Childhood epidemiology. Behavioural and intellectual development

Mental health services in schools: the challenge of locating a psychotherapy service for troubled adolescent pupils in mainstream and special schools

In Part 1, the case is presented for school-based mental health services in terms of the low utilization of community-based clinics and the high dropout rate among young adolescents attending clinics in the community. The advantages and potential pitfalls of school-based services are also assessed. In Part 2, the paper discusses the lessons learned from delivering psychotherapy services in mainstream and special schools to tackle the mental health problems presented by troubled pupils. The author describes the schools and discusses the expectations among teachers of the psychotherapist and psychologist. The role of the psychotherapist and psychologist in the schools is outlined. The types of treatment approach, the setting for treatment, method of referral, parental consent, and links with the wider network of adolescent mental health services and evaluation of outcome are considered. Finally, the author discusses the tensions that can arise between the psychotherapist and psychologist and school staff and ways of overcoming them.

Health inequalities in the early years: is there equalisation in youth?

In the light of a still prevalent view that health inequalities are an invariant feature of the life-course, this paper re-examines the thesis that youth, in contrast to childhood, is characterised by relative equality in health, and proposes a process of equalisation to account for changes in the social class patterning of certain dimensions of health between these life stages. The evidence relating to the relationship between class of background and health over the early years is first reviewed, focusing on seven dimensions of health: mortality, chronic illness, specific conditions, self-rated health, symptoms of acute illness, accidents and injuries, and mental health. The overall picture is consistent with a conclusion of relative equality of health in youth with one major exception, severe chronic illness, which particularly on the evidence of the 1991 British Census is class differentiated from infancy. In respect of other dimensions of health, notably symptoms, non-fatal accidents and (probably) mental health, there is evidence of a change in class patterning between childhood and youth consistent with a hypothesis of equalisation. Within a theoretical perspective that juxtaposes class and age (youth) based influences, it is suggested that this could occur when effects associated with the secondary (high) school, the peer group and youth culture cut across those of the family, home background and neighbourhood in such a way as to reduce or remove class differences in health. In later youth, in the post-school period, the relative balance of class and age based shifts once more to produce a "re-emergence" of class gradients in adulthood. Youth may be a barometer of the relative power of post-modern consumer culture and traditional class based structures to shape the pattern of health inequalities over the early years into adulthood.

Measurement of social inequalities in health and use of health services among children in Northumberland

Social inequalities in a variety of indicators of child health were measured using a 'small area' geographical method of social classification. Cross sectional analyses of routine child health information and of a population survey of the height of primary school children were used. Social classification was by census enumeration district of residence using the Townsend deprivation score. Over 21,000 children resident in Northumberland born between January 1985 and September 1990, and 9930 children aged 5-8.6 years in Northumberland schools were studied. The following differences between the most deprived 10% of areas and the most affluent 10% of areas were used as outcome measures: the proportion of birth weights less than 2800 g; the proportion of births to teenage mothers; the proportion of 15 month old children not immunised against pertussis; the proportion of infants not screened at 6 weeks of age; the proportion of children not screened at 18 months of age; and the mean height of children in SD scores. Between the most deprived and most affluent areas birth weights less than 2800 g varied from 18 to 11%, the percentage of teenage mothers from 18 to 3%, non-immunised children from 30 to 19%, children not screened at 18 months from 21 to 14%, and mean height from -0.2 SD scores to +0.1 SD scores. The area variation in screening at 6 weeks of age was less, but still poorer in deprived areas. It is concluded that small area methods are effective in showing inequalities in child health, even in a rural area where such methods might be expected to perform less well. Social inequalities in all the aspects of child health measured remain evident.

Antenatal and perinatal causes of handicap: definitions and size of the problem

The conditions of childhood that follow prenatal or perinatal problems are defined. These conditions are mental retardation in varying degree, the cerebral palsies, the syndrome of minimal cerebral dysfunction, language disorders and defects of hearing and vision. The difficulties in accurately measuring disability and handicap are discussed and an estimate of the size of the problem is offered. The contribution made by the low birthweight group is also considered and it is pointed out that, although within this group there is a much higher incidence of problems, the majority of children with handicapping conditions were of normal birthweight.

Psychological adjustment and diabetic control

Glycosylated haemoglobin concentrations, C peptide secretion, insulin dose, psychiatric state, intellectual functioning, and the extent to which the implementation of the diabetic regimen was shared between parent and child were studied in a cross sectional study of 50 children with diabetes aged 6-16. Indications of psychological disturbance in the children and their parents predicted low glycosylated haemoglobin concentrations in the children, and accounted for 44% of variance in blood glucose control. The child's early and independent participation in the implementation of the diabetic regimen was associated with poor control.