A qualitative exploration into young children’s perspectives and understandings of emotional difficulties in other children

Design

The study involved a combination of the draw and write technique ² (Williams, Wetton, & Moon, 1989) and focus group discussions. Focus groups were chosen rather than individual interviews to enable children to discuss their views in a familiar and less threatening way (Hill, Laybourn, & Borland, 1996). Focus groups were considered particularly useful, given the power differences between the children and the interviewer, and because the study was concerned with the everyday use of language and culture of the children, and their shared understandings of the characters in the vignettes (Heary & Hennessy, 2002; Morgan, 1997; Wilkinson, 2003, 2005).

Participants

Five focus groups were conducted with 25 school children (aged 8–9; 12 girls and 13 boys). These children attended five primary schools across three districts in a county in Northern England. Each focus group consisted of five children with a mix of genders. All participants were white British. Year 4 children were chosen, as little information is available on how British children younger than 10 years old view and understand mental health problems, despite the prevalence of mental health problems in children as young as 5 (ONS, 2005). ³

Materials

Draw and write exercise and focus group questions

The focus group schedule (see Figure 1) covered questions and prompts with the aim of exploring the children’s perceptions and causes of behaviour, how they understood the behaviour depicted, and what they thought and felt about the child in the vignettes. In conducting interpretative phenomenological analysis (IPA) with children, Smith (2004, p. 49) has suggested that ‘practitioners conducting research with these groups can draw on their own professional experience with clients to help them modify existing protocols when collecting data’. It is for this reason that the draw and write exercise was used as a non-threatening opening to the topic and as a tool to encourage further discussion using the questions and prompts detailed where necessary.

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Figure 1.

Draw and write procedure and focus group discussion questions/prompts.

Study procedures

Following ethical approval, head teachers of 142 primary schools in three adjacent districts were approached by post to participate in the study. A total of 21 schools expressed an interest in taking part in the research. Information packs were then sent via the school to parents/guardians of all children in Year 4. Parents/guardians were asked to complete and return the opt-out consent form by a specified date should they not wish their child to take part in the draw and write task and focus group discussion. Parental opt-outs ranged from 5% to 35% of each class.

With the exception of those children whose parents had opted them out of the study, child friendly information was read out and given to the children and assent was sought from each pupil. In asking for their assent, the view was taken that Year 4 children were capable of deciding to take part or not, having been informed about what participating would entail. The interviewer attempted to ensure they did not feel under pressure from their teacher to ‘help out’ by stressing that they did not have to take part if they did not wish to, and provided a number of opportunities for them to decline or change their mind.

Five children from each class, a mix of girls and boys, were randomly chosen (excluding those whose parents had opted them out of the study). This was done by randomly selecting one child from each table or area of the classroom. Children were provided with pens and a piece of A4 paper for each vignette on which to draw and write responses to the initial question asked. The vignettes (see Figure 2) were read in turn and the children were asked to draw a picture of the character discussed.

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Figure 2.

Vignettes read to children.

To reduce adult bias and misinterpretation, the meaning and content of drawings and writing were explored by the interviewer with each child individually during the activity. Alongside this drawing task questions and prompts were used to discuss the characters in the vignettes. The anxiety vignette was presented first and discussed for approximately half the session, following which the depression vignette was presented and discussed for the remaining half. The focus group discussions were audiotaped and transcribed verbatim. Each focus group lasted an hour.

Data analysis

The focus group transcripts were analysed using IPA (Smith, 1996; Smith, Jarman, & Osborn, 1999; Smith & Osborn, 2003). IPA takes a symbolic interactionist position, which assumes that in addition to an emphasis on the meanings individuals ascribe to events, the researcher must also themselves take on an interpretative role to explore those meanings (Smith, 1996). This process has been described as a double hermeneutic, where ‘the participants are trying to make sense of their world; the researcher is trying to make sense of the participants trying to make sense of their world’ (Smith & Osborn, 2003, p. 51).

The first author as the interviewer came to this research as a clinical psychologist in training, with an interest in children’s experiences of psychological difficulties, how they perceive other children who are worried and sad, and with a commitment to universal mental health promotion for children. She holds the view that children are significant and under-consulted members of society. She is also a parent of a child who was a similar age to the children interviewed; this role required recognition, however, it was also an interpretative resource. By stating this explicitly the author attempts to acknowledge and demonstrate how these perspectives and positions may have shaped the research process and analysis.

