Professional Educational, Child and Adolescent Psychology

202 Pages·2017·2.94 MB·English

UCL Institute of Education

Doctorate in Educational Psychology (Professional
Educational, Child and Adolescent Psychology) DEdPsy
(PECAP)

An exploration of anxiety problems in a secondary
school

Anna Frances Barrett

Word Count: 34,289
Student Declaration
I, Anna Frances Barrett confirm that the work presented in this thesis is my own.
Where information has been derived from other sources, I confirm that this has
been indicated in the thesis

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Abstract
This research explores the identification of anxiety problems within the context of
a girls’ secondary school in the South of England. A qualitative methodology was
adopted using semi-structured interviews and group interviews to explore the
perceptions of staff and pupils. These were transcribed and thematically
analysed following the six-stage model as advocated by Braun and Clarke.
Phase 1 involved exploring staff perceptions about how anxiety problems
present and are identified in pupils, as well as what the facilitators and barriers
are for this process. It was found that there was good understanding amongst
staff about the presentation of anxiety problems and a clear understanding of the
processes that followed when anxiety problems were identified. The main
facilitator for identifying problems was the multiple information gathering that
existed within the school and the main barrier was the fact that the school was
not actively looking for anxiety problems. Phase 2 of the research involved
carrying out semi-structured interviews with two groups of Year 11 pupils to
explore if their perceptions were congruent with Phase 1. The biggest barriers to
the pupils disclosing problems were the school’s policy to always inform parents
and the stigma they felt was associated with having a mental health problem.
They also expressed mixed views about the school’s efforts to provide mental
health education and promote resilience showing a suspicion that the underlying
agenda was still about educational outcomes.
The research supports the introduction of universal screening approaches within
schools to gather information over time which informs a comprehensive
wellbeing strategy with a graduated response to need. It also highlights the
importance of gathering the views of pupils around the practices and culture of
school life. Educational psychologists are well placed to support schools in these
endeavours

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Acknowledgements
I would like to express my utmost thanks and gratitude to the following people for
supporting me in this piece of research as well as during the rest of my Doctoral
training. I am very much indebted to you all.
• To Frances Lee and Amelia Roberts, who have not only guided me kindly
and respectfully through the research journey but have also been the
most inspiring role models. Thank you, Frances, for your dedication,
support and passion throughout the whole training experience. Thank
you, Amelia, for your brilliant ‘blue sky thinking’.
• To my awesome fellow TEPs for all the support and fun over the last three
years.
• To the dedicated school staff and pupils from my case school.
• To my lovely friends for support, hilarity and wisdom … special mention to
Babs, Gail and Anne.
• To my gorgeous children: Josh, Liv, Izzy and Alex for putting up with mum
being in the library a lot and for being my guinea pigs.
• To my lovely parents … Dad I know you would be proud.
• The biggest thanks must go to my Danny; I couldn’t have asked for a
more patient, kind and supportive husband … you can start playing golf
again now.

