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PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS
BRING MY SMILE BACK
WORKING WITH UNHAPPY CHILDREN

IN EDUCATION
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PSYCHOLOGY OF EMOTIONS,
MOTIVATIONS AND ACTIONS
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PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS
BRING MY SMILE BACK

IN EDUCATION
MARIA A. EFSTRATOPOULOU
AND
MARIA SOFOLOGI
EDITORS
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A child’s Happiness is
more important than
Their Grades
ANYTHING
CONTENTS
Foreword ix Scott Fleming
Prologue xiii Acknowledgments xvii
Chapter 1 Can We Define Happiness? 1 Craig Bridge
Chapter 2 Working with Unhappy Children
Who Have Adverse Childhood Experiences 27 Maria A.
Efstratopoulou
Chapter 3 Am I Unwanted? Working with Unhappy Children Who Are
Experiencing Bullying 45 Maria A. Efstratopoulou
Chapter 4 Am I Different? Social Identity, Difference,
Exclusion, and the (Un)happiness of the
‘Black and Minority Ethnic’ Child 69 Hadiza Kere
Abdulrahman
Chapter 5 Working with Unhappy Children
Who Are Young Carers 85 Maria A. Efstratopoulou
viii Contents
Chapter 6 Working with Unhappy Children from Single Parent

Families: A Challenging Schema 97 Maria Sofologi and Antonis
Theofilidis
Chapter 7 Family Dysfunctions: Working with Unhappy Abused
or Neglected Children 109 Aphrodite Kamari
Chapter 8 Working with Unhappy Children with Emotional
Dysthymia: The Myth of Prometheus 139 Maria Sofologi
Chapter 9 Am I Different? Working with Unhappy Gifted
Children Who Are in the Autistic Spectrum 155 Evaggelia
Markou
Chapter 10 Am I Stupid? Working with Unhappy Children
with Dyslexia and Specific Learning
Difficulties in Reading 169 Nataly Loizidou
Ieridou
Chapter 11 How Can I Say What I Am Feeling?
Working with Unhappy Children with
Communication Problems 187 Tracy Jeffery
Chapter 12 Unhappy Teachers Sailing to Unknowing Oceans:
The Burn-Out Phenomenon 229 Maria Sofologi
Conclusion 243 Epilogue 249 About the Editors 259 About the
Contributors 263 Index 269
FOREWORD
Earlier this year the eighth annual Good Childhood Report was
published about the state of children’s wellbeing in the UK (The Children’s
Society, 2019). Its findings indicated that since 2009/10 there have been
significant decreases in happiness associated with schooling, friendship
networks and life as a whole. There was also strong evidence linking lower
life satisfaction amongst children to income poverty (especially
intermittent), financial strain and multiple deprivation, as well as signalling
some implications for declining mental health and higher levels of
depressive symptoms.
Elsewhere in the world there have been similar studies that, together,
have provided the basis for international comparative analyses (e.g.,
Cheung, 2018; Inchley et al., 2016; UNICEF Office of Research, 2013).
Three themes have become clear: (i) children’s wellbeing and happiness
have become matters of global concern; (ii) the underlying causes of
children’s unhappiness are complex and multi-faceted; and (iii) the urgent
need for research-informed and evidence-based practice has never been
greater.
This important and exciting collection edited by Dr Maria
Efstratopoulou and Dr Maria Sofologi brings together the work of an
x Scott Fleming
impressive team of international social science scholars and practitioners to

address these challenges. Its timing could hardly be better. One of the key
features of the book is the scope of its coverage including human rights,
gendered aspects of bullying, ethnically diverse experiences of exclusion,
specific learning difficulties, neglect and abuse. All of these are juxtaposed
with consideration of the roles of social institutions (e.g., schools,
communities, media) as well as key agents and agencies (e.g., family,
medics, teachers). What makes it particularly distinctive, though, is the
exploration of the interface between emotions, learning and happiness. The
chapters have a very accessible structure and format, they are conceptually
sophisticated and have an explicit applied professional practitioner
emphasis. They should be read by students, researchers, policy makers and
those responsible for service delivery. If they are Bring My Smile Back:
Working with Unhappy Children in Education is likely to become a
landmark contribution.
Finally, and more parochially, I am delighted to endorse a book that
features my colleagues from Bishop Grosseteste University. With a rich
heritage in teacher education and training, this book is an embodiment of
many of our traditional values as well as a firm commitment to health-
related subject fields that form part of our portfolio of undergraduate and
taught postgraduate awards.
Professor Scott Fleming
Deputy Vice-Chancellor
Bishop Grosseteste University, Lincoln, UK
October 2019
REFERENCES
Cheung, R. (2018). International comparisons of health and wellbeing in

early childhood. London: Nuffield Trust and Royal College of
Paediatrics and Child Health.
Foreword xi
Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L.,
Mathison, F., Aleman-Diaz, A., Molcho, M., Weber, M. & Barnekow,
V. (2016). Eds. Growing up unequal: gender and socioeconomic
differences in young people's health and well-being. Health Behaviour
in School-aged Children (HBSC) study: International report from the
2013/2014 survey. Copenhagen: WHO Regional Office for Europe.
The Children’s Society (2019). The Good Childhood Report. London: The
Children’s Society.
UNICEF Office of Research (2013). Child Well-being in Rich Countries: A
comparative overview. Innocenti Report Card 11. Florence: UNICEF
Office of Research.
PROLOGUE
If you ask parents what they most want for their child, many will say
something like this: ‘I just want my child to be happy’. Whilst most of them
know that they cannot make this happen, seeing their children frequently or
deeply sad, is very confronting. It baffles parents worldwide: why are our
children so unhappy? The more we give them, the more miserable they are.
Almost a quarter of a million children in the UK report being unhappy with
their lives as a whole, according to new figures. We are faced with an
epidemic of anxiety among children. Research indicates that there is an
increase number of children and young adolescents suffering from
depression and the rates of aggression among children doubled in the last
25 years.
Most children do not know the meaning of empathy. Compassionate,
moral behaviour is considered ‘uncool.’ Scientists believe that the problems
are in the strange cultural and social practices of our modern life,
particularly in the way we raise our children. Family and teachers can help
children feel safe and nurtured with them around. We can make up later for
what our children lacked in early childhood. But, that means giving more
time to our kids and having much more interaction with them. It is time to
go back to the lullabies and bedtime stories instead of letting the TV and
social media do that for us.
xiv Maria A. Efstratopoulou and Maria Sofologi
Family schema and school environment represents different systems

that play a crucial and essential role in the developmental path of the child.
It is fundamental to emphasize that the synthesis and the cooperation of
these two distinct systems can influence negatively or positively the
developmental outcomes. This idea is closely aligned with the analytical
orientation of the content of the book approaching the relational patterns
that develop over time among family and school members. More
specifically, the ways we learn to relate to our parents, siblings and
grandparents have lasting power over how we relate to those we encounter
beyond the formal family system. As a result, the emotional systems we
create in different environments like school are acutely influenced by the
“ghosts” of our family past.
This book is an enlighten attempt to develop a “family and school
genogram” in order to provide fresh understanding of our most significant
relationships in two interactive and social schemas family and school. The
description of different challenging behaviors among children and their
school relationships gives expression to a creative and dynamic
understanding of children’s problematic behaviors. Consistent with the
nature of creation, children and their families interact in terms of emotional
systems according to complex patterns deriving both from genetic
inheritance and intergenerational learning. From birth, children and humans
are dependent upon the care and nurture of others for both physical and
emotional needs. But a significant question arises from the basis of this idea
“How a dysfunctional family can influence the emotional balance of a
child”? Dysfunctional families are characterized by broken, death-dealing
relationships creating emotional dysthymia.
In this vein this book can serve as a survival kit for educators and
specialists gaining insight into family and school network relationships.
Each chapter is heavily invested in the restoration of healthy, life-giving
relationships in school by helping educators to manage challenging
behaviours. The purpose has been twofold. First, we have sought to
document the central concepts of family systems theory and its influence on
school and on school ethos, as well. Second and most important, we have
suggested that the knowledge of different strategies in the classroom
Prologue xv
environment can transform teachers to essential actors in restoring

emotional balance of their students.
The book starts with an attempt to define Happiness and concludes with
a chapter on working with (Un)-happy teachers and the burn-out
phenomenon in professionals working with challenging students. Each
chapter is focusing on different conditions that could affect children’s
happiness from adverse childhood experiences and young carers to children
from minority groups or children neglected-abused or even unhappy
children from single parent families.
An understanding of the factors that influence children’s emotions is
essential when working with young children. Where most books in the field
offer advice to professionals on how to manage children’s behaviour, this
book aims to explore the crucial link between emotions, well-being and
learning and the wider social factors affecting children’s happiness. The
authors draw from a range of experience, examples, case studies and
educational approaches to present this engaging text on children’s’
wellbeing and emotions. Focusing on children’s happiness more than on
their academic achievements and positive behaviour, this book puts
Children’s Smiles at the heart of teaching!
Dr. Maria A. Efstratopoulou

Dr. Maria Sofologi
October, 2019
ACKNOWLEDGMENTS
In writing this book, we need to express our gratitude to all

contributors. We feel blessed to have such an inspired team of authors
(who patiently responded to our request).
World –leading Academics from different Universities are sharing their
research findings and their valuable experiences on the field. We thank
them not only for their written contribution in this book, but also for their
valuable discussions generally and their reading on earliest drafts of this
work, as well as the advice and expertise they offered on a number of
aspects of this book.
Our thanks also go to Prof Scott Fleming, for his generous foreword, to
Dr. Cecily Jones for her proofreading support and the rest of editorial and
production team.
Last, but certainly not least, we want to thank our undergraduate and
post graduate students who inspired us with their questions and concerns on
the topic. Working with young students who are unhappy, at school
settings, is extremely challenging and we -as academics- feel responsible
to help young professionals to feel ready and confident to support best their
own students to reach their full potentials and live a happy life!
Dr. Maria A. Efstratopoulou

Dr. Maria Sofologi
In: Bring My Smile Back ISBN: 978-1-53617-277-5 Editors: M. A.
Efstratopoulou et al. © 2020 Nova Science Publishers, Inc.
Chapter 1
CAN WE DEFINE HAPPINESS?
Craig Bridge
Educational Psychologist, Bishop Grosseteste University,
Lincoln, UK
ABSTRACT
When we consider happiness, we may think of people we like to be with,

places in the sun, things we have achieved and many memories of positive
times. Happiness is something that most people can relate to and is something
that many of us wish for ourselves and for others. When we stop to think
carefully about what happiness might be we can easily become confused.
Some people would consider the idea of happiness to be about having
financial security and a great job. Other people may think about the challenge
of a project or spending time at work. Others may gain huge happiness from
helping others and seeing joy in their lives. In order to understand what
‘being happy’ might involve it may be necessary to start to ask what does
research tell us about happiness and what factors may increase or decrease
happiness?
2 Craig Bridge
HAPPINESS, CHILDREN AND YOUNG PEOPLE
Understanding happiness may be an important first step in being clear

about what this common concept might be and how we might achieve it.
Understanding happiness for adults may be important, but understanding
happiness in children and young people may be of more interest to some
people such as schools, governments, parents and policy makers. Childhood
may be thought of being filled with play, enjoyment and joy. Indeed, there
may even be the belief that happiness is a right for children and young
people and something that should be encouraged and fought for. For some
young people, as for adults, life may be challenging and they may
experience periods of difficulty. Issues such as mental health, social media,
family disruption, issues of gender identity and expectation to succeed in
school and society may risk creating a less happy cohort of young people
in a society. These aspects are components of children and young people’s
lives.
The need to focus on positive life experiences and feelings is
important to help support some groups who may feel unhappy or
disengaged with society
The need to focus on positive life experiences and feelings is important

to help support some groups who may feel unhappy or disengaged with
society. Therefore, when starting to unravel the ideas associated with
happiness for children, it is necessary to focus on some specific issues and
areas. For example, we may choose to ask some of the following questions:
∙ To what extent do children have a right to happiness? ∙ What factors

do we need to consider with regards to happiness in children and
young people?
∙ How does development effect the reporting of happiness in children
and young people?
∙ How do schools support the development of happiness in young
people?
∙ What is in the impact on reported happiness from social influences?
Can We Define Happiness? 3
In this chapter the above questions will be explored with a particular

focus on the happiness of children and young people. We will start to
understand some ideas and definitions of happiness for all people and how
research has aimed to define and categorise the terms and concepts
associated with happiness. We will then explore what makes people happy
and what factors contribute to an increase in positive feelings. After looking
at these ideas we will then consider how happiness and being happy plays a
role in childhood and adolescence. Next the research around how schools
can respond and support the development of happiness will be highlighted;
there will be some consideration of how whole school approaches can be
useful and what other wider factors support happiness. Some of these wider
issues will include how age, gender, mental health, parental relationships
and social media affect reports of happiness. The final issue that will be
considered is the notion of rights for children and young people to be
happy.
AN ATTEMPT TO DEFINE HAPPINESS
In Ancient times the idea of happiness was highlighted by Socrates,

