Irritation and anger are some of the most common symptoms of depression and anxiety (Picture: Getty)

A friend recently told me that his teenage son was removed from one of his GCSE classes because his of behaviour.

He was being disruptive and causing distress for his teacher and other classmates.

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But this behaviour was driven by acute anxiety, and the communication issues he was experiencing with his teacher made matters even worse.

His teacher must have found the situation stressful, but immediately jumped to the conclusion that the problem was behavioural, rather than mental health related.


This doesn’t seem like an isolated incident, especially given how much more common it is to hear about boys being diagnosed with behavioural problems than girls.



Of children aged five to 10, 7% of boys are diagnosed with conduct disorders, compared to only 3% of girls, while there are three times as many diagnoses of ADHD (Attention Deficit Hyperactivity Disorder) in boys than girls, even though that gap closes in adulthood.

Yet girls are three times more likely to be diagnosed with depression, and are widely considered to be at a higher risk of anxiety.

Is it true that girls are more prone to emotional issues, while boys struggle more with behavioural problems, or is this diagnostic trend another example of how gender stereotypes can warp our perception?

Natasha Devon MBE is a mental health campaigner and author of the forthcoming book A Beginner’s Guide to Being Mental.

She believes that we under-acknowledge the mental health needs of boys and young men.

‘A man dies by suicide every two hours in the UK. If you look at the stats, retirement age is when men are considered at most danger of death by suicide,’ she said.

‘Yet 90% of suicides happen as a result of untreated depression and 50% of depression manifests by age of 14, 90% by age of 18, so it’s not outside the realms of possibility that the problems which led these men to end their lives started when they were at school.’

For my friend, Mark, whose son is experiencing problems in the classroom, it almost feels like a case of history repeating itself in terms of interpretation of behaviours.

Mark wrote a book about his early experiences in a children’s home where his behaviour was seen as ‘challenging’.

Looking back, he sees he was desperate for love, and discipline was one of the aspects of care that he missed out on having been brought up in transient environments, moving between foster parents and group homes.

He went on to attempt suicide on more than one occasion before finding supportive and safe environments in which to explore his emotional issues through therapy.

But that was back in the 1970s. In 2018, a time where there is so much talk and campaigning to understand mental illness, how can exclusion from class for his son be the answer?

His school says it isn’t a punishment but an opportunity to support him, his teacher and his classmates by limiting disruption in the classroom.



But exclusion or isolation is used as a punishment, so it’s hard to imagine it would be seen as anything else.

As we know from many men speaking out today, it can be more difficult for them to discuss their vulnerabilities, as a result, many boys – including Mark – act out as a way of expressing their distress, which is then perceived as a behavioural problem, rather than a mental health one.

Ms Devon said: ‘Government and charity sponsored studies will often claim that girls are more at risk of anxiety and depression, particularly middle class girls. Yet these studies use a combination of statistical data on diagnoses and asking the young people in question.

She explained that if you are female you are more likely to talk about your mental health in the first place, more likely to be understood when you do and more likely to be able to gain access to medical support, but she thinks the idea that girls suffer disproportionately from mental illness is bogus.

‘Emotional difficulties both manifest and are interpreted in a different way in masculine and feminine people from an early age.

‘Girls are encouraged to use their words, boys are taught by a culture that still uses phrases like “man up” and “grow some balls”, and that violence is more acceptable than talking. It’s hardly surprising that at primary age we therefore see more conduct disorders [being diagnosed] in boys.’

Dr Shirley Reynolds is a professor of Evidence Based Psychological Therapies at the University of Reading. She says that the issues might arise due to the different ways in which symptoms present among boys and girls.


Dr Reynolds said: ‘One of the things that causes this problem is that teachers and many health professionals are not aware that irritation and anger are common symptoms of depression and anxiety – in fact it is one of three core symptoms of depression.

‘You can actually make a diagnosis of depression without low mood being a symptom.’

So lots of boys who may be depressed don’t get identified or diagnosed and people often assume this is a behaviour problem.

‘It’s really important to find out more about the irritability or anger and you can only do this by making time and space to listen.

‘If you see that the young person also has problems with sleeping, being tired or fatigued, or is not enjoying their usual activities, those are also symptoms of depression.’

So aside from making time and space to listen, how else can schools support boys who are struggling emotionally, but unable to convey their feelings effectively?

Ms Devon said: ‘In my training with schools, I ask them to think about the environments in which boys and young men have told me they feel comfortable expressing themselves – which might include sports or music clubs, and to reflect on how accessible these are for their pupils.

‘School counsellors are wonderful, but funding cuts mean they are often shoved in a cupboard somewhere, or in the corner of a library where everyone can see them.

‘My research suggests boys (or masculine-minded people) are more likely to avoid these types of sit-down-and-chat scenarios, particularly if they’re being watched.’


Given how much the conversation on mental health has evolved in the past decade, it’s time we start facing up to the possibility that our gender biases are affecting our diagnoses.

We must open our eyes to the realities of what young people are going through and get them the help they need, rather than labeling them with whatever seems like the easiest option

For more information and advice about young people and mental health visit www.youngminds.org.uk

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