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Contents
Student Declaration ................................................................................................... 2
Abstract ...................................................................................................................... 3
Acknowledgements ................................................................................................... 4
Contents ..................................................................................................................... 5
List of Tables ........................................................................................................... 13
List of Figures .......................................................................................................... 14
List of Acronyms and Abbreviations ..................................................................... 16
1. Introduction ...................................................................................................... 17
1.1. Introduction ................................................................................................... 17
1.2. Personal and professional interest in this area of research .................... 17
1.3. The unique contribution of this study ........................................................ 18
2. Literature Review ............................................................................................. 20
2.1. Introduction ................................................................................................... 20
2.2. Background ................................................................................................... 21
2.2.1. The national agenda ............................................................................... 21
2.2.2. The local context ..................................................................................... 22
2.2.3. The Local Authority Educational Psychology Service (EPS) .................. 23
2.2.4. A brief discussion around nomenclature ................................................. 24
2.3. Anxiety ........................................................................................................... 25
2.3.1. What is anxiety? ...................................................................................... 25
2.3.2. Anxiety disorders .................................................................................... 25
2.3.3. Characteristics of anxiety problems ........................................................ 26
2.3.4. Prevalence of anxiety problems for CYPs .............................................. 26
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2.3.5. Gender differences in anxiety problems ................................................. 27
2.3.6. Anxiety problems and adolescents ......................................................... 28
2.3.7. Evidence-based interventions for anxiety problems ............................... 28
2.3.8. Assessment and identification of anxiety problems ................................ 29
2.4. Anxiety problems and secondary schools ................................................. 30
2.4.1. Detrimental impact of anxiety on CYPs in school and beyond ............... 31
2.4.2. Support for CYPs with anxiety problems in school ................................. 32
2.4.3. The role of the educational psychologist (EP) in supporting CYPs with
anxiety problems in schools .................................................................................... 32
2.5. The identification of anxiety in CYPs in schools ....................................... 33
2.5.1. Help-seeking behaviours in teenagers .................................................... 33
2.5.2. Mental health assessment used in schools ............................................ 35
2.6. Teachers’ identification of anxiety in CYPs ............................................... 35
2.6.1. Comparisons between teacher, parent and child reports of anxiety ....... 39
2.6.2. Summary of literature exploring staff’s identification of anxiety problems
41
2.7. Research questions ...................................................................................... 42
2.8. Theoretical background ............................................................................... 43
2.8.1. Identifying anxiety problems in schools; the importance of considering
context 43
2.8.2. Schools and systems theory ................................................................... 44
2.8.3. What is a system ..................................................................................... 44
2.8.4. Open and closed systems ....................................................................... 44
2.9. Bronfenbrenner’s Ecological/Bio-ecological Systems Theory ................ 45
2.9.1. Critique of Bronfenbrenner’s Bio-ecological System Theory .................. 47
2.10. Alternative theories considered .................................................................. 47
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3. Design and Methodology ................................................................................. 49
3.1. Epistemology and ontology ......................................................................... 49
3.2. Design ............................................................................................................ 50
3.2.1. Rationale for adopting a qualitative methodology ................................... 50
3.2.2. Critique of qualitative methodology ......................................................... 50
3.2.3. Rationale for selecting a case study design ............................................ 51
3.2.3.1. Critique of case studies .................................................................................. 52
3.2.3.2. Generalisability ............................................................................................... 52
3.3. Description of the case ................................................................................ 53
3.3.1. Two-phased sequential design ............................................................... 56
3.4. Phase 1: Group interviews and interviews with staff members ............... 57
3.4.1. Participants and sampling procedure ...................................................... 57
3.4.2. Methods used for data collection ............................................................ 61
3.4.2.1. The interview schedule .................................................................................. 61
3.4.2.2. Group interviews and individual interviews .................................................... 62
3.5. Phase 2: Pupil group interviews ................................................................. 63
3.5.1. Participants and sampling procedure ...................................................... 64
3.5.1.1. Interview schedule ......................................................................................... 64
3.5.1.2. Procedure for all group interviews and individual interviews .......................... 65
3.5.2. Research tools ........................................................................................ 66
3.6. Issues of reliability and trustworthiness .................................................... 66
3.7. Validity ........................................................................................................... 68
3.8. Data analysis ................................................................................................. 70
