Written by Richard Harvey, Clinical Programmes Lead. 
Both adult and paediatric populations are affected negatively by loneliness and social isolation in terms of their physical and mental health. Compared to their classmates who are typically developing, children with neurodevelopmental disorders (NDD) are more likely to be alienated and to feel lonely (Kwan et al., 2020).
According to Kwan’s scoping review, loneliness may have negative effects on a child with NDD’s mental health (depression and anxiety), learning, and development (both socio-emotional and behavioural). Additionally, these consequences could continue on into adulthood. According to Almeida et al (2021), social isolation is strongly linked to anxiety and depression in adolescents and children. Cortisol levels rise and cognitive development is negatively impacted by social isolation. Therefore, during prolonged periods of isolation, health practitioners need to closely monitor the mental and physical health of children and adolescents.
Based on reviews and studies, it can be said that humans are social animals that depend on recognising and developing relationships with others in order to survive (Bowles & Gintis, 2013; Tomasello & Vaish, 2013). In a survey conducted during the COVID-19 pandemic by the National UK Charity for Seriously ill Children, the following problems were identified:
- Over 90% of disabled children are socially isolated, with 49% of disabled children not seeing a friend in the last month either online or in person. This sadly isn’t limited to children, with three in five parents also socially isolated.
- This isolation has had a painful impact on the development of life skills in disabled children. Around half of parents highlighted a negative impact on skills, such as being out and about, communicating with others and interacting with strangers.
- As a result, both parents and children are continuing to experience poor emotional wellbeing. On average six out of ten parents are observing symptoms associated with anxiety. 72% of parents report that their child is often unhappy, downhearted or tearful. Their siblings are also affected with a high proportion of parents reporting that their other children are having negative issues regarding sleep and anxiety
Although national lockdowns and self isolation are no longer mandatory, disabled children are more likely to suffer from isolation and loneliness as a result of lack of interaction with peer group, stigma and prejudice. Therefore the findings on mental health from studies and survey’s undertaken throughout the COVID-19 pandemic remain valid and pertinent in relation to children with complex disabilities.
Occupational therapy promotes the right of everyone to engage in occupations that contribute positively to their own mental health and wellbeing. Occupation is essential to a person’s wellbeing and is an essential human right (Hammell, 2017). Loneliness and isolation have been identified as barriers for an individual to engage in their meaningful occupations which the studies above show the negative impact on children and adolescents mental health. Hammell & Iwama (2012) explore some of the key components associated with an individual’s mental health and wellbeing state. They state that wellbeing contentment requires harmony with a person’s:
- Physical/mental health
- Emotional/spiritual health
- Personal and economic security
- Self-worth
- Sense of belonging
- Opportunities for self-determination
- Opportunities to engage in meaningful and purposeful occupations
- Sense of hope
It is clear to see how a number of these themes could directly correlate with a child or adolescent with complex disabilities. The points above are vital to consider when taking a child centred approach and thinking of the child holistically. Acknowledging that the reason for seeing a child may not directly relate to their mental health, however it could be a contributing factor or may include many environmental factors which impact the points made above.
CanChild is an international scientific academic network conducting applied clinical and health services research. CanChild focuses its research on children and families of children and youth with disabilities. Notably this organisation have developed the F-Words, a paediatric focussed interpretation of the International Class faction of Function (ICF).
‘The F-words focus on six key areas of child development. Recognizing that no one factor is more important than another, we hope to encourage people in the childhood disability field to adopt this way of thinking and apply these concepts in their work with children with disabilities and their families’ (Rosenbaum & Gorter, 2011).
Friendship is linked to ‘Participation’ in the ICF framework. Rosenbaum & Gorter (2011) investigate the need for friendship and engagement for a developing child and the challenges there are specific to those children with Cerebral Palsy (CP). The narrative of this discussion included many themes pertinent to the mental health, wellbeing and development of a child with CP.
Friendship can have an impact on:
- Providing security and social support
- Developing social problem solving skills
- Friends offer a safety net and positive influences on learning
- Better attitude to school and learning
- Better self-image and self-esteem
- Motivated to maintain relationships
- Actively repair conflicts
Studies have shown that children with Cerebral Palsy and other disabilities often have fewer or no friendships. This is known to negatively impact the points highlighted above by Rosenbaum & Gorter (2011). Particularly issues around loneliness and isolation, can have a detrimental effect on a child’s mental health and a lowered self-esteem and self-image. It was found that children without a disability are more likely to make friends with those children with disabilities following exposure and education toward it. Sally Lindsay, an Occupational Therapy Professor at the University of Toronto spoke about the importance of teaching children allyship as a way to increase social inclusion (create link to article: https://www.thestar.com/life/health_wellness/2018/10/14/teaching-kids-to-be-allies-for-disability-inclusion.html?rf). The article outlines a few helpful and easy was to broach this topic with children in different environment including home and school.