Plato and Aristotle who believed that by people living a virtuous life they
would experience happiness. In recent times researchers and thinkers within
positive psychology have tried to understand the ideas around happiness to
in order to improve people’s lives. Positive psychology aims to Positive
psychology aims to apply researched psychological approaches to support
positive outcomes for all. In order to study the ideas around happiness it
became clear that researchers would need to have a workable concept of
happiness. Having this concept defined would help to standardise the idea
of happiness, enabling researchers to find out what promotes or reduces
happiness in people and society. In Hefferon and Boniwell’s (2011) book
called ‘Positive Psychology: Theory, Research and Applications’ they
stated that defining happiness was a ‘fundamental question’ for positive
psychologists to answer in order to study happiness. Many decades ago, one
researcher, Ed Diener, suggested in 1984 that the idea of happiness may be
thought of as subjective wellbeing. Thisterm is frequently used in the
writing about happiness. It is a common idea that allows the researchers to
start to agree on what happiness may be.
4 Craig Bridge
Equation provided by Hefferon and Boniwell:
Subjective wellbeing=Satisfaction with life + high positive

affect – low negative effect
Subjective wellbeing was born from a need to help people measure

positive feelings within research and within society. To understand
subjective wellbeing, we have to think about the following equation
provided by Hefferon and Boniwell: Subjective wellbeing=Satisfaction
with life + high positive affect - low negative effect. The equation shows
us that subjective wellbeing occurs when we balance the three parts of the
equation. The first section is the thought process, or cognitive process of
deciding how satisfied are we with our lives. This part of the equation is an
evaluative thought and will involve numerous ideas being weighed up in
our minds. There will be an emotional response that will feed into the
cognitive evaluation. This will be our feelings about the good things in our
lives balanced with the overall feeling of the bad things in our lives.
Subjective wellbeing is an overall cognitive and emotional balance of our
lives centred on satisfaction, offset by our overall positive and negative
feelings. So, happiness may be thought of as an evaluation based on how
we see ourselves at any given time, influenced by the emotional balance of
positive and negative emotions.
The subjective wellbeing concept of happiness is one that would be
considered ‘hedonistic’; a happiness where people would seek pleasure for
themselves so that they can feel good. This idea would be about gaining
pure happiness for ourselves. It would be a selfish happiness and would not
necessarily consider more charitable considerations. In addition to this
hedonistic happiness and subjective wellbeing, other researchers have
considered the possibility of an additional concept of happiness. This
alternative view of happiness has been highlighted by some researchers who
have suggested that this form of happiness is focused on functioning well;
this is referred to by Richard Ryan and Edward Deci in 2000 as the
‘eudaimonic’ sense of happiness. This sense of wellbeing is much more
than just feeling happy for ourselves and includes psychological wellbeing.
Psychological wellbeing and the eudaimonic form of happiness is focused
on ‘virtue and doing what is worth doing’. It is associated with fulfilling our
own true nature and can be considered related to doing things to better your
life, to add more meaning to existence.
Psychological wellbeing and the eudaimonic form of happiness is
focused on ‘virtue and doing what is worth doing’
There is some debate as to whether hedonistic wellbeing is always at

the core of eudaimonic happiness or whether these two concepts exist
separately. Indeed, Kashdan, Biswa-Diener and King argue in their 2008
work that eudaimonic wellbeing and psychological wellbeing will always
have hedonic elements within its function and others argue that they are
fully independent of one another. The Children’s Society report for 2018
suggested that eudaimonic happiness may be further explained by the ideas
of self-acceptance, environmental mastery, positive relationships,
autonomy, purpose in life and personal growth (The Children’s Society’s
2018). For the remainder of this chapter we will use the terms of subjective
wellbeing and psychological wellbeing to represent the two possible forms
of happiness-hedonistic and eudaimonic happiness.
So far subjective and psychological wellbeing have been highlighted as
two types of happiness. These two ideas and concepts can start to help us
define happiness. There is one other personal characteristic that has been
often linked to happiness- resiliency. In life there may be times when things
happen that knock people’s subjective and/or psychological wellbeing.
There may be events that people have limited control over and these events
can create many positive and negative emotions. These events can cause
some people to change how they feel in significant ways.
Resiliency is defined as ‘the flexibility in response to changing
situational demands, and the ability to bounce back from negative
emotional experiences’
How people return to their prior emotional state after a difficult event is
often referred to as resiliency. Resiliency is defined by Tugade,
Frederickson and Barrett as ‘the flexibility in response to changing
situational demands, and the ability to bounce back from negative
emotional experiences’. People who are resilient may well present with
certain skills or processes. Such
6 Craig Bridge
skills may include reframing and experiencing positive emotions, being

optimistic, having social support, using people’s own strengths and
engaging in physical exercise. People that are resilient may well have these
skills, however, it is possible to train oneself to become more resilient by
developing these attributes. One example of how to develop more resiliency
is through changing people’s thinking patterns from a negative style to a
more positive style. Such changes, or reframing, of thinking is one example
from the above list of resiliency skills that involves shifts in evaluating life
events.
Reframing would be focused on looking at a situation or scenario with
a different perspective. For example, if someone lost their job this situation
may be seen as a considerable stress and worry. By reframing the problem,
it may be possible to see this event as an opportunity to do something
different. Later in the chapter we will look at some educational programmes
that have taken these principles and applied them to help support young
people with lower subjective wellbeing. These interventions are used to
develop young people’s resilience and hopefully, reduce any impact on
their happiness as a result of any challenging life-events.
WHAT FACTORS MAKE HAPPINESS LESS OR MORE

LIKELY TO HAPPEN?
Now that the concepts of happiness (subjective and psychological

wellbeing) have been established and the idea of resilience has been
outlined, the factors that promote happiness should be considered. Seligman
(2011) suggested that there may be five methods to gain happiness:
1) Pleasure – Experiencing frequent positive emotions in life 2)

Engagement – To be involved with enjoyable tasks that are fully
absorbing
3) Relationships – To create links and connections with others
4) Meaning – To discover one’s own purpose in life
5) Accomplishment – To have a clear goal or purpose that needs to be
worked towards
As well as Seligman’s view on what creates happiness there have been

other ideas around the same topic. In 2010 Rath and Harter identified five
more essentials to happiness. The following five areas are relevant factors
in reported happiness:
∙ Career wellbeing- Where you spend most of your time during the day
∙ Social wellbeing- Love and relationships
∙ Financial wellbeing- How well money is managed
∙ Physical wellbeing- Health and fitness
∙ Community wellbeing- Your role in your community.
These five areas are seen as impacting on the level of wellbeing in life.
There is need for all five and trying to gain one over another may hinder
their overall wellbeing. Hefferon and Boniwell say that to gain all five is
hard and Rath and Harter report only 7% of people in their study achieved
the full five. From both these examples of factors that may impact on
happiness there appears to be some overlapping elements linked to
wellbeing. These are around relationships, achievement and security. Later
in the chapter we will see how these overarching elements fit into the
wellbeing of children and young people.
WHY IS HAPPINESS IN CHILDREN AND YOUNG

PEOPLE IMPORTANT?
We have already outlined the different concepts of happiness

(subjective and psychological wellbeing) as well as an additional skill
(resiliency). Now we need to consider why it is important to study and
research these concepts in regards to children and young people. In order to
address the previous point, we may also need to ask what are the gains or
benefits of having high levels of wellbeing in children and young people?
What does the research show us about the outcomes for children and young
people with high levels of happiness, subjective and psychological
wellbeing? How might schools,
8 Craig Bridge
families, carers and the community impact on happiness? What is the

global picture of happiness for children and young people?
Exploring the issues of happiness serves to both help with the issues of
mental health and depression and to develop methods and strategies that
build resiliency and coping mechanism within people and society. Reports
from research studies in the United Kingdom revealed that 2% of 11-15
year olds suffer from depression, increasing to 11% for 16-24 year olds. In
the United States they highlight research that shows ‘one in five
adolescents has a major depressive episode by the end of high school’.
Therefore, the importance of understanding wellbeing in young people
could help those that are experiencing challenge periods in their lives.
Lan Chaplin (2009) says research to address the issues surrounding
happiness in children and young people has been slow, despite the
increased interest in positive psychology and quality of life issues of recent
times. Chaplin considered the issues surrounding the limited progress in
exploring childhood happiness and unhappiness. Many of the measures
used to check adult happiness cannot always be transferred over to children
due to some of the cognitive developmental design issues of these tools;
for some children the techniques that would be used may be too
challenging. Therefore, Chaplin developed a measure that was simple and
engaging for young people aged 8 to 18 years. Considering the reality that
children and young people will be the future of the world it seems obvious
and vital that time should be spent on understanding this cohort’s views of
how things are now.
Finding the right tools to gain children’s views are very important. It
could be argued that tools and methods for gaining young people’s
perceptions of happiness need to be very accessible for all abilities and
ages. If these methods are developed then they might be used to help
policy makers and those around the young people measure how
interventions and strategies are working. For carers and those close to
children and young people, ensuring that their happiness is met would be a
high priority.
A document titled ‘The Children’s Happiness Scale’ was released in
2014 by the Ministry of Education in England. Dr. Morgan’s role as
Children’s Rights Director of England required him to investigate and
comment on the views of children and young people in care. The report
used a questionnaire, or scale, to ascertain how this cohort was feeling
about their
life and situation. Within this study Morgan stated that the ‘children we
consulted said happiness is one of the main emotions a person can have’.
The study also highlighted how the sample saw happiness as something you
develop rather than a state of mind you were born with. As an unexpected
outcome of the study the 147 children and young people identified the
issues that may reduce wellbeing, even though the work was focused on
happiness. The group described the following factors that may reduce
wellbeing and happiness:
∙ A lack of trust
∙ Being bullied
∙ People being prejudice against you
∙ Being treated unfairly
∙ Losing somebody who matters to you
∙ Not being cared for properly
∙ Being abused
∙ Not being listened to
∙ Being excluded from things
∙ Not being told things you need to know
∙ Being let down by people who should be supporting you
For those in the sample that were younger they expressed their views
about what they believed was important when asked about their wellbeing
and happiness:
∙ Being looked after well

∙ Being given good support
∙ Being able to explore and try out new things
∙ Being able to have some responsibility
∙ Being given attention
∙ Having toys and plenty of things to do
This work shows how children and young people associated their
feelings of happiness with other core values such as security, trust, equality
and care-giving. There are many ways to measure the effectiveness of
10 Craig Bridge
society. Using happiness and wellbeing as a measure is a method to

highlight issues for children in society that need to be addressed. It could
be argued that a happy society may be one that ensures good outcomes for
all, including children and young people, on core issues such as security,
trust and equality. So, if it is important to highlight issues for children and
young people through measures of wellbeing, does the research show what
can be done to address those concerns?
The Children’s Society 2018 report said that interventions for children
with low subjective wellbeing, if well designed, can help them to recover
their levels of wellbeing. This idea is supported by the research carried out
by Tomym, Weinberg and Cummins in 2015. Their work found that people
reside in a narrow positive range of subjective wellbeing. They went on to
suggest that adolescents that score the lowest on their measure of wellbeing
were able to make the biggest gains when interventions and supportive
strategies were applied. Therefore, there is a need to identify measures of
wellbeing in young people and to use this information to target
interventions. These targeted interventions should be applied to those with
the lowest subjective wellbeing ratings in order to raise their wellbeing
ratings and levels of happiness.
A happy society may be one that ensures good outcomes for all,
including children and young people, on core issues such as security, trust
and equality
This point is further supported by The Children’s Society’s report that

stated:
‘There is value in being able to identify which children are unhappy with
their lives –and why – as they can be helped.’ (p18)
This reasoning is not only a moral one, but it suggests that government
policy and funding can be better spent targeting those children and young
people who would best respond to any investment. So, there is a clear case
to support the investigation and reporting of happiness in children and
young people. Primarily, there needs to be the right measures and tools
used for children and young people that avoid problems with accessibility.
When
used, these tools would be able to inform carers and supporters what factors
are leading to changes to ratings of wellbeing for children and young
people. Secondly, the need to support the development and identification
of subjective and psychological wellbeing in childhood appears to be a
moral issue; society must invest in the emotional future of its young
people. Finally, the benefit of being able to identify and target measures of
happiness and wellbeing will ensure that intervention programmes and
money targeted on childhood wellbeing is effective and not wasted.
WHAT FACTORS NEED TO BE CONSIDERED WITH

