One in twelve (8.1%) 5 to 19-year olds had an emotional disorder, with rates higher in girls (10.0%) than boys (6.2%). Anxiety disorders were more common than depressive disorders (2.1%).

Evaluating emotional difficulties and their impact to form a hypothesis

Despite the higher rate of girls than boys with an emotional disorder in the sample (2017), I am going to tell you about a boy named Theon. Theon was originally referred by his mother for difficulties with anxious feelings. Theon was aged 9 years and in Year 4 when we first met. The initial information focused on difficulties with anxiety about going to school. From information gathered from Theon’s mum, the anxiety had become overwhelming. It had started gradually with difficult feelings about going to school, but initially he continued to attend school. This then escalated so that Theon was having difficulty attending school and, on some occasions, he did not attend school at all. Mum reported that Theon had not always had these difficulties. My initial hypothesis focused on the fact that there must be something that had arisen or become worse for Theon over time. I felt that it would be important to find out what this was so that we could target this in particular. The context for the referral involved Theon moving from Year 3 to Year 4 and continued into Year 5.

Initially I met with Theon and we worked through consultation to find out what Theon considered to be his strengths and areas of difficulty or those that caused him worry. Theon was able to talk about difficulties going to school, particularly on Mondays. We considered the significance of Mondays and what Theon achieved when he did not go to school. We also talked about what he missed when he did not go to school. The theme that arose was difficulties with spellings. Theon talked about finding spelling difficult over a long period of time and the difference between this difficulty and all the other things that he can do very well. It was evident that there was a big mismatch for Theon between all of his skills and his difficulty with spelling. Theon was able to rate his strengths and difficulties on a simple scale of 1 to 10, where 1 is ‘bad’ and 10 is ‘good’. Theon was also able to say what he would like to get better at over the next six months: To be able to improve in my spelling.

Assessment planning and implementation

In order to consider the nature of the difficulties, I planned to complete a standardised assessment. I wanted to be able to compare Theon’s difficulty with that of a peer group in order to see if there was a difficulty present. This felt important as sometimes children’s perceptions can be different to reality. I thought I needed to check this before deciding on a way of helping Theon to deal with the anxiety. I used the Wechsler Individual Achievement Tests – 3rd UK Edition (WIAT-III UK) to measure Theon’s current achievement on spelling, reading and writing. Obviously, the standardised nature of this assessment provides comparison to a sample of peers. However, it also gives a snapshot of achievement which provides a guide to work with when considering the nature of Theon’s difficulties. It is also important to combine outcomes from testing with information from consultation and observation. Information was used from teacher and parent observations, as well as consultation. The Wechsler Intelligence Scale for Children – Fifth UK Edition (WISC-V UK) was also used to provide some assessment of cognitive processes affecting reading and spelling, e.g. visual working memory (picture span), visual discrimination (Symbol Search) and Coding (Visual tracking).

Following the standardised assessment, observations and consultation, it was possible to see that despite appropriate intervention at the word level over a long period of time, Theon’s difficulties remained persistent. The outcomes of the assessment were discussed and drafted in a report with recommendations for use at home and school. However, although Theon was more aware of the fact that there was a reason why he found spelling difficult and this was in contrast to his high achievement in other areas (E.g. maths problem solving), he continued to experience serious anxious feelings about his difficulty.

Therefore, in order to support Theon with managing his anxiety, we arranged some individual sessions which involved application of cognitive behaviour therapy and personal construct Psychology (PCP). Theon attended initial sessions every two weeks for a period of twelve weeks. Following this, Theon came once during every school holiday until he reached Yr 6 and no longer needed to come. During the sessions, we considered the systems around Theon, E.g. Home and School, the significance of spelling tests on Mondays during Year 4, the original experiences that led to the escalation of the anxiety, the thoughts, feelings and actions involved in some of the scenarios that caused the anxious feelings and ways in which Theon could modify or shift these responses.

Management

Over the course of the two years, Theon was able to speak about what had caused the anxiety, the reasoning behind it and the irrational nature of the anxiety once it started to overwhelm him. Theon was able to break incidents down into thoughts, feelings and behaviour and to consider ways in which he could regain control of the free-flowing anxiety. Looking back over particular examples enabled Theon to see how the anxiety linked to spelling had become bigger than this and affected his perceptions of school altogether. The outcome of the work was that Theon started to attend school again and, although he is aware that he finds spelling difficult, he had an understanding of why it is more difficult for him than other subjects. There are things Theon can do about it and he felt less worried. On last involvement, Theon was looking forward to starting Year 7 at his new secondary school.

Case study by Melanie Adkins, Educational Psychologist