partnerships in priority areas, launched by the National Management Programs Center, funded by contract No. 91-063 / 14.09.2007 of the Ministry of Education, Research and Youth in the National Research and Development Program (PNCDI II). The project is set up following a partnership between Babes-Bolyai University – project coodonator and West University Timisoara – Center for the Study of Parent-Child Relationship (CICOP), “Lucian Blaga” University Sibiu, Pitesti University, “Iuliu Hatieganu”University of Medicine and Pharmacy, Cluj-Napoca – Department of Child and Adolescent Psychiatry, Resource Center for Romm Communities (RCRC),Movement Civic Engagement” (CEMO).

BIBLIOGRAPHY:

1. Bowen, N.K., 2006. „Psychometric properties of the Elementary School Success Profile for Children”, Social Work Research., 30 (1), pp. 51-63.
2. Eggert, L.L., Thompson, E.A., Randall, B.P. şi Pike,K.C., 2002, „Preliminary effects of brief school-based prevention approaches for reducing youth suicide-risk behaviours,depression and drug involvment”, Journal of Adolescent Psychiatric Nursing, 15(2): pp. 48-65.
3. Nash, J. K., 2002, „Neighborhood effects on sense of school coherence and educational behavior in students at risk of school failure”, Children and Schools, 24(2), pp. 73-89.
4. Ordinul nr. 374 din 10 aprilie 2006 privind Strategia în domeniul sănătăţii mintale.
5. www.successcolar.ro.