REGARDS TO HAPPINESS IN CHILDREN?
Schools may be well positioned to support the concepts of resiliency as

well as subjective and psychological wellbeing. In many countries children
and young people may spend considerable amount of time in school.
Research has shown that people who score high on wellbeing tend to have a
higher educational attainment than those who score lower on the same
scales. With schools being measured on attainment and educational impact
and with a role in supporting emotional and mental health needs, the case
for schools being involved in childhood wellbeing seems clear.
In the UK, data from some sources show that schools may have been a
contributing factor in increasing ratings in young people’s wellbeing. The
Children’s Society (2018) reported that there has been a significant increase
in happiness in UK schools and schoolwork from their measures and
samples from 2003-4 until 2015-16. This paints a positive picture of how
schools can and are making an impact on subjective reports of happiness.
However, it would be too simplistic to see schools alone as the sole cause
of this positive trend. The report does not attribute the gains to a source. It
could be that children and young people are engaging in more peer support
or help from carers and/or parents. What it does show is that schools are
now perceived to be places of increased wellbeing than they did
historically.
If schools are the areas that have supported the gain in reported wellbeing,
then intervention may have been the cause of this rise. There are several
interventions that support young people to develop the skills and
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feelings associated with happiness. Some of these interventions are

individual, some group and some whole school interventions. Next, we will
look at a sample of some interventions that try to intervene in supporting
young people so that they may have a more positive school experience.
Some of these interventions are aiming to target problem solving skills,
build resiliency, encourage helpful thinking and build the components of
subjective and psychological wellbeing.
In the United States the Penn Resilience Program is a school-based
intervention curriculum designed to improve resilience and promote
effective problem-solving skills. There are 7 ‘learnable’ skills of resilience.
It aims to teach and educate young people to challenge any habitual
pessimistic styles of thinking. It is based on cognitive behavioural
techniques and uses these principles to promote more resilient ideas. It is
run over 18-24 one-hour sessions. Although originally a US intervention
there has been some adoption of the approach in UK. However, the
research into the effectiveness of the Penn Resilience Program (PRP) has
been inconsistent with studies finding mixed outcomes.
In Australia the Bounce Back programme, by Helen McGarth and Toni
Noble, is a scheme focused on developing resilience in children and young
people. It is built on the idea that the vast majority of short-term
interventions are not sustainable. It is a secondary and primary school age
programme. According to their work, they focus on coping strategies, being
optimistic and dealing with difficult circumstances. The programme uses an
acronym poster to explain the approach:
∙ B= Bad times don’t last. Things always get better. Stay optimistic. ∙
O= Other people can help if you talk to them. Get a reality check. ∙
U= Unhelpful thinking makes you feel more upset. Think again. ∙ N=
Nobody is perfect – not you and not others.
∙ C= Concentrate on the positives (no matter how small) and use
laughter.
∙ E= Everybody experiences sadness, hurt, failure, rejection and
setbacks sometimes, not just you. They are a normal part of life.
Try not to personalise them.
∙ B= Blame fairly. How much of what happened was due to you, to
others and to bad luck or circumstances?
∙ A= Accept what can’t be changed (but try to change what you can
first).
∙ C= Catastrophising exaggerates your worries. Don’t believe the worst
possible picture.
∙ K= Keep things in perspective. It’s only part of your life.
Research into how school interventions are delivered shows some

interesting results. Interventions may be delivered individually, in small
groups, in class groups or as a whole school/whole community approach.
Wells and colleagues carried out work in 2003 on the effectiveness of class
based versus whole school interventions and found that whole school
programmes are more likely to be effective than class-based interventions.
In 2018 the UK Government provided advice to schools around mental
health and behaviour. In the early part of the document it was made clear
that ‘a whole school approach is one that goes beyond the teaching in the
classroom to pervade all aspects of school life’ (Department for Education:
Mental health and Behaviour in Schools, 2018).
In 2006, Peterson suggested the common features that make for a
school that encourages engagement includes having a safe environment
where the school’s purposes are articulated and shared. Additionally, the
school would be explicit about the goals for students, with an emphasis on
the individual student and rewarding efforts or improvements. There is a
clear mandate for schools to support and intervene around subjective and
psychological wellbeing, as well as developing life skills to promote
happiness. Programmes can be applied and used to promote better
outcomes. The need to develop a whole school approach, alongside smaller
interventions would appear logical and backed by some research.
AGE AND GENDER DIFFERENCES WITH REGARDS
TO HAPPINESS
When considering the issues of happiness and wellbeing it is worth

taking time to understand the cognitive and social developmental factors
that may impact on how happiness is understood and reported. Piaget’s
theory of
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children’s cognitive development is a hugely influential piece of work from

the middle of the last century. In his work he suggested that children
develop their understanding of concepts through a series of stages. Each
stage highlighted possible skills that would be present and, by virtue, skills
that may not have developed. According to his theory of development,
children between the ages of 7 years and 11 years are just beginning to
understand more abstract ideas; this stage was termed the concrete
operational stage. This is a transitional period and some children may be
very concrete with their thinking. In other words, some children at this age
need to have actual examples of ideas and concepts. For a child to
understand and manage the abstract idea of emotions and wellbeing they
may need concrete examples. Piaget thought that because this period of
development is progressive some children would find abstract ideas
difficult to use and fully understand. However, as the child experiences
more examples of abstract ideas they may start to understand these
concepts more.
Children may be more likely to describe happiness in concrete,
hedonistic and global positive terms, whereas adolescents may define
happiness from a more abstract point of view
According to Piaget, after 11 years of age young people can

demonstrate abstract and hypothetical reasoning, which may mean they
would find the ideas of subjective and psychological wellbeing more
accessible. At this point, the young person shifts into the formal
operational stage. This is the stage where the concepts of self and identity
develop, metacognition (thinking about your thinking) and hypothetical
thinking (test out our ideas) evolve. It could be simple to argue that these
cognitive skills would be important when considering wellbeing; even
more relevant when asking young people to reflect on their view of their
own wellbeing. Although Piaget’s work has been monumental within
education, society and research, he has many critics. For the purpose of this
chapter we will avoid going into the issues and criticism associated with
his theory and instead draw attention to the fact that rigid age stages may
not be a useful guide. Earlier in the chapter, there was time given to
explain how happiness may be a subjective value, based on the equation of
evaluating life against negative and positive feelings around wellbeing.
Considering the life-experiences, mental,
cognitive and developmental differences children, adolescents and young

people possess, the process of evaluating happiness will be very variable.
López-Péres, Sánchez and Gummerrum reported in 2016 that from
considering research around the cognitive and social differences of children
and young people it may be that there is a shift in how children talk about
happiness as they grow older. They add, that children may be more likely to
describe happiness in concrete, hedonistic and global positive terms,
whereas adolescents may define happiness from a more abstract point of
view. If this is accurate then it may be that how we talk to children and
young people about happiness may need to be different to take this idea
into account. Equally, we have to expect different answers if we ask
different questions at different ages to people that have experienced
different lives. With this in mind, Chaplin (2009) used an accessible
research method to engage with a sample of 8 to 18 year old US children
and young people. She wanted to explore what might be the differences in
what was important to her sample when asking about wellbeing. Firstly,
the study found five sources of childhood happiness from reports provided
by the sample: “people and pets,” “achievements,” “material things,”
“hobbies,” and “sports.” Secondly, she found that these five sources of
happiness varied with age. She found that during middle childhood hobbies
and people were the most important sources of happiness. However, the
older children in the study shifted from hobbies to material things. The
eldest members of the study reported a shift from material things to
achievements. Overall, people and pets remained a central source of
happiness for the whole sample. Finally, across all the ages, the sample
reported that materials things were important to their happiness ‘not
because of their functional value, but more so for their symbolic value’.
When considering how gender may impact on reports of happiness and
wellbeing, Hefferon and Boniwell’s book reported that researchers have
found no difference with gender with regards to responses to levels of
happiness and wellbeing. This was also supported by research carried out
by Lu and Gilmour in 2004 who also found no gender differences in
happiness ratings for adults. Interestingly, Chaplin found gender
differences when children elaborated on the source of their happiness. As
already stated, Chaplin had devised a more engaging measuring tool and
used this with more traditional techniques to find out what made children
and young people
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happy. In this instance she adapted the measuring tool to make it more
accessible to young people and hopefully gain their ratings of happiness
more accurately. In her work she found the sources of happiness showed
difference between genders.
Across the entire sample and age range, females reported more that
‘people’ and ‘pets’ made them happy compared to males. Males reported
that ‘sports’ gave them more happiness than compared to the females in the
study. Studies have shown that there may be differences in how age and
gender influences reports of wellbeing. What also seems really important is
the way in which these perceptions are captured. Perhaps over time more
precise tools will be developed and repeated in order to ensure we have
more reliable ideas around happiness.
CULTURAL DIFFERENCES AND HAPPINESS IN

YOUNG PEOPLE
With an increasing global perspective being part of modern life, there is

a relevance in exploring how wellbeing may or may not differ in different
cultures and different countries. Do different cultures report differently to
what makes children and young people happy? There is research to show
that people in different cultures may have varying views about what
provides happiness. In one study from 1997, Lu and Shih asked Taiwanese
adults what made them happy. The members of the study stated that being
praised and respected by others was more associated with their happiness
than achievement at work.
As well as considering the differing views of what provides happiness
there is evidence that different countries rate their emotions differently. The
Gallup Global Emotions Report in 2018 gathered responses to questions
about positive and negative emotions. The survey involved phone calls and
face-to-face interviews with around 1000 adults aged 15 years and older.
These discussions took place through the year and targeted 143 countries.
The participants were asked to respond to both a Positive Experience Index
and a Negative Experience Index with a range of scores of 0 to 100 on both
surveys. The Positive Experience Index questions included the following:
∙ Did you feel well-rested yesterday?
∙ Were you treated with respect all day yesterday?
∙ Did you smile or laugh a lot yesterday?
∙ Did you learn or do something interesting yesterday?
∙ Did you experience the following feelings during a lot of the day
yesterday? How about enjoyment?
(Gallup Global Emotions Report, 2019)
From the Positive Index there was an overall ‘world’ score of 71. There
were differences in ratings on the Positive Index with Paraguay and Panama
scoring 85 to a low of 43 for Afghanistan. This may indicate that there are
differences in ratings on the index scale but it should be noted that there are
different measures being used to discuss the ideas of happiness and
wellbeing. With a focus on young people, the United Nations Children's
Fund (UNICEF) compared and reported on children’s subjective wellbeing.
They published ‘an overview of children’s subjective wellbeing in 29
developed countries’ (UNICEF Office of Research, 2013). The publication
uses reports from 11, 13 and 15 year old young people using the Cantril
ladder originally developed by Hadley Cantril in 1965. This is another tool
that has been used to explore happiness and people in different cultures and
countries. The original ladder tool was designed around a ladder with a 0-
10 point scale range.
Considering the differing views of what provides happiness there is
evidence that different countries rate their emotions differently
The person would be asked a standard question and then asked to rate
the answer on the scale (Figure 1).
The questions would focus on hopes and fears and would require the
subject to use the ladder’s scale to reply giving a number. In using the
scale, the results would be numerical data and would allow comparisons of
other questions to be made, as well as allowing analysis to be carried out
on the results. The original method used the following instructions and
questions:
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∙ Here is a picture of a ladder (Figure 1). Suppose we say that the top
of the ladder represents the best possible life for you and the
bottom represents the worst possible life for you.
∙ Where on the ladder do you feel you personally stand at the
present time?
∙ Where on the ladder would you say you stood five years ago? ∙
And where do you think you will be on the ladder five years from
now?
10
Figure 1. Happiness Ladder.
From using the ladder and the data it provides, the UNICEF 2013
report stated that Netherlands, Iceland and Spain had the highest ranking
for child self-ratings using the Cantril ladder. At the other end of the scale,
Lithuania, Poland and Romania ranked the lowest. This data demonstrates
that ratings of wellbeing are variable by different locations. It is important
to consider that happiness, subjective and psychological wellbeing are
likely to be culturally influenced as demonstrated by Lu and Shih’s study
mentioned earlier in this section. The UNICEF data only included 29
countries and many of these countries are defined by the report as being
‘developed’.
As already stated earlier in the chapter, using the right tool for the job is
very important when conducting research. If the question or technique that
is used is not appropriate or confusing for the children and young people
there is a risk that the reporting could be inaccurate. Therefore, there may
be
issues within children, such as cognitive and developmental issues, that

make measuring wellbeing difficult, but there may also be challenges
across cultures. It would be possible to ask how uniform is the idea of
wellbeing in all cultures? Equally, how does a society and culture influence
our cognitive evaluation and emotional responses to questions around
wellbeing? Indeed, The Children’s Society report commented that
measuring differences in wellbeing differences in cross cultural studies
may be a challenge but it may also ‘shine a light on aspects of children’s
lives’.
MENTAL HEALTH AND HAPPINESS IN YOUNG PEOPLE
It is already mentioned that according to recent studies in the United

