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Surge in mental health problems among primary school pupils  

Mounting ADHD referrals have some asking if Finnish kids have been given too much responsibility at too young an age.

Peruskoululaiset opiskelevat.
Like adults, some children are more sensitive to noise and other stimuli. Image: Antti Haanpää / Yle

The number of primary school students in Finland being referred to psychiatric evaluations for attention deficit hyperactivity disorder (ADHD) and other neuropsychological symptoms has doubled in the last five years.

According to figures from the National Institute of Health and Welfare (THL) requested by Yle, over 66,000 children between the ages of 6 and 13 were evaluated for ADHD, attention deficit disorder (ADD) or autism spectrum disorders such as Asperger syndrome in 2018, up from half this amount in 2014.

Assistant professor Päivi Lindholm from Oulu University Hospital's child psychiatry unit says that it is not necessarily the case that school children are any more prone to mental health disorders than they were in the past, but that the social and parental requirements being made of children are changing.

"Class sizes are huge, and people forget to provide the necessary support or don't have time to guide the children in the right way. The kids are left with too much freedom and responsibility," she says.

New core curriculum to blame?

Lindholm says neuropsychological disorders often involve various sensory sensitivities. Stimuli overload can overburden more sensitive children and weaken their ability to take in information and concentrate. She says Finland's core curriculum, renewed in 2014 with an emphasis on open learning environments, presents challenges.

"Children spend more and more of their time trying to control their physiological state, which affects regulation of their emotions and behaviour. At the same time, the onslaught of visual and audio stimuli is amplified in a large group, creating even more of a social load," she says.

In this way, the school day becomes quite stressful for the students, the psychiatric professor contends, negatively affecting school performance.

"Each of us has a stress threshold that is exceeded at different levels for different people. Some children can keep it together through the school day and then crash when they get home. Others reach their limit already at school," Lindholm explains.

A problem the nation needs to address

Assistant professor Lindholm says it is time for Finland to take a step back and look at the big picture, as the statistics show that children's mental health symptoms have moved beyond being a marginal problem.

"It would be important to bring the experience of kids and parents, as well as education and social and health care professionals doing the practical work into the open," she says.

Aslak Rantakokko, an equality specialist with the Finnish Parents' League, agrees that Finnish decision-makers and society should not just quietly accept the explosion of neuropsychological problems among school-aged children.

"Now we're trying to get more teachers, more counsellors, and more psychologists. That's all good, but isn't it in a way fundamentally accepting the problem? Why isn't Finland having a public conversation about the roots of the issue?" he asks.

Medication should not be taboo

Anita Puustjärvi head of the Kuopio University Hospital's child psychiatry unit agrees with Lindholm's assessment of school changes, saying that modern learning environments and techniques are not supportive of children with special needs.

"Some of the children can benefit from sitting on an exercise ball or lying on the floor while they work, but this introduces more disturbing stimuli to the space, as some of the kids are moving around the whole time. What we need to focus on is minimizing the disturbing factors and maximizing the benefits," she says.

Puustjärvi says that education experts should explain better what the core curriculum means when it talks about boosting independent study.

"Being more self-directed does not mean that pupils study independently, it means that the teacher sets the framework within which the student can then choose things appropriate to their age level. A child is not a mini-adult, and this is often forgotten in schools. Cognitive control is still developing in children, and is not fully formed until they are in their early twenties," she says.

Puustjärvi adds however that medication is not necessarily the bogeyman it has been made out to be in discussions on ADHD and similar disorders.

"After all, we don't think it is a negative thing for a diabetic to take insulin," she says.

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