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3.8.1. Inductive vs deductive analysis ............................................................... 70
3.8.2. Semantic or latent level of analysis ......................................................... 71
3.9. Research diary .............................................................................................. 75
3.10. Reflexivity ...................................................................................................... 75
3.11. Researcher’s beliefs and values ................................................................. 76
3.12. Ethical Considerations ................................................................................. 77
3.12.1. Informed consent .................................................................................... 77
3.12.2. Rapport building ...................................................................................... 78
3.12.3. Risks to participants ................................................................................ 78
3.12.4. Pupil participants ..................................................................................... 78
3.12.5. Feedback to participants ......................................................................... 79
4. Results .............................................................................................................. 80
4.1. Introduction ................................................................................................... 80
4.2. Main themes .................................................................................................. 80
4.3. Theme 1: Signs and symptoms ................................................................... 81
4.3.1. Sub-theme 1: Girls mentally shut down .................................................. 81
4.3.2. Sub-theme 2: Somatic and physical factors ............................................ 82
4.3.3. Sub-theme 3: Behavioural signs ............................................................. 82
4.3.4. Sub-theme 4: Lack of coping strategies .................................................. 83
4.4. Theme 2: Perceived risk factors .................................................................. 83
4.4.1. Sub-theme 1: Influences from home ....................................................... 84
4.4.2. Sub-theme 2: School pressure ............................................................... 85
4.4.3. Sub-theme 3: Perfectionist vs could be anyone ...................................... 85
4.5. Theme 3: Perceptions of school culture and practices ............................ 86
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4.5.1. Sub-theme 1: Liaising with parents ......................................................... 87
4.5.2. Sub-theme 2: Communication processes ............................................... 87
4.5.3. Sub-theme 3: Change of focus: building resilience ................................. 88
4.5.4. Sub-theme 4: Adaptions vs rules ............................................................ 90
4.5.5. Sub-theme 5: Staff fears ......................................................................... 91
4.5.6. Sub-theme 6: Academic vs pastoral ....................................................... 91
4.5.7. Sub-theme 7: Support systems ............................................................... 93
4.6. Theme 4: Barriers to identifying anxiety problems ................................... 94
4.6.1. Sub-theme 1: Genuine anxiety? ............................................................. 94
4.6.2. Sub-theme 2: Not looking for it ............................................................... 95
4.6.3. Sub-theme 3: Stigma .............................................................................. 95
4.6.4. Sub-theme 4: Parents as hindrance ....................................................... 96
4.6.5. Sub-theme 5: Behaviour misinterpreted ................................................. 96
4.6.6. Sub-theme 6: Limited time and resources .............................................. 97
4.7. Theme 5: Facilitators for identifying anxiety problems in schools ......... 98
4.7.1. Sub-theme 1: Education around anxiety ................................................. 98
4.7.2. Sub-theme 2: Information gathering processes ...................................... 99
4.7.3. Sub-theme 3: Trigger points ................................................................. 100
4.8. Researcher reflections from staff interviews ........................................... 101
4.9. Pupil main themes ...................................................................................... 102
4.9.1. Theme 1: Pupils’ perceptions of school culture and practices .............. 103
4.9.2. Sub-theme 1: School support ............................................................... 103
4.9.3. Sub-theme 2: Parents always informed ................................................ 105
4.9.4. Sub-theme 3: Results-driven culture ..................................................... 105
4.9.5. Sub-theme 4: Resilience-building strategies ......................................... 106
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4.10. Theme 2: Factors influencing help-seeking at school ............................ 106
4.10.1. Sub-theme 1: Relationships with staff ................................................... 107
4.10.2. Sub-theme 2: Stigma ............................................................................ 108
4.10.3. Sub-theme 3: Therapeutic vs authoritative role .................................... 108
4.10.4. Sub-theme 4: Importance of confidentiality ........................................... 108
4.10.5. Sub-theme 5: Previous experiences ..................................................... 109
4.11. Theme 3: Causes of stress ........................................................................ 109
4.11.1. Sub-theme 1: Competing demands ...................................................... 110
4.11.2. Sub-theme 2: Social pressures ............................................................. 110
4.11.3. Sub-theme 3: School pressures ............................................................ 110
4.12. Non-anxiety group theme: Coping strategies .......................................... 111
4.12.1. Sub-theme 1: Planning and organisation .............................................. 111
4.12.2. Sub-theme 2: Support from friends and family ..................................... 111
4.12.3. Sub-theme 3: Agency ........................................................................... 112
4.12.4. Sub-theme 4: Balance of activities ........................................................ 112
4.13. Theme from anxiety group: Lack of coping strategies ........................... 113
4.13.1. Sub-theme 1: Lack of coping strategies ................................................ 113
4.13.2. Sub-theme 2: Negative thinking ............................................................ 113
4.14. Researcher reflections from pupil interviews .......................................... 114
4.15. Summary ..................................................................................................... 114
5. Discussion and Conclusions ........................................................................ 116
5.1. Introduction ................................................................................................. 116
5.2. Research question 1 ................................................................................... 116
5.2.1. How school staff perceive anxiety problems to present ........................ 116
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