Kingdom 2% of 11-15 year olds and 11% of 16-24 year olds suffer from
some kind of depression. This is a significant number of young people.
However, it is possible that this figure is much higher if we factor in those
children and young people who may go undetected. Considering the high
occurrence of depression and possibly other mental health issues there is an
obvious need to consider how and if mental health effects measures of
subjective and psychological wellbeing.
Initially we may assume that having a mental health diagnosis would
result in low reports of wellbeing. However, research mentioned by The
Good Childhood Report (The Children’s Society, 2018) states that children
and young people without mental health diagnosis may have low subjective
wellbeing measures, and some children with a diagnosis may have high
wellbeing scores. The report states that the outcomes for both groups can be
just as poor regardless of diagnosis or no diagnosis. This raises the
possibility of using measures of wellbeing in any diagnosis pathway to help
identify young people who may be unhappy even without any mental health
diagnosis.
By society and communities intervening, developing resilience and
creating positive environments to support those with low wellbeing ratings,
there may be scope to create a knock-on effect to other children and young
people. Being around happy people can help to increase individuals’ levels
of happiness. Studies have shown that when individuals mix with happy
people in small groups and networks they can be an increase in their
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happiness; there can be a cycle where happy people make other people
happy.
Interventions for managing mental health and increasing happiness and
wellbeing exist. For the purposes of giving an alternative example that
targets trauma through positive dialogue we will look at one such
intervention. Loveday, Lovell and Jones (2018) have reviewed the research
for an intervention called Best Possible Selves (BPS) intervention. This
intervention developed by Laura King in 2001 requires people to write
about themselves in the future based on the assumption that things have
worked out as best as possible. This approach contrasts with other forms of
reporting on traumatic events by avoiding a negative dialogue and a revisit
to the trauma. Its positive approach resulted in the same outcomes as those
writing about traumatic events but was reported by the participants as
being less upsetting. This review and this intervention provide an
alternative model for supporting people with difficulties. Allowing people
to consider positive futures to deal with trauma there is scope to increase
wellbeing through mental health interventions. If the same outcomes can
be achieved but the route is a less upsetting then perhaps not only can
people be supported back to happier lives but it can be done in a positive
way. What is also relevant to this topic is the fact that the approach can be
done verbally, allowing young people a more accessible route to receive
support.
THE ROLE OF SOCIAL MEDIA
With social media playing a more significant role in many people’s

lives it is worth considering how social media may or may not be
impacting on ratings of wellbeing. Many studies have looked to compare
different groups against each other, comparing those who use social media
and those that don’t. In response to this a recent study by Orben, Diemlin
and Przybylski (2019) looked at comparing factors within the subjects;
they chose to look at those that already use social media. They used
analysis of over 12 000 10- 15 year olds data from the United Kingdom.
The analysis focused on whether there was an impact on adolescent’s life
satisfaction ratings when they used more social media than they normally
do and whether they use more social media when their life satisfaction
ratings change. Their findings
were ‘trivial in size’. These small changes with regards to social media
behaviour and wellbeing measures were also identified by other
researchers. This study seems to show that wellbeing is not significantly
altered by changes in social media use. Such findings highlight that
research can help to address any common held beliefs such as social media
makes children and young people less happy.
Despite the lack of evidence around social media use and wellbeing
changes, the above did raise a slight question for the researchers. They
noted that there were small effects with females. They found that females
had increases in life satisfaction predicting lower social media use. The
researcher highlighted the need for research to continue to avoid any
reactionary hype which may lead to ineffective and costly policy making.
Moving slightly away from social media and considering internet use
generally, Ying Yang and colleagues investigated the impact that internet
addictive behaviour had on subjective wellbeing for Chinese adolescents.
They found in their 2017 study that there was momentary pleasure from
using the internet but this did not lead to any long term wellbeing. They
found that internet addictive behaviours actually suppressed the positive
relationship between pleasure and wellbeing. They concluded that internet
addictive behaviour negatively impacts on adolescence’s behaviour to find
meaning in their lives.
The area of social media and internet culture is a relevant and current
issue in society. When considering the impact it may or may not have on
young people’s wellbeing it can be difficult to draw general conclusions.
What does appear to be coming from some research is the need to prevent
any alarming and rash reactions to preliminary findings. Equally, there
needs to be more studies using reliable methods to help understand if new
technologies help society’s wellbeing or hinder it.
THE ROLE OF PARENTING IN CHILDREN’S WELLBEING
Considering the impact of parents in wellbeing research we revisit Lan

Chaplin’s 2009 work that has been mentioned previously in the chapter.
Her work found evidence that the relationship between parents and
children is very important. López-Péres and colleagues also found that as
the child
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moves into adolescences the relationship of a close friendship becomes

most important. Finally, López-Péres, Sánchez and Gummerrum draw the
conclusion that younger children may define happiness on the basis of their
relationship with their parent whereas young people and adolescence may
express happiness on the basis of their close relationships with friends.
Therefore, in childhood the need for a positive child-parent relationship is
relevant in the development of happiness.
So, when considering parenting and developing relationships what may be
the crucial factors for building this wellbeing? In the book by Cameron and
Maginn’s: Seven Pillars of Parenting from 2008, the authors are focusing
on what elements parents may provide to their children to promote
wellbeing. The actual Seven Pillars of Parenting include the following:
∙ Care and protection – Sensitivity to a child’s basic needs shows the

child that we care and that the child is important
∙ Secure attachment – Appears to act as a buffer against anxiety and to
operate as a protective mechanism
∙ Positive self-perception – Essential to allow the development of a
positive self-image
∙ Emotional competence – This ability underpins the successful
development of relationships outside the family and may moderate
susceptibility to and propensity for later mental health problems.
∙ Self-management – Prevents inappropriate behaviour when enticing
or compelling outside factors try to intrude.
∙ Resilience – Resilient individuals seem to be able to understand what
has happened to them in life (insight), develop understanding of
others (empathy) and gain control over their life experiences
(achievement).
∙ A sense of belonging – Research on relationships has established
human beings as fundamentally social and highlighted the need to
belong.
This list of ‘pillars’ consists of seven areas that may help in the
development of positive psychological wellbeing. It is noted that the list of
concepts includes areas that have been discussed previously in the chapter.
These include the ideas of positive self-perception, emotional skills and
resiliency. The sample of work shows that parents and carers have a key
role in providing the conditions for developing children’s wellbeing. When
young, children appear to report the importance of their family in gaining
subjective wellbeing. By creating safe and secure environments it seems
that parents’ skills and support can help to ensure children and young
people can feel happiness through childhood.
HUMAN RIGHTS AND THE RIGHT TO BE HAPPY

IN CHILDHOOD
In 1989 The United Nations Convention on the Rights of the Child was
adopted by the United Nations assembly. It is a statement that expressed the
rights of children and came into force in 1992. All United Nations members
have ratified (formally agreed to) the Convention with the exception of the
United States. Although the 54 articles or sections of the convention do not
directly state a right for children to experience happiness, there are a
number of articles that could benefit a child or young person’s life and
therefore lead to an increase in wellbeing. For example, Article 2 focuses
on non discrimination and Article 3 is concerned with the best interest of
the child and young person. Article 6 challenges actions that opposes the
child’s right to life, survival and development and Article 12 is the child’s
right to be heard. These four articles are considered by UNICEF to be the
‘General Principles’ which in themselves help to inform the other articles.
FINAL THOUGHTS
In this chapter the issue of happiness and the challenge of defining this
fundamental idea has been introduced. By providing a possible working
idea of subjective and psychological wellbeing we have shown how
happiness may be linked to hedonistic and eudaimonic types of pleasure
and happiness. Examples of some factors that may increase or reduce
happiness includes relationships, career, health, relationships and
resiliency. In terms of children and young people, there is evidence that
schools and families can
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have an impact on how happiness can be promoted and how young people
may be able to develop more useful thinking and resiliency skills. There
are cultural and developmental issues associated with reporting of
happiness. Positive mental health is an important area to consider in
developing happy children and young people. Social media has a role to
play too, but this may be an on-going and evolving factor. Finally, there
are key documents and world-wide endeavours to ensure the promotion
and maintenance of happiness for children and young people.
It has been stated previously in this chapter that society may be judged
and measured on how it responds to the needs of its people. To finish, it is
argued that the happiness of all, including children and young people, is a
relevant and meaningful responsibility. For the next generation of the world
observing and taking note of their happiness seems a worthy endeavour, on
an ethical, political and humanistic perspective.
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UNICEF Office of Research (2013). Child Well-being in Rich Countries: A
comparative overview. Innocenti Report Card 11, UNICEF Office of
Research, Florence.
Chapter 2
WORKING WITH UNHAPPY CHILDREN WHO

HAVE ADVERSE CHILDHOOD EXPERIENCES
Maria A. Efstratopoulou
Alcoholism causes physical and emotional health problems. The person

with alcohol and/or drugs addiction experiences the brunt of the physical
problems, but people who are close to them often share the emotional side
effects of the person’s addiction. Family members of alcoholics can
experience anxiety, depression and shame related to their loved one’s
addiction. Family members may also be the victims of emotional or physical
outbursts. A person addicted to alcohol may try to shield their family from
the impact of alcohol abuse by distancing themselves. Unfortunately,
isolation does little to protect family members from the financial and
emotional side effects of alcoholism. Neglect can also have a negative impact
on loved ones. Alcohol abuse and alcoholism can have devastating impacts
on families. Children of alcoholics may be at risk for academic and
psychiatric problems. Therapy and counselling can aid families affected by
alcohol abuse issues.
CHILDREN LIVING WITH SUBSTANCE MISUSING PARENTS
Alcohol abuse has the potential to destroy families. Research shows

that families affected by alcoholism are more likely to have low levels of
28 Maria A. Efstratopoulou
emotional bonding, expressiveness and independence. Couples that include

at least one alcoholic have more negative interactions than couples that are
not affected by alcoholism, according to research. Relationships are built on
trust, but many alcoholics lie or blame others for their problems. They are
often in denial about their disease so they minimize how much they drink or
the problems that drinking causes. This deterioration of trust damages
relationships and makes family members resent one another.
Child protection cases that feature in the UK media are reminders of
how babies and children can be vulnerable to harm from parents and other
adults, and how frequently these cases involve binge or chronic substance
use. According to the Advisory Council on the Misuse of Drugs (ACMDs)
“Hidden Harm” report, parental drug use can compromise a child’s health
and development from conception onwards. Parental substance misuse has
been associated with genetic, developmental, psychological, psychosocial,
physical, environmental and social harms to children. The unborn child
may be adversely affected by direct exposure to alcohol and drugs through
maternal substance use. The risk of harm however, depends on the age of
the child, the nature and patterns of substance use and contextual factors in
which the substance use occurs. Social deprivation and the financing of
drug or alcohol consumption may restrict money allocated to meet basics
needs for the child. Inadequate monitoring, early exposure to substance
taking behaviours, modelling behaviour and the failure to provide a
nurturing environment can result in maladaptive and dysfunctional
behaviour and other poor outcomes for the child.
Alcohol addiction can make parents impulsive and unstable. Their
parenting skills diminish as the problem progresses and tend to interact
with children in inconsistent ways, sending mixed signals
The potential for harm is not likely to be limited to dependent substance

use. Binge drinking or regular non-problematic drug use can affect a
person’s control of emotions, judgment and ability to respond to situations,
particularly during periods of intoxication and withdrawal. Being under the
influence of substances may affect parental responsiveness to the physical
or emotional needs of a child. For example, while parents recover from a
hangover, babies and young children may be under-stimulated, whilst older
Working with Unhappy Children … 29
children may carry the burden of household responsibilities and caring roles
for siblings. Research attempting to unveil the types of harm associated
with parental substance misuse is largely restricted to retrospective cohort
studies. Much of this work has attempted to identify adverse childhood
experiences (ACEs) in the context of parental alcohol misuse among
unhealthy/addicted adult populations. Exposure to parental alcohol abuse is
highly associated with ACEs. Compared to persons reporting no ACEs, the
risk of heavy drinking, alcoholism and depression in adulthood is
significantly increased by the presence of multiple ACEs. A study
examining ten ACEs (childhood emotional, physical, and sexual abuse,
witnessing domestic violence, parental separation or divorce, growing up
with drug abusing, alcohol abusing, mentally ill, suicidal, or criminal
household members) found that the risk of having all of these was
significantly greater among adult respondents who reported parental alcohol
abuse. Due to its sensitive nature and parents’ fear of social services
involvement, it is extremely difficult to conduct research to answer these
questions. We are yet to determine the effects parental heavy drinking
episodes and recreational illicit drug use have on children.
The latest drug strategy document for England estimates that there are
around 330,000 problem drug users in England - the majority of whom are
of parenting age. The document places heavy emphasis on reducing the risk
of harm to children of drug-misusers, expressing a commitment to
addressing the needs of parents and children by working with whole
families to prevent drug use and reduce risk. In terms of the prevention
agenda, it aims to promote the sharing of information across institutions
e.g., ensure children’s social services are aware of drug-using parents
where children could be at risk and promises to ‘expand their approach so
that it increasingly focuses on young children and families before problems
have arisen’. Linked to this is a commitment to take a ‘wider preventative
view’ focusing on all substances including alcohol misuse. Regarding
treatment, the aims are to prioritise cases causing the most harm to
families, by ensuring prompt access into effective treatment, assessment of
family needs and intensive parenting support. It also aims to ensure that
drug-misusing parents become a target group for new parenting experts,
with Family Intervention Projects for families considered to be ‘at-risk’.
When it comes to estimating the number of children at risk of harm
from parental substance misuse, two sources are used as the
epidemiological data on which the above targets are centred. The ACMD
Report "Hidden Harm" estimated there are between 250,000 - 350,000
children of problem drug users in the UK, representing 2-3% of all under-
16 years old, and the 2004 Alcohol Harm Reduction Strategy for England,
estimated there being 780, 000 - 1.3 million children living with adults
with an alcohol problem. There are, however, limitations with both of these
estimates.
The number of children estimated to be living with drug- misusing
parents is an extrapolation of treatment data alone, that is, records of drug
users presenting for treatment until the end of 2010. There is a concern that
women are less likely to access treatment, yet more likely to reside with the
child, therefore this could be an underestimate of the true number. It is
unclear how alcohol problems were defined and if they relate to the UK
definitions of misuse. It appears to reflect drinking at a level considered in
the UK as hazardous in one of the surveys. Thus, the existing estimates
used to inform current UK policy and setting of targets for the next decade
are dated, not based on local epidemiological data sources, and need
improving and broadening to include the combination of alcohol and other
co-existing problems that can lead to adversity.
In contrast to considerable policy investment in addressing the needs of
children living with substance misusers and in identifying good practice,
the underlying epidemiological evidence has fallen short. For policy and
commissioning responses to adapt to meet the needs of both parental
substance misusers and their children, we first need to understand the nature
and scale of the problem. Without knowing the number of potentially at-
risk families, we are unable to assist them until they come to the attention
of agencies at crisis point. The current study set out to update, improve and
broaden earlier estimates to include alcohol, drugs and multiple/elevated
risk factors of harm e.g., concurrent mental distress and substance use. This
was achieved through secondary analysis of existing national household
surveys which have captured relevant data. Attempts to generate new data
to answer this research question are likely to be hampered by social
desirability effects, thus generating unreliable estimates.
NATIONAL SURVEYS PROVIDED APPROPRIATE DATA
A few years ago, a National Survey in the UK attempted to access the