The analytic process was informed by guidelines by Smith et al. (1999), Smith and Osborne (2003) and Smith and Eatough (2006). IPA has a concern with people’s experiences and understandings, as well as with their perceptions and views. The present study is designed to examine the perceptions and views of children regarding peers with mental health difficulties, but in accordance with IPA the analysis is concerned with how participants draw on and make explicit their own experiences in reaching these understandings.

The first transcript was read a number of times, and notes and initial thoughts about items of research focus were made in one margin. The transcript was read again and emergent theme titles were noted in the other margin. Each theme was listed on an index card with instances from the data relating to that theme noted on the appropriate card to support the theme and provide a trail back to participants’ actual words. ⁴ Connections between these themes were explored and developed, returning to the text to check interpretations against what the child or children actually said. Analysis continued with the other transcripts in turn in the same way. When new themes emerged these were checked for in earlier transcripts. The presentation of findings that follows is organised around themes that emerged from the transcripts in an inductive way, therefore, rather than derived from existing theoretical ideas or our preconceptions.

‘I think he’s a bit worried and sad because…’: Searching for an explanation ⁵

Much of the children’s etiological explanations appeared to be of a psychosocial, external nature, with little mention of biological, or internal, causes or labels associated with the medical model; ‘mental illness’ as a cause was mentioned by just one child, with another explaining the anxious character’s difficulties in terms of personality factors, ‘I know why he’s worried, because he’s a serious person and he doesn’t want anything to happen to him or anything’ [4/B1: 10]. ⁶

Some participants made sense of possible causes by drawing on the physical symptoms in the vignettes and engaging in a literal interpretation of why the character was experiencing such symptoms, such as difficulties sleeping and loss of appetite for Alex. The importance of acceptance by peers and their potential power in influencing feelings were also implicated:

Others’ understandings of Charlie and Alex’s difficulties were more sophisticated, and involved them extrapolating from the information given. Anticipation and fear of making mistakes in school work or valued activities, being different and not fitting in, negative perceptions of themselves, their misinterpretation of others’ intentions and resulting lowered confidence or self-efficacy were identified as causes:

I think he’s a bit worried and sad because he thinks he shouldn’t do his work wrong, and he’s gonna really get shouted at and then Miss is going to give him a report when he gets shouted at, to his mum and dad, and then his mum and dad’ll shout at him. [2/B1:3]

Standing out, speaking up and being or looking different in any way were viewed as a negative experiences and leading to worry about being singled out, ‘My picture, she thinks that like all the other children are looking at her, so she’s like, ‘Do they think I’m different?’ [1/G2:2].

Staying emotionally healthy involved characters having a sophisticated understanding of peer relationships, others’ actions and intentions – evidence of an advanced ‘theory of mind’, the ability to ascribe thoughts, feelings, ideas and intentions to others. Characters’ misinterpretations of others’ intentions were seen as responsible for their emotional difficulties, and were later to be implicated in views of how responsible they were for their own feelings (see Empathy versus blame).

Yeah, my Charlie, all these people here (points to her picture), they’re in a gang and they’re talking behind her back just but, they were like only like doing it for fun. (…) They are talking about her behind her back, saying she’s weird, yeah, ‘look at her’ and stuff but she takes it seriously. [1/G2:5, 6]

Negative evaluation from peers was centred on difference, not fitting in and on appearance, ‘She’s worried because it’s the first day back and she’s worried she might get called names cos she looks a bit weird’ [5/G2: 3]. Friendship and peer relationships were key, ‘I don’t want to go to school. My friends might not like me’ (Charlie’s words, 1/G1:5), with bullying featuring heavily in causal explanations:

Like, em, she’s worried about all the people surrounding her especially like her mates and stuff (…) but they’re going out to play but she never wants to go out to play because she’s,… she feels like they’re behind her back all the time. They’re laughing and stuff. [1/G2:7]

The significance of appearance in attracting friends, and the effects of not being accepted by peers as a result of difference, can be seen in the interchange below. This excerpt also provides insights into why children bully and the challenge that difference evokes, particularly evident in the final view of B1:

For some children deprivation and loss were causal factors, both in socio-economic terms and in the characters’ experience of family relationships. Material wealth was considered essential to one child’s developing view of Alex. When asked to draw a picture of him he replied, ‘it’s hard because you don’t know if he’s rich or something’ [3/B2:14], his emerging view of the character seemingly hampered by the lack of information about Alex’s economic circumstances. Where poverty was assumed as a cause, its effects in causing further difficulties, such as addiction and antisocial behaviour, became apparent in the shared meaning-making between participants, as illustrated below:

