Is the current obsession with testing and targets bad for children's health? Health professionals and teachers fear that the relentless pressure to achieve is harming children's mental health and hindering recovery from chronic illnesses like myalgic encephalomyelitis (ME). When pupils crumple under the strain, there are often too few resources to help them.
For some time, heads have been worried about the effects of exam stress on children as young as seven. Now, Young Minds, the charity which has representatives from 24 professional bodies in the mental health field, has voiced concerns about the effects on pupils of the testing and exam regime.
It says that teaching ruled by targets and exams is an unhealthily narrow approach to education and reflects society's emphasis on achievement at all costs.
"Children need to be very robust and resilient to survive," says Peter Wilson, director of Young Minds. "We are living in a highly competitive society. Everyone is anxious to be watertight against disaster and people see academic success as a way of guaranteeing their future."
Some schools are prepared to be flexible towards pupils who are struggling with depression or ME, by allowing them to attend part-time or by relaxing deadlines. But, as Peter Wilson points out, teachers who are themselves under pressure from the Office for Standards in Education and league tables may find it hard to be patient with the apparently growing numbers of pupils who are struggling with ill-health.
Mental health problems of all kinds appear to be increasing in children and young people. It is difficult to confirm the upward trend because of the different methodologies used over time, but most experts point to the work of Sir Michael Rutter, the eminent child psychiatrist, who believes that mental health difficulties are rising in children of all ages.
In the most comprehensive study which exists, published in 2000, the Office of National Statistics found that one in 10 UKchildren aged five to 15 suffered from a "significant" mental health disorder, including major depression, obsessive compulsive disorder and anorexia.
Recent research for the Royal College of Psychiatrists by Dr Mike McClure, a consultant adolescent psychiatrist, found a decline in the number of people willing to take their own lives in every age group except teenagers.
The steepest rise in suicide attempts is among girls aged 15 to 19.
A long-term study of Scottish children's mental health by the Medical Research Council in Scotland has also revealed that psychological distress in girls aged 11 to 15 has increased significantly since 1987, peaking in 15-year-olds. Professor Patrick West of Glasgow University sees a clear link with academic pressure, as the levels of distress rose just before exams.
Young Minds has calculated that in any secondary school of 1,000 pupils there are likely to be 50 pupils who are seriously depressed, 100 who are suffering "significant distress" and at least five girls with an eating disorder. A reasonable amount of stress is healthy and education is only one influence on young people's mental health but many would agree that academic pressures are not helping.
Some paediatricians also link exam stresses to chronic illnesses like ME or chronic fatigue syndrome. Originally dismissed by some as a form of school phobia, ME is now the most common cause of long-term absence from school, according to figures in last year's report from Sir Liam Donaldson, the chief medical officer. It is often triggered by a viral illness like glandular fever.
In the report, Sir Liam described it as a "real, serious and debilitating condition" and he has urged doctors to take it more seriously.
Dr Nigel Speight, a consultant paediatrician in Newcastle and a member of Sir Liam's working group on ME, believes that the introduction of AS- levels has had a negative impact on young patients' recovery. Dr Speight, who is carrying out the first long-term research into children with ME in the UK, says that some pupils manage to recover sufficiently to take their GCSEs, but that AS-levels the following year often lead to a relapse.
Dr Speight suggests that it is better for sick pupils to take a year out of school to recover, as the "sausage machine system" makes part-time attendance difficult.
The problems of pupils who are too sick to attend school are compounded by the lack of home tuition. The Department for Education and Skills guidelines say that children who have missed more than 15 school days should be entitled to at least five hours' home tuition per week, if they are well enough to benefit. But children in some education authorities have to wait at least 10 weeks to see a tutor and then may only be offered one or two hours.
Young people with mental health problems also face patchy medical services.
In Scotland, Dr Graham Bryce, a consultant psychiatrist who is heading an inquiry into child and adolescent mental health, has reported waiting lists of at least three months for children with deep problems. Most of the teachers he surveyed would like to help these pupils but have received little or no training in this area. Many are suffering from stress themselves.
The recommendations of the Bryce inquiry include more support for schools and a clear framework showing schools and health services how they should work together.
Dr Bryce says schools have a crucial role to play in promoting emotional well-being and resilience. He argues that an "emotionally focused" school will help pupils to cope with academic pressures. Some schools have already adopted initiatives which help pupils cope with stress by boosting their self-esteem and making them more emotionally robust.
Schools which are promoting students' emotional well-being are finding that standards are also improving, according to Dr Katherine Weare, reader in education at the University of Southampton. But Dr Weare, who is advising the DfES on combating stress in schools, says that the Government needs to think hard about the impact on pupils and teachers of the drive to raise standards.
Contact: Young Minds www.youngminds.org.uk ; Association of Young People with ME www.ayme.org.uk; www.dfes.gov.uksickchildren; Promoting Children's Mental Health Within Early Years and School Settings, DfES Publications 0845 6022260; Developing the Emotionally Literate School by Katherine Weare, to be published October 2003 by A Paul Chapman pound;15.99 The Issue: Friday magazine, 13-16
SITTING GCSES ON THE SOFA
SIXTEEN- year-old Carly Webb has not attended school full-time since she was 10. Diagnosed with ME after a bout of glandular fever, she suffers from aching joints and muscles and is unable to walk far. Carly also has headaches and finds concentrating difficult.
"I am supposed to be revising for my AS-levels now, but it's difficult to take the information in," says Carly, who is studying further maths and chemistry. She has not been to school since she was in Year 10, but still managed to achieve six GCSEs last year.
The Webb family have had to fight to get Carly's two hours of home tuition a week, and to win concessions from examination boards. Carly took her GCSEs lying on the sofa at home, with frequent rest breaks.