problem and provide appropriate data. Five surveys were considered to
assess the bigger picture in UK and Scotland; the General Household
Survey (GHS), the Household Survey for England, (HSfE), the National
Psychiatric Morbidity Study (NPMS), the British Crime Survey (BCS),
and the Scottish Crime Survey (SCS). The GHS and HSfE household
surveys were conducted around the same time and used the same measures
of alcohol consumption (including indicators of binge drinking), although
weekly consumption could only be calculated for a sub-sample (those
reporting that they drink the same amount each day). Respondents had
been asked "which day in the last week did you drink the most?" and were
then asked to list how many of each type of alcoholic beverage they had
consumed on this day. Each recorded beverage was converted into units of
alcohol and summed to provide total units consumed on that day.
The UK Government definition of binge drinking was calculated for the
sample, i.e., 6 or more units in a single drinking occasion for women and 8
or more units for men. This is above (twice) the maximum recommended
daily benchmark, stating that ‘regular consumption of 2-3 units a day for
women and 3-4 units a day for men does not lead to significant health risk’.
The researchers adopted the government’s definition of binge drinking as
an accepted UK convention - this is not to imply that there is parental risk
for all drinkers meeting these criteria, nor, indeed that there is no substance
related parenting risk in those who do not reach these thresholds. The
NPMS contained data on problematic (hazardous, harmful and dependent
drinking). Hazardous drinking (a pattern of alcohol consumption that
increases the risk of harmful consequences for the user or others) was
defined as a score on the Alcohol Use disorders Identification Test of 8 or
more. Harmful drinking (consumption that results in consequences to
physical and mental health) was defined as a score of 16 or more. The
Severity of Alcohol Dependence Questionnaire was used to identify
alcohol dependence in this survey. The two crime surveys and the NPMS
were used to examine illicit drug use, the NPMS to look specifically at
cumulative risks and the SCS to look at examples of harm resulting from
substance misuse in the household.
What Do the Findings Suggest?
Overall, the figures suggest that the number of children living with at
least episodic binge drinkers or illicit drug users is greater than previously
thought. In 2014, 3.3 - 3.5 million children in the UK were living with at
least one binge drinking parent. Having a non-binge drinking adult in the
household offers a positive role model, and can mitigate against harm
caused by the problem-drinking parent. Therefore, the near half a million
children living with a lone-binge drinking parent and the 957,000 children
with two binge-drinking parents could be more vulnerable to harm. Whilst
there is no evidence to suggest that parental binge drinking is associated
with harm to children, adults in this category were ‘at least’ binge drinking.
Some would have been problem drinkers and there is literature emerging to
suggest that problem drinking is associated with childhood adversity.
Whilst the data does not imply that these children experience adverse
consequences, the potential for exposure (assuming it occurs in the home)
to modelling heavy drinking behaviour exists, as does neglect and less
adequate parental responses to accidents and emergencies (child injuries,
fires and other adverse events which are more likely to occur in the event of
intoxicating substance use). These new estimates complement the existing
estimates on treated addiction populations and add to what we know.
Unfortunately, however, they remain a long way from what we need to
know. Around one million children in the UK live with an adult who has
used an illicit drug in the past year, and just under half a million children
live with someone who has done so in the past month. It is not possible to
directly compare with the Hidden Harm estimates since they are generated
from different populations, and using different methodologies. It is
plausible that illicit drug use could constitute smoking cannabis when the
drug user does not have responsibility for child care, thus posing no acute
risk of harm.
Parental experience of blunted emotions/feelings, anxiety or
depression in addition to substance use may restrict the child’s social and
recreational activities
It could be argued that any drugs use can create a social learning model,
and that regular use may result in chronic effects that are more likely to
compromise parenting capabilities. Equally, however it could constitute

regular use of cocaine or heroin in the home environment, where the child
could be exposed to drug taking behaviours, paraphernalia, dealers, and the
potential to ingest or experiment with the drug. The finding that the number
of children living in a household where the only adult was a drug user had
more than doubled between 2010 and 2015, points to increasing
vulnerability in single-parent families and highlights the need for child
protection efforts to determine need, as well as risk.
The finding that 334,000 children were estimated to be living with a
dependent drug user is broadly consistent with the Hidden Harm estimate
relating to treated drug users. The finding that 107,000 children lived with
an adult who had experienced a drug overdose, is an indicator of the
possible severity of drug misuse among this predominantly untreated
population. Given that it is estimated that there are 116,809 injecting
heroin or crack cocaine users in England alone in 2016/7, the current
estimate of only 72,000 children living with an injecting drug user in the
UK is low and may reflect a reluctance to disclose injecting behaviour in
the context of household surveys. The potential for cumulative
disadvantage for children living with adults with multiple problem
behaviours is a particular concern as co morbidity has been linked to less
effective treatment engagement and additional difficulties in parenting.
Parental mental illness featured in one third of 100 reviews of child deaths
of abuse and neglect.
Parental substance misuse was a concern for 52% of families placed on
child protection registers and for 62% of children subject to childcare
proceedings. Therefore, the risk of harm to children of parents with co
morbid substance misuse and mental health problems is likely to be even
greater. Parental experience of blunted emotions/feelings, anxiety or
depression in addition to substance use may restrict the child’s social and
recreational activities. Finally, the observation that large numbers of
children have witnessed violence occurring in the context of substance
misuse is a major concern for both teachers and child protection agencies.
Growing Up in an Alcoholic Household Can Be a Lonely, Scary and

Confusing Experience
It is often said that alcoholism is a family disease, because the entire
family unit and every member who is part of it suffers. Alcoholism takes an
especially high toll on children, who often carry the scars associated with
an alcoholic parent’s drinking well into adulthood. It is ‘estimated that
more than 28 million Americans are children of alcoholics, and nearly 11
million are under 18 years of age. Growing up in an alcoholic household
can be a lonely, scary and confusing experience, and research shows it
impacts nearly every aspect of a child’s existence.
Children who are raised by a parent with an alcohol addiction are more
likely than other children to experience emotional neglect, physical neglect
and emotional and behavioural problems. They are also more likely to do
poorly in school and have social problems. Approximately 50 percent will
develop an alcohol addiction later on in their own life.
Birth Defects
Babies whose mothers consume alcohol while pregnant can develop an
array of physical and mental birth defects. Collectively known as foetal
alcohol syndrome disorders, this group of conditions can range from mild
to severe. At the most severe end of the spectrum, foetal alcohol syndrome
can include a constellation of physical defects and symptoms and
behavioural issues. Children with FAS often have small heads and
distinctive facial features, including a thin upper lip, small eyes and a short,
upturned nose. The skin between the nose and upper lip, which is called the
philtrum, may be smooth instead of depressed.
Children with FAS may also suffer from vision and hearing difficulties,
deformed joints and limbs, and heart defects. The disorder can also affect
the brain and central nervous system, causing learning disorders, memory
problems, poor coordination and balance, hyperactivity, rapid mood
changes and other problems. Nearly 8 percent of women in the United
States continue drinking during pregnancy, and up to 5 percent of new-
borns suffer from foetal alcohol syndrome. These children have a 95
percent chance of developing mental health problems such as anxiety and
depression. They also are at high risk for Attention Deficit/Hyperactivity
Disorder, substance abuse and suicide.
POOR SCHOOL PERFORMANCE
Children of alcoholics tend to struggle more in school than other

children. Studies show that children with alcoholic parents tend to perform
worse on tests and are more likely to repeat a grade. They are also more
likely to truant, get suspended and drop out of school. Behavioural
problems in school — such as lying, stealing and fighting — are common,
and children from alcoholic households tend to be more impulsive than
other kids. These problems often start early. Children with alcoholic
parents tend to have poorer language and reasoning skills, according to the
National Association of Children of Alcoholics. While the cognitive
deficits observed in some children of alcoholics may be related to FASDs,
environmental factors also appear to have an influence. The chaos and
stress of their home environment, in particular, can make it hard for a child
to stay motivated and organized — two ingredients that are vital to
academic success.
Emotional Problems
Alcoholic households are often chaotic and drama-filled. Daily life with
an alcoholic parent is highly unpredictable and unreliable. Many alcoholic
households are also often violent. Having an alcoholic parent increases a
child’s risk of being physically sexually or emotional abused, according to
the Centers for Disease Control and Prevention’s Adverse Childhood
Experiences study. Emotional neglect is common in an alcoholic
household. Sadly, a parent in the throes of addiction is simply unable to
provide the consistent nurturing, support and guidance their child needs and
deserves. In addition, all too often, the parent who is not an alcoholic is too
swept up in their spouse’s disease to meet the child’s needs. These
dysfunctional family dynamics and trauma exact a heavy psychological toll
on the child, who may respond to these stressors in different ways.
Some retreat, withdrawing into their own world. These children may
have few friends and may be depressed. Others may live in denial —
pretending nothing is wrong. This is often a learned behaviour in alcoholic
households, where the entire family strives to keep the parent’s addiction
secret. Some children react to all the chaos and confusion by becoming
hyper-responsible. These “parentified” children often end up taking care of

the alcoholic parent, the household, neglected siblings and themselves.
Unfortunately, these children often end up having trouble setting healthy
boundaries in relationships and can end up struggling with issues of co
dependence for years to come.
Domestic violence is the intentional use of emotional, psychological,
sexual or physical force by one family member to control another.
Victims who struggle with addictions face significant barriers to receive
treatment
Feelings of confusion, vulnerability, shame, guilt, fear, anxiety and

insecurity are all common among children of alcoholics. Many of these
children go on to develop symptoms of post-traumatic stress disorder as
adults. Children of alcoholics are four times more likely than other children
to develop an alcohol addiction. While about 50 percent of this risk has
genetic underpinnings, the actual home environment also plays a role.
Research shows that a child’s risk of becoming an alcoholic is greater if
their alcoholic parent is depressed or suffers from other co-occurring
disorders. Their risk also goes up if both parents are addicted to alcohol
and other drugs, if the alcohol abuse is severe and if there is violence in the
home.
Children of addicted parents experience greater physical and mental
health problems and generate higher health and welfare costs than do
children from non-addicted families. Inpatient admission rates and average
lengths of stay for children of alcoholics are 25-30% greater than for
children of non-alcoholic parents. Substance abuse and other mental
disorders are the most notable conditions among children of addiction. It is
estimated that parental substance abuse and addiction are the chief cause in
70-90% of all child welfare spending.
Children of addicted parents have a higher-than-average rate of
behaviour problems. Studies comparing children (aged 6-17 years) of
alcoholics with children of psychiatrically healthy medical patients, found
that children of alcoholics had elevated rates of ADHD (Attention Deficit
Hyperactivity Disorder) and ODD (Oppositional Defiant Disorder)
compared to the control group of children. Research on behavioural
problems demonstrated by children of alcoholics has revealed some of the
following traits: lack of empathy for other persons, decreased social
adequacy and interpersonal adaptability, low self-esteem, and lack of

control over the environment. In addition, research has shown that children
of addicted parents demonstrate behavioural characteristics and a
temperament style that predispose them to future maladjustment.
Research Findings on Academic Achievement
∙ Children of addicted parents score lower on tests measuring school