Parental interest was significant in keeping children healthy, ‘maybe their mum doesn’t know, maybe their mums and dads don’t care, because they don’t do their homework’ [3/B3:5], while parental neglect and disinterest, tied up in ideas of economic deprivation and stereotypes, and resulting from loss, were used to explain the cause of Charlie’s worry and his/her experience:

But like her mum’s one of them… kind of people…who like goes out every night and leaves her on her own when she goes bowling. (…) Because her dad died, and her mum, her mum was so upset, so that she tries to leave Charlie on her own, and the house is really like a flat, just on the corner of the street (…) and Charlie has to make her own tea. [1/G2:11, 12]

Participants drew on their own personal experience in considering explanations for the characters feelings and behaviour, picking out the detail in the vignettes that was most meaningful or relevant to them or when they identified with an aspect of the character’s experience, ‘That used to be me. Cos I didn’t used to eat much, cos I thought I was fat’ [5/G2:13], ‘I would be most like Charlie because when I first started school everybody just walked straight past me and they used to pretend that they didn’t see me’ [4/B1:30].

Meaning-making occurred between children, who were happy to share their own experiences of feeling like the characters:

‘She’s kind of overacting a tiny bit’: Empathy versus blame

This theme encompassed children’s views on how responsible the character was for their difficulties. Ideas around blame were informed by perspectives on aetiology, and led to emotional, attitudinal and behaviour responses to the characters.

Both Charlie and Alex were at times viewed as over sensitive or over reacting to external events:

She’s kind of like, as [name G1] said, overacting a tiny bit, because it’s like, some of her fault, she’s taking it really, really seriously, and them children was just like playing a game. But then she thought, ‘I won’t play with them now, because they keep on being mean to me’. [1/G2: 13]

The characters were also sometimes viewed as having control over their behaviour and the capacity to respond in a different way:

I don’t think I would really (be friends) because if he wants to do that I’d try and tell him what’s the point of doing all those things, people do care about you, but if he keeps on doing it then I wouldn’t be friends with him. [4/G1: 26]

Where children held such views of Charlie and Alex, their responses towards them were largely negative, involving them being seen as culpable for their behaviour.

These views on culpability were bound up in, and influenced, participants’ responses to the characters, particularly in terms of social distance and friendships. Friendship was often conditional on certain behaviour, particularly being motivated to change, illustrated in the following discussion of whether participants would be friends with Alex:

In the current study social distance was also influenced by the consequences of the characters’ difficulties for participants themselves. For example, participants viewed other children as possibly not liking Alex because he had a ‘reputation’ and because he might direct harmful behaviour to them. In the following excerpt empathy towards Alex was apparent, however, despite this awareness:

Ideas around culpability were also tied up in the characters’ misinterpretations of others’ intentions; although whether this misinterpretation was viewed as due to a deficiency in the character’s resilience or as a consequence of their feelings was unclear:

I think that’s it’s finally her fault this time. (…) It’s really her fault, because loads of people are joining in. (…) Just this boy laughed at her. This is her fault this time. Because Alex is looking at other people and they’re playing on stilts and stuff, they’re saying, ‘come and play Alex, we’re pretending we’re clowns’ and all that, but she’s saying ‘no I don’t want to’. And then she’s talking to the teacher, ‘I can’t sleep, I don’t like school, people are horrid to me, I’m sad, I want to go home’. [1/G2:21]

Despite many of the characters’ experiences being within the realm of participants’ understanding and experience, participants often viewed Charlie and Alex as different to them, particularly with regards to being culpable for their difficulties, possibly in an attempt to distance themselves from their experience and so confirm their own position of safety. By labelling or accusing the victim, in this case Charlie or Alex as victims, for example, of bullying, participants protect themselves from the possibility that such an event could happen to them:

Preferences for one character over another were again based on participants’ perspectives on culpability, and on how easy it would be to help them change, based largely on the causes behind his/her difficulties:

Again, where the characters’ experiences were outside those of participants, they were viewed as harder to help and therefore less inclined to be seen as potential friends.

