Looking back on my own childhood growing up in Belfast in the 1970's and 80's during what became known as the 'Troubles' adversity was the norm - community violence, poverty and institutional sexual abuse were common. There were children in my school with behavioural problems, those who were anxious or bullied, and others who were socially isolated. At that time, these difficulties weren't seen as mental health problems. Rather, the child was the problem: they were breaking rules, they weren't learning, they were disrupting others.
Thankfully we have made much progress since then. As a clinician and developmental neuroscience researcher at UCL and the Anna Freud Centre I have been privileged to be at the cutting edge of much new research and practice innovation. We have made a great deal of progress in the last thirty years. Many of the problems that children experience are now recognizable in our collective vocabulary: autism, attention-deficit hyper-activity disorder (or ADHD) and conduct disorder to name but a few. We have community mental health teams. There have been major advances in brain imaging research. Surely our children are now much better off? If I am honest...I am not so sure. I do worry about how much practical progress we have really made in promoting the mental health of our children.
I became interested in this area of research because I wanted to know more about why - and how - mental health problems emerge in the first place. Ten years ago I set up the Developmental Risk and Resilience Unit with Essi Viding at UCL and we decided that these questions would form the basis of my new research programme.
So what have we learnt? Last year Essi and I proposed a new theory, which argues that early adversity embeds latent vulnerability for future mental health problems. Children adapt to early chaotic, unpredictable or violent home or community settings in ways that help them survive and cope. However, the biological and psychological changes associated with these adaptations come at a high price: they can carry a lifelong increased risk of mental health problems. Children adapt to 'fit' atypical and disturbed environments in ways that are not helpful when they go out into the world to make friends, learn and develop as adults.
The most striking thing about our neuroscience findings has been that even 'healthy' children exposed to adversity, with no diagnosed mental health problems, show significant changes in brain structure and function. Half of all adult mental health problems begin by age 14. Do we really think these disorders emerge out of the blue? Our neuroscience findings strongly suggest not - rather, they suggest that there are likely to be signs of vulnerability and opportunities for prevention that we are simply missing.
This brings me back to the issue of mental health in primary school-age children. And by mental health I don't mean the rather medicalized construct of psychiatric disorder. Rather, mental health in the sense of children being lively, curious, and playful, of feeling valued and loved. That is what mental health really means.
When children are anxious, acting out, impulsive, or struggling to concentrate we must see this as a communication of need. These children need our help. They need adults, at home, in their school and in their community to be interested, to listen, to provide predictability and safety and care. If they have experienced adversity - family breakdown, the death of a parent, domestic violence - their ability to emerge resilient following these experiences depends on the presence of trusted adults who can scaffold their ability to regulate stress and make sense of their experiences.
Without a trusted source of help, a child can be overwhelmed and maladaptive coping strategies can become established. It is so important to try to see that the problem is not 'the child'. The problem - and the solution - is with the adults. Parents, families, teachers and schools need support, advice and occasionally specialist help - so that they can ensure that the children in their care are listened to, understood and loved in the way they deserve.
I think back to my own childhood growing up in Belfast. I had a stable home with loving parents and several teachers who went well beyond their role to take an interest and support me. Without them I doubt the view from my desk would be the sunny London skyline I see now: I would not have emerged unscathed, nor achieved my potential. Surely all children deserve a chance to enter adulthood with ambition, hope and a genuine opportunity to flourish. To achieve that we need to ensure that we prioritize - and fund - the mental health and well-being of our youngest citizens. Society will be richer, in every sense, if we do.
Young Minds Matter is a new series designed to lead the conversation with children about mental and emotional health, so youngsters feel loved, valued and understood. Launched with Her Royal Highness, The Duchess of Cambridge, as guest editor, we will discuss problems, causes and most importantly solutions to the stigma surrounding the UK's mental health crisis among children. To blog on the site as part of Young Minds Matter email firstname.lastname@example.org