achievement and exhibit other difficulties in school.
∙ Sons of addicted parents performed worse on all domains measuring
school achievement, using the Peabody Individual Achievement
Test-Revised (PIAT-R), including general information, reading
recognition, reading comprehension, total reading, mathematics and
spelling.
∙ In general, children of alcoholic parents do less well on academic
measures. They also have higher rates of school absenteeism and
are more likely to leave school, be retained, or be referred to the
school psychologist than are children of non-alcoholic parents.
∙ In one study, 41% of addicted parents reported that at least one of
their children repeated a grade in school, 19% were involved in
truancy, and 30% had been suspended from school.
∙ Children of addicted parents were found to be at significant
disadvantage on standard scores of arithmetic compared to children
of non-addicted parents.
∙ Children of alcoholic parents often believe that they will be failures
even if they do well academically. They often do not view
themselves as successful.
TOOLS FOR TEACHERS TO HELP
All too often, alcoholism and other drug addictions become a family
legacy. More than fifty percent of today’s addicted adults are children of
alcoholics, and there are millions challenged by other problems that result
from alcoholism or drug addiction in their families. It is essential to spare

children from unnecessary years of silence, shame, and suffering caused by
parental addiction. Through effective prevention measures, educators can
play a major part in this process. Individually and collectively, we can be a
voice and a steadying force for children who can’t always speak for
themselves. The tools educators can use to encourage this process are: age
appropriate information, skill building, and the bonding and attachment
derived through healthy relationships.
Accurate, Age-Appropriate Information
The alcoholic home front is armoured by denial, delusion, and the “no
talk” rule. Consequently, children of addicted parents don’t always
understand what is happening in their families and, not surprisingly, some
believe that it’s all their fault. The predominant feeling for many children
isn’t sadness, anger, or hurt; it is overwhelming confusion. Children of
alcoholics need accurate information about alcohol, other drugs, and the
disease of alcoholism. By learning about denial, blackouts, relapse, and
recovery, young people can make better sense of what’s happening at
home. They may also come to see that they are not to blame and that they
can’t make it all better. Providing children with these important facts in an
age
appropriate manner is crucial, so they are not overwhelmed, burdened, or
further confused.
Skill Building
Children of alcoholics and other drug-dependent parents are at greater

risk for many behavioural and emotional problems. Empowering them with
a variety of life skills helps them cope with many challenges. For example,
some children face difficult situations with family violence, neglect, and
other stress. These children can learn a variety of coping and self-care
strategies to stay safe. Some of these children may allow their feelings to
build up inside until they are ready to explode or become sick with stomach
aches and headaches. The educator can teach them how to identify and
express their feelings in healthy ways, especially by finding safe people

they can trust. Others may lack confidence and self-esteem. These young
people can learn to love and respect themselves through experiences in
which they can succeed and thrive. Studies on resilience have confirmed
the importance of skill-building activities for children living with
adversities such as alcoholism in the family. Resilience research examines
various protective factors which allow individuals to overcome the odds
and bounce back
Bonding and Attachment
While accurate, age-appropriate information and skill building help

children of addicted parents immeasurably, perhaps the most important gift
is the bonding and attachment children attain in healthy relationships with
others. As a result of broken promises, harsh words, and the threat of abuse,
children in many families learn the “Don’t Trust” mantra all too well;
silence and isolation can become constant companions. These children
grow up to become parents who, without help, carry their childhood with
them. As a teacher, you may be faced with parents at conferences who are
unsure of themselves, feel guilty, or are constantly stirred by
remembrances of their childhood. Your assurance and validation will help
them.
Building trust is a process, not an event. Time is key. An educator’s
words take on added meaning and significance as the youngster deeply
considers the source. A child may hear accurate information about
alcoholism and other addiction in a brand new way. Moreover, a child can
build upon his or her strengths and resilience as a result of the conscious
modelling provided by the caring adult. As children learn to trust, they
learn to feel good about who they are and what they can become. They
develop the ability to make better decisions that help them to gain control
over their environment, so they are more self-reliant. Learning to trust
lowers their anxiety and shame, and then they can be taught more
effectively.
There are physical symptoms which may reflect serious home
problems; for example, chronic fatigue, confusion, or emotional strain
ADDITIONAL SUGGESTIONS FOR EDUCATORS
There are at least three ways you as an educator can help a child whose
parent is dependent on alcohol or other drugs.
Be an Effective Listener and Communicator
This means helping your students to express their feelings and thereby
deal with their fears and aspirations. One of the more unfortunate problems
experienced by some children of addicted parents is that they have no one
to talk with about their needs, fears, and hopes. With certain restrictions,
every educator can help students talk about what they like and dislike
about their lives. However, it is important to know when assistance from
other professionals is necessary. It is crucial that you know your
competencies and your limitations.
Knowing Your Limitations
You must consider your school’s policies and legal, ethical, and
professional obligations as well as your competencies in deciding what you
should and should not do with students. It is very important that you seek
assistance in areas where you are not authorized to function. If you are not
employed as a therapist, then you should not try to act as one. If there is any
doubt about the severity of a student’s personal or social problems, there
are usually counsellors, school psychologists, or school social workers
available who will gladly offer their assistance.
A valid concern may be how the parents will react when they learn that
their child has confided a family problem to someone outside the family.
Will an irate addicted parent come to school complaining that you have
interfered in their family’s private business? If you limit your discussions
with a student to the student’s feelings and to an understanding of how
alcoholism and addiction affect a family, there probably will be no cause
for parental concern. Furthermore, if you take care to avoid communicating
that
the student’s difficulties are related to his or her parent’s alcoholism/

addiction, and instead direct attention to the student’s school and social
performance, the parent is very likely to welcome your help. Alcoholism/
addiction is unlikely to be a part of a discussion with parents. In part, this is
because denial of drinking-related problems is essential to those alcoholic
parents who want to continue drinking. In addition, the spouse of the
alcoholic may feel the need to refrain from talking about drinking-related
difficulties. If the topic comes up, it may be best for you to remain silent on
the subject of the parent’s drinking or drug use.
ESTABLISHING INTERACTIONS
In attempting to establish group interactions, keep in mind that many

children of alcoholics and other drug-dependent parents may find it difficult
to make new friends. Many are very withdrawn or are complete loners.
Although professional educators may be aware of the benefits to be derived
from peer relationships, their skills will be tested to prove such benefits to a
student who has never had friends. The student, for example, may take the
advice to seek out friendships and confide in a peer who does not
understand or, worse, one who ridicules the student. Structured adult-
facilitated support groups can mitigate such results. If group discussion
appears to be too formal or stigmatizing, a walk-in centre for students may
prove workable. A walk in centre can serve multiple purposes by dealing
not only with home life but also with students’ many other problems. Such
a centre could serve not only as a place for activities and discussions, but
also as a place to obtain information on a variety of subjects ranging from
alcohol and drug use to whatever else concerns them. Remember, whatever
activity is fostered, the purpose of that activity is to assist students; it
should not be used to attempt changes in the students’ home environments.
Perhaps your greatest contribution will be helping students discover that
their feelings are normal and that it is permissible to be confused and
sometimes upset about one’s home environment. Exploring a student’s
feelings with him or her can help you to obtain a better understanding of
the student. More importantly, an exploration of feelings may allow the
student to grow in self-understanding.
Carefully Observe Each Child and Situation
What you learn by direct observation can be especially useful in

pinpointing where the child needs the help that you can provide.
Counsellors, school nurses, and coaches often have a special advantage of
observing conditions about which the students, their families, or other
professionals need to know. When you are with students, of course, you
need to be very observant if you are to help them understand their
conditions. You may observe many details that will give you clues about
their peer relationships, academic interests, achievements, their need to talk
to you or some other trusted adult about their problems, their willingness to
share attitudes and confidences, and their evaluations of their home
situation. This last concern will probably be difficult for you to explore
and, in the beginning, may be reflected more in how they act than in what
they say.
If child abuse or neglect is suspected, the law requires immediate
referral of the student in question to an appropriate child protection
service
When you are near students, you should be sensitive to a number of

things. Among these are physical symptoms which may reflect serious
home problems; for example, chronic fatigue, confusion, or emotional
strain. Although educators should be alert to these symptoms, health care
professionals can play an especially important role in making valid
observations about students whom they suspect have health-related
problems stemming from home lives. Because of their training in health,
nurses, health educators, and physical education staff can detect subtle
details of a student’s appearance beyond the obvious bruises that might
suggest parental abuse or neglect. If child abuse or neglect is suspected, the
law requires immediate referral of the student in question to an appropriate
child protection.
Students suffering symptoms of strain are usually more noticeable to
health workers than to others. School health workers also are aware of
students who have frequent headaches, high levels of anxiety, and constant
fatigue. Collaborating with these staff colleagues for the benefit of children
of addicted parents could be very helpful. Besides obvious physical abuse
and neglect, educators should notice when students exhibit symptoms of

excessive fatigue or strain.
These symptoms may be more obvious on certain days than on others.
For children of alcoholic parents, these patterns are likely to reflect the
occurrence of conflict within the home. For example, if an alcoholic parent
is a chronic weekend drinker, every Monday the child may be listless or fall
asleep in class. On Tuesdays through Thursdays the student may appear to
be somewhat energetic, and on Friday he or she may exhibit high levels of
tension, possibly dreading the coming weekend. Of course, different
patterns can occur. If your in-service programme on children of addicted
parents includes staff trained on signs of alcoholism, they will be able to
alert you to other symptoms produced by living in a family with
alcoholism. It is important that you remain alert to the needs of your
students. If you are accurate in your observations, you can be of
considerable help to them. Your accurate observation of students may
allow you opportunities to inform parents and colleagues about what they
can do to help students and when referral to professional counsellors may
be needed.
BIBLIOGRAPHY
Forrester, D., & Harwin, J. (2008). Parental Substance Misuse and Child
Welfare: Outcomes for Children Two Years after Referral. British
Journal of Social Work, 38:1518-1535.
Huizink, A.C., & Mulder, E. J., (2016). Maternal smoking, drinking or
cannabis use during pregnancy and neurobehavioral and cognitive
functioning in human offspring. Neurosciences Behavioural Reviews
Journal, 30, 24-41.
Manning, V., Best, D., Faulkner, N., & Titherington, E. (2009). New
estimates of the number of children living with substance misusing
parents: results from UK national household surveys. Bio Med Central
Public Health, 9:377 doi:10.1186/1471-2458-9-377.
National Centre on Birth Defects and Developmental Disabilities Centers
for Disease Control and Prevention Department of Health and Human
Services. Foetal Alcohol Syndrome: Guidelines for Referral and
Diagnosis: National Task Force on Foetal Alcohol Syndrome
and Foetal Alcohol Effect; 2004. http://www.cdc.gov/ncbddd/fas/
documents/FAS_guidelines_accessible.pdf.
NOFAS-UK (The National Organisation for Foetal* Alcohol Syndrome
UK) http://www.nofas-uk.org/
Roberts G., & Nanson J. (2003). Best practices foetal alcohol
syndrome/foetal alcohol effects and the effects of other substance use
during pregnancy. Ottawa: Health Canada.
Chapter 3
AM I UNWANTED?
WHO ARE EXPERIENCING BULLYING
Maria A. Efstratopoulou, PhD

ABSTRACT
Childhood bullying is a major risk factor for health, educational

attainment and social relationships. Bullied children are twice as likely as
non-victims to suffer from psychosomatic problems, such as headaches,
abdominal pain, sleeping problems, poor appetite and enuresis. They are at
increased risk of psychiatric disorders including depression, eating disorders,
self-harm and suicidal behaviour. They also have high rates of poor academic
performance resulting from absenteeism and worries at school. Experience of
bullying victimization is one of many possible determinants of suicidal
ideation and suicide-related behaviours. Bullying – an aggressive behaviour
that is intentional, repeated, and involves a power imbalance – is a major
public health concern. Despite the efforts of schools to prevent or stop
bullying, bullying is still highly prevalent worldwide.
Childhood bullying is a major risk factor for health, educational

attainment and social relationships. Bullied children are twice as likely as
non-victims to suffer from psychosomatic problems, such as headaches,
abdominal pain, sleeping problems, poor appetite and enuresis. They are at
increased risk of psychiatric disorders including depression, eating
disorders, self-harm and suicidal behaviour. They also have high rates of
poor academic performance resulting from absenteeism and worries at
school.
Bullying is a systematic abuse of power characterised by repeated
psychological or physical aggression with the intention to cause distress to
another person. Over half of young people (55%) report having recently
been bullied, with 10–14% experiencing chronic bullying lasting for more
than six months. Bullying occurs at similar rates across all socio-economic
strata with both minority ethnic and white youths reporting comparable
levels of victimisation.
Although often perceived as a school-based problem, bullying is
increasingly community-based. Social networking sites and smartphones
have brought with them a new phenomenon – cyber-bullying, which can
happen at all times and in all places. Recent figures show that 15% of 15
year old in the UK have experienced cyber-bullying. Girls are more likely
to experience psychological, emotional and cyber-bullying, whereas boys
are more likely to be physically bullied. Over 16,000 young people in the
UK aged 11–15 years are estimated to be absent from state school with
bullying as the main reason, and a further 78,000 are absent where bullying
is one of the reasons given. The adverse consequences of childhood
bullying continue into adulthood leading to substantial health and wider
societal costs. This includes difficulties with employment and social
relationships, and mental health consequences such as general anxiety
disorder, panic disorder, agoraphobia, depression, and suicidal acts.
GIRL VS BOY: THE DIFFERENT TYPES OF BULLYING
It is a sad fact that most young people experience bullying at some

stage. However, while boys and girls are equally likely to be on the
receiving end, for a girl it’s more often hidden to the casual observer. That
is why it’s
Am I Unwanted? 47
important for parents to recognise the signs of bullying among girls and be
aware of its dangers.
What are the key differences between the way girls and boys bully or
experience bullying? With girls, bullying tends to be subtle. It’s more likely
to involve social bullying tactics such as ostracism, alienation and rumor
spreading than face-to-face verbal bullying. Girls are more likely to engage
in premeditated bullying, whereas with boys, bullying tends to be more
opportunistic psychological or emotional bullying. With boys, bullying is
more likely to be physical.
Some boys like the status that comes with getting involved in fights.
Girls are more likely to be involved in surreptitious and psychological
bullying (such as hurting feelings) rather than physical bullying. Girls may
be bullied by both other girls and boys. Boys, in contrast, are more often
bullied only by boys. When bullying is physical, adults tend to react
quickly. With a girl bully, because the bullying is more likely to be
psychological, it can be harder to spot – but it’s just as important to act.
‘With boys there might be aggression, punching. With girls, it is covert.

