Signe Lo Scott Larsen, a practitioner in Denmark with experience of working in schools with children with developmental differences, shares her reflections on stress and well-being in a mainstream school context.
In this article, I will outline a framework that can help shed light on issues revolving around school well-being and the high amount of non-attendance among children with autism and other diagnoses in the public school system. The article will clarify why it is essential to understand the transactional stress between the child, parents, and staff members in schools.
Dynamics at take in the context of inclusion
In Denmark, children with autism spectrum disorders (ASD) must continuously be included in the public school system. There is an indication that the inclusion of children with ASD is a complex area that requires knowledge and pedagogical contributions to succeed. A study by Landsforeningen Autisme in 2021 shows that 45% of children with ASD do not attend school due to stress and failure to thrive. That is a significant increase since 2019, when the number was 35% (”Autismeforeningens inklusionsundersøgelse 2021”, 2021). In addition, 77% of parents of autistic children within the school system believe that their children do not receive the support they need.
But what is it that we need to understand when working with autistic children and inclusion, and how do we break the negative tendencies for children with autism who have a hard time in school?
Including children with ASD in the standard school system can be a complex task for teachers, pedagogues, supporters, and leadership. Studies show that it is not merely the children that are challenged. There is an indication that the parents and the children are vulnerable in relation to a reduction in general well-being (Richmond et al., 2009). Challenging behaviour can also leave parents feeling stressed and burned out (Lovell et al., 2011).
Moreover, a report from the National Board of Social Services concerning school refusal among children with ASD points out that the cooperative climate between the children's parents, administration, and/or school is more important than first presumed (”Børn med autisme og skolevægring,” 2016). Stress among parents is therefore identified as a significant factor that requires attention and intervention, and that discovering ways to moderate or mediate stress among parents can increase a family’s function (Lovell et al. 2011).
Teachers and pedagogues are therefore faced with handling different critical issues concerning the child and parents' stress. Scientific research points toward the importance of also being attentive to the teacher's and pedagogues’ mental health, given that challenging behaviour amongst children with ASD can be linked with negative emotional reactions from their supporters, such as anxiety, fear, sadness, and helplessness (Butrimaviciute & Grieve, 2013). Stress amongst supporters is identified as a critical variable in the causes of challenging behaviour among children with ASD (McDonnell et al., 2007). Therefore, there is a need to outline a holistic understanding of the work-related processes which can cause stress among school staff (Rippon et al., 2020).
Transactional stress
As we know from Lazarus and Folkman’s (1984) stress model, stress arises from an individual's (or family’s) interaction with their environment. When people believe that environmental stressors have overwhelmed their resources, they use coping mechanisms to restore function. However, if an individual’s coping mechanisms are either poorly adjusted or cannot accommodate the new demands, the result is stress. Lazarus and Folkman (1984) underline stress as an individual matter and, therefore, subjective. Parallel with this understanding, stress amongst parents arises when a family cannot cope with a stressor (e.g., the child’s challenging behaviour or requirements from cooperation with the school), where they cannot utilise the accustomed coping strategies to tackle the situation. The exact mechanism asserts itself concerning the child and the teachers and pedagogues, and one can understand stress as a transaction between individuals who are mutually affected by one another.
The transactional stress model leads to the natural conclusion that the supporter’s role is to start breaking down the negative pattern, which generates stress in the system surrounding the child with ASD. Firstly, the staff must utilise knowledge about the person-environment transaction to consider factors such as mood, demands, tone of voice, behaviour, and language in the transaction with a child with ASD and parents, given that these are obvious potential stressors (McCreadie and McDermott, 2014).
Secondly, the staff is responsible for identifying their own stress and developing adjusted coping strategies concurrently with the practical situations that play out.
Turning an eye toward the child – to understand the main features concerning ASD
As previously mentioned, attending to the needs of a child with ASD in the school context can be a daily challenge. Teachers can come up against a range of distressed behaviours, that can be challenging to manage without the right coping resources. Autism is also described as encompassing ‘autisms’ rather than a single “autism” (McCreadie and McDermott, 2014). Some fundamental features of autism can help teachers ascribe meaning to the interplay with the child, especially if they are unsure how cognitive processes give way to the behaviour they see.