There are several benefits of social inclusion on a child’s mental health and wellbeing. The studies and research mentioned within this article suggest that inclusion can help to improve the following:
- Reduction in symptoms of depression and anxiety
- Increase social and cognitive development
- Increased sense of belonging, meaning and satisfaction
- Being included and inclusive can build awareness: being seen and therefore contributing to tackling stigma
The New Economics Foundation (2008) discuss the concept of 5 ways to approach wellbeing, which can be used as a guide for anyone involved in caring for children or adolescents with disabilities. (create a link: https://neweconomics.org/uploads/files/five-ways-to-wellbeing-1.pdf). These 5 simple steps are always a good way to approach many problems around the topic of wellbeing and mental health:
- Connect
- Be active
- Keep learning
- Give to others
- Be mindful
In summary, the evidence and clinical opinion suggest that engaging in meaningful occupations elicits many benefits to our mental health and wellbeing. Children with disabilities are more at risk from isolation and loneliness, which is known to lower self-esteem, self-image and can lead to poor mental health outcomes. This article highlights some of these issues children with disabilities face and attempts to inspire the reader to continue to think holistically when working with this client group. By promoting engagement and participation, as well as being an ally for those with disabilities, can assist in better mental health outcomes for children with disabilities.
Reference list
A report presented to the Foresight Project on communicating the evidence base for improving people’s well-being. (n.d.). https://neweconomics.org/uploads/files/five-ways-to-wellbeing-1.pdf
Almeida, I. L. de L., Rego, J. F., Teixeira, A. C. G., & Moreira, M. R. (2021). Social Isolation and Its Impact on Child and Adolescent Development: A Systematic Review. Revista Paulista de Pediatria, 40. https://doi.org/10.1590/1984-0462/2022/40/2020385
CanChild. (2013). Canchild.ca. https://www.canchild.ca/
Hammell, K. W. (2017). Opportunities for well-being: The right to occupational engagement. Canadian Journal of Occupational Therapy, 84(4-5), 209–222. https://doi.org/10.1177/0008417417734831
Kwan, C., Gitimoghaddam, M., & Collet, J.-P. (2020). Effects of Social Isolation and Loneliness in Children with Neurodevelopmental Disabilities: A Scoping Review. Brain Sciences, 10(11), 786. https://doi.org/10.3390/brainsci10110786
Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218–1239. https://doi.org/10.1016/j.jaac.2020.05.009
National UK Charity for Seriously Ill Children. (n.d.). WellChild. Retrieved January 25, 2023, from https://www.wellchild.org.uk/
Rosas, A. (2013). A COOPERATIVE SPECIES: HUMAN RECIPROCITY AND ITS EVOLUTION. Revista de Filosofia Aurora, 25(36), 343. https://doi.org/10.7213/revistadefilosofiaaurora.7778
Rosenbaum, P., & Gorter, J. W. (2011). The “F-words” in childhood disability: I swear this is how we should think!. Child: Care, Health and Development, 38(4), 457–463. https://doi.org/10.1111/j.1365-2214.2011.01338.x
Tomasello, M., & Vaish, A. (2013). Origins of Human Cooperation and Morality. Annual Review of Psychology, 64(1), 231–255. https://doi.org/10.1146/annurev-psych-113011-143812
About the author – Richard Harvey
Richard has gained a wealth of experience working in the postural management industry since 2016 in both product roles and educational and training positions. In this time he obtained a Post Graduate Certificate in Posture Management for People with Complex Disabilities from Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust. Prior to this he held several positions as a Therapy Technical Instructor over an 8 year period, specialising in paediatrics and complex needs.
In 2023, Richard completed his training to become a qualified Occupational Therapist at London South Bank University. His ambitions are to use his experience and knowledge to help to develop clinical practice of posture management, whilst empowering the profession of Occupational Therapy to be leaders in this field. Richard has a passion for supporting and advocating for children and adolescents to engage and participate in meaningful occupations and activities. To contribute in breaking down barriers and challenging ableism that prevents any child from reaching their full potential.
Richard enjoys being active and has a number of hobbies outside of work including Crossfit and Badminton. In 2020 Richard became a qualified Level 2 Badminton England coach, and enjoys teaching and sharing his passion for the sport.