On the whole Charlie was favoured over Alex. This appeared mainly to be due to the perceived seriousness of Alex’s difficulties in comparison to Charlie’s. In fact, Charlie was viewed in a positive light by many participants, as harmless due to the innocuous nature of worry itself:

Where Alex was preferred this was due to less tolerance being shown for Charlie due to his/her worry being viewed as unfounded. How participants viewed the emotions depicted in the vignettes was therefore key to their subsequent views about and responses to the individual characters.

‘If he gets help now he’ll have a better life’: Consequences and solutions

Through the children’s discussions a theme that related to ideas that worry and sadness had wider consequences and effects, some of a social nature that may exacerbate the characters’ difficulties, such as avoidance of social situations or school, was identified. Worry was seen as powerful, as growing and generalising out in a cycle that was difficult to break or gain control over, until fears became a self-fulfilling prophesy:

I think, he’ll keep, he’ll keep going to school worrying, and every time he worries he imagines things ‘badder’ happening, and it’s like, he gets visions, he gets like, he imagines things outside, and he thinks like people are going to laugh at him, and then keep kicking, keep hurting him, and he thinks he’s, and he’s worrying so much that’s happened. [1/B1: 13]

Anticipation of other negative experiences as a result of worry or sadness included experiencing nightmares, loss of sleep, losing friends, social withdrawal and school work suffering.

Externalisation of emotions was inferred by some participants, ‘it gets other people to make them worried’ [4/B1:16], ‘I’m going to draw me and Alex trying to get her out of the worriness’ [2/G2: 22], suggesting perhaps that these children had the capacity to see the problem as an external one, rather than perceiving Charlie or Alex as the problem. This, however, does not fit well with participants’ general derogation of the characters as previously discussed, illustrating once again the complexity of their understanding.

Again personal experience was commonly drawn upon to inform participants’ sense-making of the consequences of emotional experience, particularly when considering the outcome for the characters, and how they could learn from what happened to inform feeling differently in the future:

Once his mum’s shouted at him it would have already happened so he’ll be like have nothing to worry about. (…) Cos sometimes I get shouted at and, I realise, well I’ve already been shouted at so I’ve got nothing to worry about so why am I crying? [2/B1: 12]

Solutions to the characters’ difficulties were often influenced by the perceived causes of their difficulties. For example, where differences in appearance and not fitting in was considered the cause, simplistic solutions about changing appearance were highlighted, the responsibility for change being with the person themselves rather than others becoming more tolerant of difference. The role of film and television was apparent in such sense-making:

With the exception of one participant [3/B3], whose etiological explanation was of poverty and potential mental illness, and mentioned professional medical or social care interventions, no participants viewed professional help as necessary or valuable for Charlie or Alex, preferring to site solutions in the everyday and informal. All participants were keen to help the characters to feel better, mainly by being their friend or helping them to make friends. In the present study, such everyday coping strategies and solutions to alleviate the characters’ distress did include, however, concepts and messages that could be viewed as discourses from the domain of mental health promotion. These included keeping busy:

and sharing problems informally with others,

I would just ask her what the problem was, and if she says, “I’m really worried,” and I would just say, “Well, I’ve been worried once, and I figured that out, so why don’t you have a talk to your mum about it?” [2/G2: 10.11]

What could be interpreted as traditionally psychological methods of ‘treatment’, or concepts and language within the culture of clinical psychology, were also highlighted in participants’ talk. Once again, however, these were given an informal, lay perspective by participants and seen as occurring within the realm of everyday solutions to difficulties, rather than existing solely in the professional world. ‘Early intervention’ was seen as important, before difficulties escalated and got out of control:

The perceived significance of cognitions and ‘thinking errors’ occurred alongside concrete, visual methods to bring about change, illustrating both simplistic and more complex understandings of solutions. This was highlighted by two girls in the excerpt below:

For many participants it made perfect sense for Charlie and Alex to be friends together in order to feel better. In addition to their shared experience and how this could help them help each other, there was an element of them deserving each other, particularly where they were viewed as less powerful than their peers or as over sensitive in comparison. Participants viewed the characters as ineffectual in their ability to make friends, privileging themselves as better able to make friends for them. In the following excerpt this solution also eases the participant’s discomfort:

The use of vignettes

Vignettes have become increasingly popular due possibly to the increasing recognition of the limitations of questionnaires in studies of attitudes and perception (Gould, 1996, in Hughes & Huby, 2002). However, their use has advantages and theoretical and methodological limitations.

