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Mental Capital and Wellbeing: Making the most of ourselves in the 21st century
State-of-Science Review: SR-D9 Social Cognition and School Exclusion
Professor David Skuse Institute of Child Health University College London
This review has been commissioned as part of the UK Government’s Foresight Project, Mental Capital and Wellbeing. The views expressed do not represent the policy of any Government or organisation.
Summary Exclusions from school for disruptive behaviour are of considerable concern to parents, to educators, and to society in general. For many children who are permanently excluded, persistent antisocial behaviour ensues, leading eventually to criminality. For some years, it has been suspected that when such behaviour begins in middle-childhood, the prognosis is worse, and that there are underlying neurodevelopmental deficits affecting social adjustment. In this review, we consider the evidence that a considerable proportion (up to one-third) of children excluded from primary school have autistic-like behaviours of mild to moderate severity, in the context of normal intelligence. Exclusion is associated with deficits in social-cognitive competence of an autistic character in an even higher proportion (up to 70%). The appropriate management of excluded children must take regard of these hitherto unrecognised, and hence untreated, conditions. Recommendations are made for better identification of, and interventions with, affected children.
1. Background The number of exclusions from school is a cause of increasing concern to parents, teachers and the general public. In 2005/6 (Department for Children, Schools and Families, 2007) there were 343,840 fixedperiod exclusions (data available from secondary schools only). In the previous year 2004/5 there were 43,720 fixed-period exclusions from primary school (i.e. over 1% of the primary school population). In 2005/6 there was a total of 9,170 permanent exclusions, 11% of which were from primary schools. The most common reason for exclusion was persistently disruptive behaviour (30% of permanent exclusions and 21% of fixed-period exclusions). A quarter (25%) of fixed-period exclusions involved verbal abuse, threatening behaviour or assault on an adult, and a further 18% involved assault on a fellow pupil. Exclusion is not an uncommon problem: in 2004/5, 5.12% of the total school population had one or more fixedperiod exclusions. More than one per thousand (0.12%) of all school children were permanently excluded and such children eventually obtain on average only 10% as much education as their peers (Parsons, 1996). Boys are four times more likely to be permanently excluded than girls. Children in special schools are at particularly high risk: 18.9% were subject to fixed-period exclusions in 2004/5 and, overall, children with Special Educational Needs (SEN) are more than eight times more likely to be excluded than children without SEN, whether or not they have statements of special educational needs (Department for Children, Schools and Families, 2007). Targets to reduce school exclusions were introduced after the rapid rise in exclusions following the implementation of the national curriculum, league table pressures and local management of schools. These targets were criticised by schools because they distorted the enforcement of school behaviour policies. They were seen as penalising schools for excluding students, and hit hardest at those schools with the most challenging students, therefore with the highest levels of exclusions (National Literacy Trust, 2007). The relationship between early learning difficulties, exclusion from school, and crime, has been described as a ‘downward spiral’, in which children who lack basic literacy and numeracy skills develop low self-esteem and become disillusioned with education, eventually leaving school early (Basic Skills Agency, 1997). Being excluded from school is associated with a significantly higher likelihood of becoming a teenage parent, being unemployed, becoming homeless later in life, or serving a sentence in prison (Social Exclusion Unit, 1998). Exclusion amongst primary school children is of particular concern. Such children are showing a pattern of socially-unacceptable conduct that is unduly likely go on to become ‘life course persistent antisocial behaviour’. Such early-onset behaviours are often associated with minor, hitherto unspecified, neurodevelopmental anomalies (Moffitt et al., 2001).
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Research published in the Social Exclusion Report (1998) suggests that teachers are often uncertain of the distinction between poor behaviour and behaviour that reflects underlying psychological difficulties requiring specialist management. With current government and media attention directed at reducing the rate of school exclusion, there is increasing impetus to understand the factors underlying disruptive and aggressive behaviour. It should be possible to introduce more efficient and appropriate supports and interventions, if the aetiology of the behaviour that led to exclusion is understood (Ripley and Yuill, 2005).
1.1. Autistic spectrum disorders and school exclusion On the basis of a survey of approximately 1,000 parents, the National Autistic Society reported that one in five children with autism has been excluded from school, 20 times the national average (Barnard et al., 2000). This figure included both temporary and permanent exclusions. High-functioning (normal-range intelligence) children with ASD (Autistic Spectrum Disorders) were reported to be at particular risk of school exclusion compared to their cognitively less-able counterparts (National Autistic Society, 2001), perhaps because their problems were not recognised as being indicative of a neurodevelopmental disorder, which is conventionally thought to be characterised by mental retardation and global learning difficulties. A recent set of interviews with children attending the Social Communication Disorders Clinic at Great Ormond Street Hospital illustrates the problems faced by them at school (Chilvers, 2008). All had average or high intellectual abilities and many had been suspended or excluded on several occasions. Transcriptions are verbatim. Louise, 12 years, describing her difficulties with one aspect of social cognition – the ability to read other people’s social cues: “…being an aspie [someone with Asperger syndrome] at school is like being on the reflective side of a two-way mirror. It feels this way because, in a sense, the other kids can see you, but you can’t see them. Another metaphor for this feeling would be to say that you are on Big Brother, but are the only housemate”. She goes on to say ”..it all stems from an aspie’s inability to pick up social cues and convention, and therefore it can feel like the other kids are mind-readers in comparison to you, and believe me, they take advantage the best they can”. Parent of a 12-year-old autistic boy, describing why they removed their child from school voluntarily: “I couldn’t stand it seeing him so distressed. It was a last resort, but I had to take him out of school and educate him at home... it’s exhausting.” Brendan, 15 years, describing how he was bullied and the temptation to respond aggressively – a course of action that often leads to exclusion: “I was bullied quite a bit at school, and thought the teachers were very slow, ignorant, lazy, uncaring, pitiful, incompetent etc. Boy, I can go on for ages describing how badly they did in sorting out bullies. I only held back in having a fight because of my dad’s career success and because of a certain girl I admired for a long period of time”.
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1.2. Definitional issues The term ‘Autism Spectrum Disorders’ (ASD) is used here to describe children who have severe and persistent impairment in all, or some of the following domains: reciprocal social interaction skills; communication skills; patterns of stereotyped behaviour and restricted interests (ICD-10 criteria: World Health Organization, 1996). Typically, the consequence of such impairments is to experience difficulties with social relationships, especially with peers, and to fail to understand subtle aspects of verbal and non-verbal communication such as gestures or facial expressions. Many difficulties experienced by individuals with ASD reflect deficits in so-called ‘Theory of Mind’, the ability to attribute mental states that are independent of one’s own thoughts to others, in order to predict and explain their behaviour (Baron-Cohen et al., 1985). Children with social communication deficits that are associated with ASD usually fail to appreciate social hierarchies: they tend to treat adults in positions of seniority in the same way as their peers. This can lead to their appearing rude to teachers, because they fail to understand why their interaction style is regarded as inappropriate (Gilmour et al., 2004). They do not appreciate subtleties of language, such as emotional tone, metaphor and sarcasm, and so become bewildered when they are disciplined for following instructions literally. Many, perhaps most, children with ASD have average or above average IQ (Skuse, 2007). Autistic traits are also overrepresented in children with very low IQ (