It is about reputations, freezing individuals out, excluding them from the
social group.’
Social Bullying Tactics: Peer Exclusion
This is extraordinarily undermining – and therefore effective from the

bully’s point of view – because in a young person’s world, social
relationships matter more than anything. A young girl is wired to connect,
so anything that hinders or threatens this is a massive blow.
If a girl is being squeezed out of her social circle by a bully or bullies, it
will overshadow everything else in her life. To you, as a parent, it may
seem like an overreaction, but all your girl wants is to be part of a gang of
friends – they’re the center of her universe and what make her life worth
living (she thinks).
Girls’ Bullying Focuses on Physical Appearance
Young people worry greatly about fitting in, so it’s not surprising that
girls’ bullying often focuses on looks, especially looking ‘different.’ A
study in the UK found 56% of girls had been picked on because of their
weight, body shape, height or hair colour. Because girls care so
passionately about fitting in and being part of their social group, being
bullied about their appearance can hit them especially hard. Research has
found that being bullied, even infrequently, raises the risk of depression in
girls, whereas with boys the risk is only raised if the bullying is frequent.
The research also found that girls who are bullied are more at risk of
engaging in substance use.
Another heart-breaking finding from the study was that girls who had
been bullied then consequently refused to believe nice things said about
them – especially about their looks. Being a victim of bullying is
devastating for girls’ self-esteem. It’s important as a parent to be aware of
what’s going on in your daughter’s life. How are her friendships
developing? Is she being kind to others and receiving the kindness she
deserves from them?
Friends or ‘Frenemies’? Spotting the Signs of Bullying
‘Frenemies’ is the name given to people who might pretend to be a

friend, when in fact they undermine others’ self-esteem and positive body
confidence – often because they’re lacking in self-confidence themselves. It
can take a while to realise that a girl who appears to be a friend is actually
working against you and is perhaps, in an indirect way, herself a bully.
Teasing and Taunts
What were the most common taunts when you were young? “Four eyes,”
“freckle-face,” “tubby”? Most of the names we remember being called as
kids are related to looks. Sadly, not much has changed. A UK government
study by Ofsted called No Place for Bullying found that today’s pupils
most commonly experience bullying related to appearance. In
Am I Unwanted? 49
primary schools, bullies focus on physical traits such as red hair, or being
tall or small, or “fat” or “skinny.” In secondary schools, other aspects of
appearance come under attack – clothes, hairstyles and accessories that
don’t conform to the latest trends.
Girls and boys often disagree, fight, tease and banter with their friends.
But bullying is different. According to the US Government’s Stop Bullying
website, it is “unwanted, aggressive behaviour among school aged children
that involves a real or perceived power imbalance. Bullying includes
actions such as making threats, spreading rumours, attacking someone
physically or verbally, and excluding someone from a group on purpose.”
What Are the Signs of Bullying?
How can you tell if your child is being bullied? Parents should be
aware of the following indicators:
∙ Change in behaviour or emotional state – are they suddenly more

withdrawn or aggressive than usual?
∙ Physical signs – such as cuts, bruises or damaged clothes ∙ Avoiding
school – making excuses and feigning illness ∙ Lack of interest –
especially in the things your child normally enjoys ∙ Some signs may
indicate bullying specifically about looks. For example, your child:
∙ Changing the way they dress or look – maybe trying a drastically
different hairstyle or stopping wearing glasses
∙ Attempting to cover up their size – perhaps by wearing baggy,
shapeless clothes
These signs can be just a normal part of growing up, though. So instead
of jumping to conclusions, encourage your child to open up to you.
TALKING TO YOUR CHILD ABOUT BEING BULLIED
If you are agonising over the best way to talk to your child, it is best to
approach them honestly. “You don’t have to mention bullying to start
with,” she advises. “Instead, try something like: ‘I’m worried about you, I
think you’re unhappy.’”
Alternatively, you could start a conversation in a more neutral way by
asking questions about your child’s day. For example, “What was one good
thing that happened to you today? Any bad things happen? Did you sit with
friends at lunch?” Let your child know you are there to help – but be clear
that you can only do so if you know what is happening. If they insist,
nothing is going on, do not push the issue, but treat it as a warning flag to
keep looking for signs.
From Talking to Taking Action
Dealing with bullying can take time, so be patient and understanding.

Show your child you’re there to support them, and offer reassurance that
there’s no need to change their appearance. Find a way to tackle the
bullying together using the action checklist below.
More Than Half of Young Women Are Bullied at School Because
of How They Look
Some youngsters miss months of education to avoid their tormentors,
according to the survey. Researchers spoke to girls in England and Wales,
between the ages of 15 and 22. They found 56 per cent were abused
verbally, physically or online because of their weight, height or hair colour.
Only one in five said they were personally happy with their appearance,
and 53 per cent said they had since gone on a diet, according to the
research.
‘All bullies are cowards, but persecuting the weakest takes a special kind
of nastiness.’
It was heartbreaking to learn that young women had been punched and
kicked simply because they could not afford the best clothes, or humiliated
Am I Unwanted? 51
on the internet due to their size. Just over half of young women who were
bullied said they played truant from school, with one girl missing six
months of education and her exams. The main reason for bullying was
weight, followed by hair colour - almost entirely girls with red hair. Other
reasons included height, clothing and racism.
About 40 per cent said they missed meals to get thinner, and 17 per
cent said they had been on a diet since the age of 12 or younger. More than
60 young women were surveyed. Of these, six said they had either taken
laxative pills or made themselves sick to keep their weight down. Bullied
girls refused to believe nice things said about them. Although 91 per cent
said their families and friends called them beautiful, one 17-year-old girl
from London said: ‘Even if a Celebrity walked into the room and told me I
was gorgeous, I still wouldn’t believe it.’
‘The demonization of young people is rife and there is far too much
pressure on women in particular to look a certain way. It is up to all of us,
from teachers to parents, and magazine editors to programme makers, to
celebrate women for who they are.’
Encouragingly, the report found 60 per cent of those who were abused
because of their appearance thought they could turn to a friend, relative or
teacher for help. Many of the young women questioned came from poor
backgrounds, and either lived alone or with a single parent.
WHAT ABOUT CYBERBULLYING
AND SUICIDE (ATTEMPTS)?
Suicide is the second leading cause of death for Canadian youth aged
10–24. Each year, on average, 294 youths die from suicide. A recent report
indicated that Eastern Ontario has a suicide attempt rate two times greater
than the provincial average (6.78 vs. 2.96 per 1,000). Females aged 15 to 19
years in Eastern Ontario have a 50 per cent higher rate of suicide than the
rest of the province. These alarming data support the crucial need for
research data to understand the determinants of suicide and suicidal
behaviour among children and adolescents. Experience of bullying
victimization is one of many possible determinants of suicidal ideation and

suicide-related behaviours. Bullying – an aggressive behaviour that is
intentional, repeated, and involves a power imbalance – is a major public
health concern. Despite the efforts of schools to prevent or stop bullying,
bullying is still highly prevalent worldwide. Information and
communication technology (ICT) have emerged as a recent vehicle for peer
aggression worldwide. Cyberbullying provides to perpetrators the benefit of
lack of face to-face contact. It is more pervasive than traditional bullying,
as it can happen anytime and anywhere. Consequently, bullying which
usually takes place in school is now also occurring at home. Among
features that may distinguish cyberbullying from traditional bullying, the
anonymity afforded to perpetrators and the limitless potential audience
consisting of bystanders and observers are even more redoubtable. The
inability of victims to have any control over acts of cyberbullying may
result in feelings of powerlessness in the person being bullied. As a result,
the damage experienced in cyberbullying may be largely social and
emotional in nature and is exacerbated by the intensity of the threats
inflicted. The growing number of cyberbullying victims over the past
decade and the deleterious effects of cyberbullying on victims are of great
concern. Several studies have shown that traditional bullying among
youths is associated with depression, suicidal ideation and non-fatal
suicidal behaviour.
Cyberbullying has been defined as the use of email, cell phones, text
messages, and Internet sites to threaten, harass, embarrass, or socially
exclude.
However, the psychological outcomes of cyberbullying remain

inconsistent and unclear, probably because of its recent development. While
some authors think that the consequences of cyberbullying tend to parallel
those of traditional bullying, others believe that cyberbullying may be even
more psychologically distressing than regular school bullying.
An emerging body of research has begun to identify an association
between cyberbullying and mental health problems. Several correlates have
been identified among victims of cyberbullying, such as increased
depression, suicidal ideation, and non-fatal suicidal behaviour (suicide
attempts). The psychological mechanisms underlying the association
Am I Unwanted? 53
between bullying victimization and suicidal ideation and suicide related

behaviours are less well understood. According to Agnew’s social
psychological strain theory of deviance, strained social relationships and
events pressure individuals into committing deviant acts.
Bullying is known to be a source of strain. It makes victims feel angry
and frustrated, therefore putting them more at risk to engage in deviant
behaviours. From this, it can be reasoned that bullying victims are at an
increased risk of suicidal ideation, plans and attempts as coping responses
to their victimization. Since depression is a well-known risk factor for
suicidal behaviour, it may therefore be accounted for in these causal chains
as victims may first endure episodes of depression before progressing to
suicidal ideation, plans and attempts. Based on the nature and intensity of
threats and individual vulnerability of the victim, cyberbullying and school
bullying may directly result in suicidal ideation, plans and attempts.
A recent study has documented the mediating role of depression on the
association between bullying victimization and suicide attempts among
American high school student girls using data from the Youth Risk
Behaviour Survey. However, their analyses were not adjusted for covariates
and potential confounders reported in the literature to be associated with
experience of bullying victimization and/or report of suicide attempts such
as substance use, sedentary activities, and also importantly the amount of
time spent on a computer, in as much as the experience of cyberbullying
depends, at least in part, on use of the Internet. Thus, the independent
effects (direct or indirect pathways) of bullying victimization on suicidal
ideation and non-fatal suicidal behaviour controlling for other risks
behaviours are not clear. A recent study examined the association between
cyberbullying and school bullying victimization with suicidal ideation,
plans and attempts among middle and high school students. In addition, the
research investigated whether the presence of depression mediates these
associations. It was hypothesized that cyberbullying and school bullying
victimization results in higher likelihood of suicidal ideation, plans and
attempts, and that depression would mediate these relationships, while
controlling for sociodemographic variables, substance use, sedentary
activities, and the amount of time spent on the computer.
Cyberbullying is an emerging phenomenon; lack of youth’s awareness
and psychological preparedness to deal with such issues might increase
their
vulnerability. It has been reported that there is a significant lack of

knowledge regarding Internet safety among youths. Enhancing awareness
among schoolchildren is therefore a crucial step towards preventing
cyberbullying victimization. This could be tackled by parents and schools
discussing Internet safety and cyberbullying with children. On the other
hand, there is a need to strengthen ongoing bullying prevention to make the
school environment a safe and happy place.
The Mediating Role of Depression