Generally vignettes allow for inclusive participation for children, irrespective of reading ability and age. They have the potential to engage and encourage children to talk and enable children to have control over discussing their personal experiences, if and when they wish to. Their ‘story-telling’ nature is relaxing, pleasant and familiar for children, and may reduce feelings of being under pressure by the interview process (Kayser-Jones & Koening, 1994, in Schoenberg & Ravdal, 2000). They also provide children with a greater control over the research interaction, such as where the discussion goes and what is significant for them. These were considered as particularly important issues, given the authors’ commitment to respecting the children as experts, giving them a voice and involving them as fully as possible in the research process.

Due to their hypothetical nature, the distance between respondents and vignette characters can facilitate the unpacking of beliefs and perceptions, particularly in studies of sensitive phenomena (Barter & Reynold, 2000; Hughes, 1998; Schoenberg & Ravdal, 2000), and obtain information beyond the participants’ current personal situation (Finch, 1987). This was particularly important for the children in this study, as the authors were concerned with their perceptions of emotional difficulties that they may not have experienced themselves. The children were not asked about their own experiences of feeling like the vignette characters until the very end of the focus group, and only then in a tentative way. However, all spontaneously brought their experiences, or those of others they were close to, into their discussions much earlier.

Vignettes are static when compared to real life, and it is acknowledged that they do not reflect the reality of people’s lives; indeed, Kinicki, Hom, Trost, and Wade (1995, in Hughes & Huby, 2002) suggest that vignettes in the form of ‘paper people’ are simple abstract stimuli that ‘impose lower interpretational demands than videotaped or real life events’ (Hughes & Huby, 2002, p. 383). ⁷ It was beyond the scope of this study to videotape and play scenarios to participants; however, the children appeared to find the characters and storylines believable and the context of school in which the characters were described probably helped make their experiences relevant to participants. It is important to state, however, that the content of the vignettes will inevitably have influenced the children’s discussions. For example, much of the content related to the characters’ behaviour at school, which may have affected the extent to which the children considered the school environment in their perceptions of the characters, (although the children’s sense-making was by no means limited to school and included much discussion of the characters’ difficulties in their home environment, with family members and external events implicated too).

A number of studies indicate that responses to vignettes do not reflect how individuals act in reality (Carlson, 1996; Rahman, 1996, both in Barter & Reynold, 2000); however, others conclude that not enough is known about the relationship between the two. The nature of the IPA approach taken in this study views the children’s perceptions, and the process of meanings and interpretations used in reaching the action or behavioural outcome, as the main concern rather than their actual behaviour, which as Barter and Reynold (2000) state, will always be situationally specific. As Hughes and Huby (2004) state, vignettes are rarely used as a means of simulating complete reality, and in this study they were used as a practical and non-threatening way of encouraging children to consider the topic in question. It is important to acknowledge, however, that the children’s responses cannot be taken as predictors of their action, and their understandings of Charlie and Alex may not relate to real peers with the same difficulties. Future research could explore attitudes and emotional responses of young children towards real peers rather than hypothetical characters. One study with older children has done this, reporting that 12 year olds’ attitudes were positively biased towards hypothetical characters (Juvonen, 1991).

While the research was able to provide a greater understanding into the perceptions of young children towards peers’ emotional difficulties, the findings cannot be generalised to all children of a similar age. In accordance with IPA studies, the sample was small and relatively homogenous, in that all the children were White British, lived in the North West of England and attended state primary schools. As IPA is less concerned with empirical generalisability ⁸ or the ‘validity’ of findings, as these are positivist concepts and do not fit with the epistemological basis of IPA, it could be argued that such ‘limitations’ have less relevance here (for example, Chamberlain, 2000). Further research with children from diverse cultural and socio-economic backgrounds may be useful in gaining an understanding of how those groups of children understand the topic in question.

In conclusion, young children’s perceptions and understandings of emotional difficulties in other children were sophisticated and complex. Their understanding of causes were mainly of a psychosocial nature and feelings of sadness and worry were viewed largely as understandable and acceptable, with little stigma; however, the degree to which characters were perceived as culpable affected participants’ emotional and behavioural responses towards them, including social distancing. Emotional difficulties were viewed as a normal part of childhood experience, an expected part of growing up and of increasing social experience. However, they were not viewed as inconsequential experiences, particularly with regards to their implications for friendships and self-esteem.