Lorna Wing has described autism as a ‘triad of impairments’, with three deviations within the areas of social interaction, communication, and the limitations of behavioural repertoire, play, fantasy, and interests. Furthermore, for several years, sensory processing problems have been the object of increasing attention in research-related areas (Dunn, 2001).
Overall, the main features of ASD, contribute to a great extent to a feeling of oneself in an interplay with the surrounding world, which is characterised by qualitative and very individual and unique interpretations. In this way, it is key to know the main features of ASD in order to interact fittingly with the child and plan out the pedagogical learning environment, which considers the child’s strengths and vulnerabilities. This is a complex package of knowledge, which demands a lot of the teacher's abilities to convert knowledge and flexibility into practice. A solution will be more obtainable by introducing an understanding of stress and a knowledge of these main features, heightening an exploration of the child’s stress level.
An autism-friendly learning environment
There is obviously a long row of factors concerning the environment at the school, which can influence the student's stress level in a negative or positive direction. Environmental factors such as noise, scolding, workload, and large gatherings have been identified as essential stressors by students with ASD (Saggers, 2015). Owing to the child’s concrete and detail-focused understanding of the world, it can furthermore be hard to interpret and let go of an unclear or indistinctive phrasing or message. On the positive side, environmental factors such as visual support systems, support in relationships with other children along with a predictable and recognizable learning environment have been identified as supportive factors for the student with ASD (Milton, 2014).
Several scientists have questioned whether an increased focus on the biological aspects of the diagnosis will undermine attention on the requisites for healthy development during childhood, such as emotional connectedness, balanced interactions, and care (Fisker, 2012). Within developmental psychology, it is commonly accepted that the child and its surrounding environment develop in a transactional process (Broberg et al., 2008).
Applying a relational perspective to the phenomena of school absence and reduced well-being makes it possible to think in a more nuanced way, and consider significant circumstances that should be in place for children with ASD to thrive in a school context. Teachers' ability to mentalise is a stepping stone to understanding how one can create balanced interactions with both neurotypical children and children with ASD.
Mentalising is partly about being able to understand what lies behind the behaviour we see in others, and partly to be aware of what happens in oneself. When we mentalise our own and others' behaviour, it often makes sense and becomes more understandable. A mentalisation approach, where we try to understand ourselves in the interplay with the other, is characterised by openness, balance, empathy, curiosity, and patience (Hagelquist, 2012).
Therefore, it is essential that teachers do not forget autistic cognition and subjective comprehension, and how these influence interactions with the social situations one can find oneself in with an autistic child. Knowledge about how the child’s difficulties lead to stress is therefore central to the teacher's ability to identify stress responses, and thus construct an environment where the child can cope.
The teacher’s expertise is not alone a question about the teacher’s choice, but should also be seen in the context and conditions that the teacher is working in and as a part of a broader organisational culture with relational and structural aspects in mind.
Parental cooperation
In the public-school context, a central part of the cultural and political agenda is to involve parents in cooperation concerning the child’s learning and development. This applies to the all children, including those with additional needs. Nevertheless, studies conducted to examine parents’ experience with special education show that parents do not always feel heard by the school, or involved in planning pedagogical aid (Andersen, 2011).
Therefore, the planning of pedagogical effort must consider parents' involvement and perspectives in the layout of student plans and efforts to ensure the child’s learning and well-being. If, for example, the child’s behaviour is not interpreted as a sign of failure to thrive in situations where this is exactly the case, the likeliness of adequate adjustments is limited (Elmose, 2010). There are indications that parents in general experience that teachers must have knowledge about the child’s unique needs in order to interpret and understand the student's behaviour (Egelund & Tetler, 2009). Likewise, a child with ASD often displays stress differently in different areas, and there can also be times when the child’s stress responses can be hard to observe in school (Halsall, Clarke & Crane, 2021). Therefore, it is to be expected that the parents often experience more signs of stress at home than in school. It is therefore essential that the demands and expectations for the child match the cooperation with the parent. If this knowledge is not considered or present, situations can arise where the students' needs are misinterpreted and thereby not met.
The parents’ involvement should, at the same time, be balanced so that parents are not overinvolved and overburdened in the decision-making processes, for example if teachers were to become directly dependent upon their help to handle specific practical situations.