The mediating role of depression on the relationship between bullying
victimization and non-fatal suicidal behaviour justify the need for
addressing depression among victims of cyberbullying and school bullying
to prevent the risk of subsequent suicidal behaviour. The mediating role of
depression suggests that cyberbullying and school bullying victimization
among schoolchildren may lead to elevated depressive symptoms, resulting
in more suicidal ideation, plans and attempts. However, the partial
mediating role of depression in the relationships between school bullying
victimization and both suicidal ideation and plans, suggest that factors
other than psychological distress may also play a role as mediators in these
etiological relationships. Indeed, there are many other factors that can
contribute to teenagers’ suicidal behaviour (e.g., family violence, sexual
orientation, physical and sexual abuse, interpersonal losses, etc.).
It is crucial to provide suicide prevention training to teachers and
parents to help them identify symptoms or changes in behaviour related to
depression and suicide among children and adolescents. Besides,
schoolchildren should be encouraged to seek support from peers and family
when experiencing bullying victimization. This has been reported to
provide significant buffering effects on depressive symptoms. The
relationship between bullying victimization and depression is reciprocal.
Bullying victimization can cause depression and depressive symptoms may
place some youths at increased risk for victimization. However, research
has demonstrated that the path from victimization to depression is stronger
than the path from depression to victimization.
The prevalence of cyberbullying (17.4%) and school bullying (25.2%)
documented in UK are comparable to those recently reported in Canada
(33,34) and elsewhere using similar definitions and time frames to assess
Am I Unwanted? 55
cyberbullying and school bullying victimization, and the same age groups
(grade). These substantial proportions indicate that school bullying is still
prevalent among middle and high school students, and that cyberbullying
also largely occurs within this population. This supports the need for further
actions and attention to protect children and adolescents.
Research revealed gender differences in report of cyberbullying
victimization, but not school bullying victimization. Girls were twice as
likely to experience cyberbullying victimization as boys. These results are
congruent with several other studies that documented a higher prevalence of
cyberbullying victimization among girls. This may be due to the fact that
cyberbullying is text-based, and girls communicate more often using text
messaging and email than boys. Not surprisingly, research findings also
indicated that the longer the time spent on the computer, the greater the
likelihood of cyberbullying victimization. Similar results have been
reported by many researchers who observed that time spent on-line, and
computer proficiency were related to cyberbullying behaviour. Augmented
time spent on Internet heightens the likelihood of experiencing
cyberbullying. Given the prominent place of the Internet in today’s
lifestyle, especially among children, banning it is quite impossible and may
not be a helpful measure against cyberbullying. Instead, placing limits on
time spent on the computer may help decrease such threats. Furthermore, it
is important for parents and schools to learn how to keep children safe
online.
Research Studies on Childhood Bullying

Childhood bullying is an important policy concern. Nearly half of
victims of bullying report having thoughts about suicide and self-harm with
negative impacts extending across the life-course. Being bullied in
childhood is common, and socially patterned. However, factors explaining
the role of social inequalities in being bullied are unclear. Using a
contemporary United Kingdom (U.K.) birth cohort, researchers aimed to
assess and explain social inequalities in the risk of being bullied.
An analysis of the U.K. Millennium Cohort Study (2016) using a sample of
12, 706 children surveyed at four sweeps (aged nine months, three, five
and seven years) was carried out. The main outcome was a binary, child
reported measure of being bullied at age 7. Household income quintile at
birth was the main measure of socio-economic conditions. Relative risk
(RR) and 95% confidence intervals (95% CI) for being bullied were
estimated using regression, by household income quintile. Risk factors for
being bullied, included individual (e.g., emotional resilience, health status
including obesity), parental (e.g., maternal mental health and discipline)
and peer relationship (e.g., friends) factors.
Results indicated that by age seven, 48.7% of children self-reported
being bullied. There was a social gradient; 53.4% in the lowest income
quintile reported having been bullied, compared to 43.9% in the highest.
Male sex, young maternal age, higher child BMI and Strengths and
Difficulties Questionnaire (SDQ) scores and worse maternal mental health
were independently associated with an increased risk of being bullied,
whilst having a good friend was protective.
The important conclusion from this study, using a nationally
representative cohort, indicated that about half of seven-year olds reported
being bullied, with a greater risk for children from the poorest homes.
Increased risk was largely explained by social differences in other risk
factors for bullying including friends, maternal mental health, and
individual factors including emotional resilience and BMI. Interventions
addressing these risks and promoting protective factors are likely to reduce
social inequalities in being bullied, improving mental health outcomes for
the most vulnerable U.K. children. With the self-reported primary outcome
to be the main study limitation, future research studies should investigate
the role of social inequalities in the bullying of adolescents.
Who Can Help?

General Practitioners (GPs) in the UK can offer supportive counselling
either within the practice, or from a third sector agency specializing in bully
and/or supporting young people. They also have access to a range of other
resources as recommended by the Royal College of General Practitioners
(RCGP). If bullying is affecting the young person’s education, the GP can
refer them to the Educational Psychology Service or to Children and
Adolescent Mental Health Service (CAMHS), if there is evidence of severe
mental health issues. In addition to this, GPs are optimally placed to
identify and treat the physical and psychological consequences of bullying
outlined above. Talking to someone about bullying is the first step to
getting help, but up to 40% of children never disclose bullying to their
parents.
Am I Unwanted? 57
The opportunity to discuss bullying with a healthcare professional may

provide an important avenue to break the silence and initiate help.
Given the impact on health, children who are being bullied are likely to
have greater need for health care than their non-bullied peers. Although
research to confirm the extent to which this leads to more frequent
attendance at general practice is lacking, previous work with school nurses
has confirmed that there is a positive correlation between self-reported
health symptoms (e.g., poor sleep, frequent headache) and frequency of
bullying experienced. In the UK, school nurses do not typically consult
with every student in the school every year. However, in some countries,
such as Denmark, where an annual consultation is routine, students who
are being bullied are more likely to report positive effects of their dialogue
with the school nurse, and to initiate additional visits to the nurse.
“I do not really see the link between GP and bullying.

If I go in with a tummy ache or headache I would just want to get in
there get medication and then come out.”
(Young female, aged 14)
Awareness of the Link between Bullying and Health

Most young people and parents demonstrated their understanding that
bullying can be a cause or contributory factor in both physical and mental
ill-health throughout the comments they provided. In many cases they
spoke from experience and included personal examples. A minority,
however, appeared unaware of bullying as a potential risk factor for
common health concerns.
Experience of approaching the GP for support with bullying-related
health problems was variable. GPs were perceived to lack understanding of
bullying and its links to physical and mental health. Parents were
particularly critical:
“A medical problem may well be the first sign of bullying … it would be

helpful if GPs were more aware of how prevalent bullying is and included it
in any assessment of the child” (Parent, female, aged 52).
THE APPROPRIATENESS OF GP INVOLVEMENT
Whilst both young people and parent participants were overwhelmingly

in favour of GPs being better able to identify and support young people
who are being bullied, they also expressed a number of reservations. A
very small minority felt that tackling bullying was outside the doctor’s
remit and should remain the responsibility of teachers and parents. Both
young people and parents thought GPs being removed from the school
setting was an advantage. The doctors’ independence from both the family
and school was considered beneficial and likely to allow a more objective
assessment of the child and situation. In addition to this, young people felt
it would be easier to talk to a more independent adult:
“…it may be easier to talk to someone that they know probably doesn’t
know the people they are talking about and that they won’t tell them.”
(Young person, female, aged 14).
Over half of the parents surveyed thought that if their child was being
bullied that they would probably tell the doctor, if asked, and those leaving
comments identified the doctor’s approach to questioning as being key to
facilitating disclosure. Parents and young people agreed that they would be
more likely to report bullying if they understood why the doctor was asking
(i.e., the link between bullying and health). Other key factors were GP
sensitivity and offering reassurance:
“As long as they were friendly and genuine I would quite happily talk
about problems if someone was there to listen. I wouldn’t talk if it was
spoken about in a generic way like a check mark against their daily tasks.”
(Young person, #176, female, 22)
Young people felt the most significant barrier to disclosure was the
feeling that they didn’t have an established relationship with their GP. They
expressed concern about their lack of connection with their doctor, and the
difficulties this may present in feeling safe talking to them:
Am I Unwanted? 59
“You might not even want to tell an adult you trust, let alone one that
you don’t really know” (Female, 13).
Other concerns expressed by both young people and parents included

whether GPs have the appropriate training and experience to deal with
bullying, and the time pressure of brief appointment slots.
Confidentiality and the Presence of Parents
A significant number of young people expressed a preference for the

questionnaire being anonymous, but in the context of the comments it
appears that there may have been some confusion between the terms
‘anonymous’ and ‘confidential’:
“I know that this would be kept completely anonymous between myself
and the doctor…” (Young female, 14)
While participants acknowledged the link between bullying and health

and understood that the doctor would be trying to help, some felt that being
asked about bullying might be uncomfortable or awkward, but could offer a
means of relief:
“I would personally feel weird and in an awkward position.

However, if one person does know about my situation they may help me
and I may not be a victim any more.” (Victim, female, 14).
Discomfort was expected to be greater if their parents were present, and

a few young people questioned whether children would disclose bullying in
their parent’s presence. Many young people expressed a preference for
parents/carers not to be present during discussions about bullying. Most
parents, however, expected their child’s disclosure to be shared with them,
and some expressed a desire to be the first person to help their child. Others
gave a more balanced view about providing support to the child:
“Would hope that my child would share info with me, but it is important
that they know it would be confidential if they wish.” (Parent, female, 42).
Practical Issues Surrounding Screening
Participants identified a number of practical issues regarding the use of

a screening questionnaire to identify young people who are being bullied,
including delivery format and venue. There was a strong preference among
young people for initially answering questions about bullying in a paper or
online questionnaire rather than verbally face-to-face:
“I think this would be a more suitable and effective way of approaching

this topic … it’s easier to write things down than speak to someone” (Victim,
female, 17).
Young people’s opinions were divided on the appropriateness of

completing the questionnaire in the GP’s waiting room. Some participants
felt that this was a good way of asking and that completing the
questionnaire in the waiting room would result in better engagement.
“I would feel comfortable answering a questionnaire in the waiting room

as it gives me something to do while I’m waiting … I think it would then be
easier to speak to the GP about when you went in”
(Victim, female, 16).
However, while positive about the idea of completing the

questionnaire, others raised concerns about privacy in the waiting room
and suggested alternatives, such as completing it at home or online.
Parental concerns were focused on the possibility of the questionnaire
causing distress to a child, while others questioned whether a child would
complete the questionnaire honestly. It was observed that the questionnaire
would only be of use if the doctor valued the questions and the responses
provided.
Both young people and parents recognised the link between bullying and
health, and would welcome greater GP involvement in recognising and
supporting young people who are being bullied, providing this was done in

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PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS

BRING MY SMILE BACK

WORKING WITH UNHAPPY CHILDREN

Additional books and e-books in this series can be found on Nova’s

BRING MY SMILE BACK

WORKING WITH UNHAPPY CHILDREN

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Chapter 6 Working with Unhappy Children from Single Parent

impressive team of international social science scholars and practitioners to

Professor Scott Fleming

Cheung, R. (2018). International comparisons of health and wellbeing in

Family schema and school environment represents different systems

environment can transform teachers to essential actors in restoring

Dr. Maria A. Efstratopoulou

In writing this book, we need to express our gratitude to all

Dr. Maria A. Efstratopoulou

CAN WE DEFINE HAPPINESS?

When we consider happiness, we may think of people we like to be with,

HAPPINESS, CHILDREN AND YOUNG PEOPLE

Understanding happiness may be an important first step in being clear

The need to focus on positive life experiences and feelings is important

∙ To what extent do children have a right to happiness? ∙ What factors

In this chapter the above questions will be explored with a particular

AN ATTEMPT TO DEFINE HAPPINESS

In Ancient times the idea of happiness was highlighted by Socrates,

Subjective wellbeing=Satisfaction with life + high positive

Subjective wellbeing was born from a need to help people measure

There is some debate as to whether hedonistic wellbeing is always at

skills may include reframing and experiencing positive emotions, being

WHAT FACTORS MAKE HAPPINESS LESS OR MORE

Now that the concepts of happiness (subjective and psychological

1) Pleasure – Experiencing frequent positive emotions in life 2)

As well as Seligman’s view on what creates happiness there have been

WHY IS HAPPINESS IN CHILDREN AND YOUNG

We have already outlined the different concepts of happiness

families, carers and the community impact on happiness? What is the

∙ Being looked after well

society. Using happiness and wellbeing as a measure is a method to

This point is further supported by The Children’s Society’s report that

WHAT FACTORS NEED TO BE CONSIDERED WITH

Schools may be well positioned to support the concepts of resiliency as

feelings associated with happiness. Some of these interventions are

Research into how school interventions are delivered shows some

When considering the issues of happiness and wellbeing it is worth

children’s cognitive development is a hugely influential piece of work from

According to Piaget, after 11 years of age young people can

cognitive and developmental differences children, adolescents and young

CULTURAL DIFFERENCES AND HAPPINESS IN

With an increasing global perspective being part of modern life, there is

Figure 1. Happiness Ladder.

issues within children, such as cognitive and developmental issues, that

MENTAL HEALTH AND HAPPINESS IN YOUNG PEOPLE

It is already mentioned that according to recent studies in the United

THE ROLE OF SOCIAL MEDIA

With social media playing a more significant role in many people’s

THE ROLE OF PARENTING IN CHILDREN’S WELLBEING

Considering the impact of parents in wellbeing research we revisit Lan

moves into adolescences the relationship of a close friendship becomes

∙ Care and protection – Sensitivity to a child’s basic needs shows the

HUMAN RIGHTS AND THE RIGHT TO BE HAPPY