Meeting with parents demands an effort from the teacher to explore the personal resources that parents have available within a given context. A family may experience getting weekly messages about their child having a hard time at school as stressful, and this situation can be avoided by regular weekly conversations, where the teacher can also bring positive feedback and stories from the child’s life at school. Another family may need to be involved in the decisions about workload, the child's academic areas of interest, or the amount of homework. Therefore, organisations and teachers should be sensitive toward strategies that parents utilize, and be careful not to undermine the ones they use before suggesting new strategies. If not, the result can be another source of stress for the parents. The mentalising attitude of the teachers can therefore become central to understanding the parent's individual perspectives, and thus help along the parent's adaptive coping so that the family is maintained – or regenerates function.
Staff stress
The fundamental stress of the child and family’s daily struggle with handling environmental factors are, as described, a significant theme in the area of inclusion. It therefore presents high demands for the pedagogical staff to accommodate the child and family’s demands. Partly, the quality of the teacher-student relationship and how autism friendly the learning environment is can influence factors such as the student's general well-being and stress levels. Partly, the teacher's ability to involve the parent’s viewpoints and navigate the demands and resources the parents have available will influence the family’s ability to function and co-produce with the school.
Inclusion in school for students with ASD is, therefore, a source of stress for teachers and pedagogues and demands a certain amount of adjustment to be tackled. Therefore, it helps if the teachers are attentive to their own emotional selves.
The mentalising theory points out that bad mentalising first and foremost is seen as an absence of focus on the inner conditions, and thereby a lack of viewing one’s own and others' actions as internally motivated.
Emotion regulation is central to mentalising, and through the consciousness of your emotions, the individual move toward being able to regulate these (Klinge, 2016). When a child with ASD, in consequence of stress, becomes frustrated (e.g., by demands not being met or needs that are not being fulfilled), the teacher's response to the child's reactions will directly influence how the practical situation plays out. If the teacher knows that the situation is stressful for themselves, the chances for a matched interaction are improved. The same is in evidence concerning parent cooperation, where the teacher's ability to understand and incorporate the family's perspectives directly influences the family's ability to cope with stress. When emotional states are recognised and understood, the ability to cope adaptively with the stressor is increased (Allison & Fonagy, 2012).
To improve work in this area, the focus should be on the staff learning to use interventions that focus on the ability to regulate their own emotions in the interplay with children, and cultivate their adaptive coping in situations with increased stress. Research points out that such interventions can be beneficial to improving the staff's psychological functions, which results in fewer episodes of challenging behaviour in children with ASD (Larsen et al., 2019). The Low Arousal Approach is a particularly useful mechanism for this, as it concerns itself with thoughtful considerations about how one can help the child regulate emotions in a conflict situation and avoid using restrictive practices (McDonnell et al., 2015).
Therefore, an essential point in understanding stress is that the focus should be more directed toward the transactional stress between students, parents, and staff, and that staff should receive training and tools to be able to cope with their own stress.
Collaborative learning
Increased knowledge sharing about children with ASD and the transactional stress in connection with inclusion is essential for school staff. One positive factor that is identified in relation to reducing work-related stress is cooperation with external collaborators. For example, outside consultants can deliver a holistic understanding with the expertise of biological, psychological, and social needs (Rippon et al., 2020). The collaboration with partner organisations, which consists of procuring information about autism and the staffs areas of responsibility, can help with more successful practical situations. The collaboration should take place within a collaborative framework, pointing at problem understanding and solutions because of the different perspectives that together will contribute to joint solutions (Bang on Dalsgaard, 2005).
In this understanding, there is a need for a general shift, where the focus in connection with inclusion is not only about the target group but the school community as a whole. Hence, pedagogical considerations should, to a higher degree, encompass staff coping, stress, and well-being, and how the individual teacher and pedagogues assess practical situations and utilise knowledge. Issues that arise in practice should be written in an organisational framework and viewed in a holistic, collaborative, and practice-oriented approach, where the help being yielded includes value-based talks about transactional stress. With this sequential support and knowledge sharing for teachers and pedagogues, a possibility for reducing stress and furthering well-being arises for children, parents, and staff in the common public school.
Written by Signe Lo Scott Larsen
Translated by Sarah Kathrine Dahl Moslund
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