Behaviour of concern

All behaviour has meaning. Children and young people communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is. The behaviour used to communicate can be made stronger and more likely by how it is responded to. For example, if a child becomes aggressive because of a demand placed on them, often the demand is taken away.

Everybody, whether young or old has times when they are upset, angry, worried, confused or hurt. Strong emotions can be tough to understand, express and manage, particularly for children and young people who may not have the language or ability to communicate verbally what they are experiencing. When a young person’s behaviour becomes concerning, it may be that they are experiencing a strong, overwhelming emotion that is hard for them to manage. Behaviour serves a purpose and is useful in some way even if there are unintended or negative consequences. For example, if a young person is feeling angry they may become verbally or physically aggressive. Whilst verbal and physical aggression is not a helpful or appropriate response, it is a way of communicating and expressing how the young person is feeling.

Many young people respond to strong and overwhelming emotions impulsively and reactively in the moment and without much thought or consideration of the consequences. This is why sometimes children and young people (and even adults) can behave in extreme or concerning ways from time to time.

Experiencing different emotions at a time that are strong and overwhelming is very confusing for a young person and may lead to unpredictable or changeable behaviour. The factors that influence how a child or young person may behave include:

If a child or young person is behaving in a way that is concerning or that places themselves or others at risk, it can be worrying and difficult to know how best to support them. We have put together a download of top tips that you might find helpful as well as video of a workshop on how to manage concerning behaviour.

There are a number of resources that may also be helpful to you and your child in better understanding the function of the concerning behaviour and how to find other ways of achieving the same function without needing to use concerning behaviour.

CAMHS Behaviour of Concern Referral Guidance

 What we do, what we don’t do and what you can do if you are worried about your child

All behaviour has meaning. Children and young people communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is. A young person’s behaviour can be made stronger and more likely by how it is responded to. Here’s a guide to help you know how best to support your young person if they are behaving in a way that is concerning. This is not an exhaustive list; there may be other behaviour and responses to this which have not been included:

Low Level

Behaviour that most young people will display from time to time

Type and nature of situation that may impact on a young person’s behaviour

It is common for children and young people to behave in ways that concern adults from time to time. The behaviour they display tends to be situation specific, short term and can be managed with the love and support of parents/ carers. Behaviour of concern is often a result of young people experiencing emotions such as worry, sadness, frustration/ anger, guilt or shame. Examples of situations which might provoke these feelings include:

  • Not feeling heard or understood; difficulties expressing themselves.
  • Demands being made (and having to do things they don’t feel able or want to do).
  • Perceived or real pressure or expectations by others.
  • Uncertainty and unpredictability (such as the way adults respond).
  • New/ unfamiliar things and change/ transition.
  • Inconsistency (such as; inconsistent rules or boundaries, disrupted or chaotic routines and living environment).
  • Conflict (either witnessing this or being part of this).
  • Perceived or real rejection or abandonment by others.
  • Perceived or real being ostracised (being left out) and not having or feeling connected to others.
  • Low self-esteem and beliefs of being a failure/ not being good enough.

Factors such as tiredness, hunger, not feeling physically or being in pain well can impact on how young people cope, respond and behave.

Some young people with physical disabilities and conditions, learning disabilities or those with neurodevelopmental difficulties (such as Autistic Spectrum Condition or Attention Deficit Hyperactivity Disorder) may have additional difficulty in being able to identify, express and communicate their emotions, thoughts, needs or preferences. This struggle may result in strong emotional responses and behaviour of concern.

What you might see or a young person might report

  • Appearing unsettled, distracted or irritable.
  • May appear more challenging or oppositional/ argumentative.
  • Shouting or verbally aggressive (e.g., name calling, swearing).
  • Crying or becoming distressed.
  • Not telling the truth.
  • Avoidance of or refusal to doing things when asked or expected.
  • Withdrawal from spending time with friends or family or persistently seeking reassurance.
  • Having bad dreams/ mild sleep disturbance.
  • Having some physical symptoms such as feeling sick, hot and clammy, tummy aches.
  • Appearing restless and fidgeting.

Things to try, support and Next Steps

  • Normalise that having feelings such as worry, sadness, frustration, guilt or shame are natural emotions and responses to events and situations.
  • Try to identify the situation which has led to the young person experiencing a strong emotional response. It may be possible to problem solve the situation. If not, acknowledge and validate the young person’s feelings.
  • Make sure basic needs have been addressed e.g., the young person is getting good quality and enough sleep, is not thirsty or hungry and is not feeling unwell or is in pain.
  • Ensure that messages, rules and boundaries, language and adult behaviour is consistent, reliable and predictable.
  • Prepare young people for change, transition, unfamiliarity or unpredictability (e.g., give warning, discuss worries and concerns, problem solve how to do things, offer support).
  • Give children limited options (i.e., choose this or that)- as too much choice can be overwhelming.
  • Ensure routines in the morning and evening.
  • Stay calm and be clear in your own communication. Avoid getting into lengthy debates, explanations or arguments.
  • Use techniques to help young people manage their emotional responses in more helpful ways here are some strategies to try;

An A-Z of coping strategies: https://youtu.be/5EXpkVw3fh0

How and when to use a coping box: https://youtu.be/OyfgodSSdV4

  • Role model and demonstrate that you can do things even when you experiencing strong emotions and have urges to respond or behave in certain ways. Young people often learn and copy language and behaviour that they experience so try to respond in ways that role model to the young person.
  • Watch our parent/ carer workshop on Coping and Resilience Skills here: Film to be added
  • Watch our parent/ carer workshop on Challenging Behaviour: https://youtu.be/RMPn3gTEh5Q
  • Download our top tips sheet for parents on how to manage challenging behaviour Film to be added

Moderate Level

Behaviour that some young people display and may need some support with

Type and nature of situation that may impact on a young person’s behaviour

The behaviour of a young person appears out of context or disproportionate to the situation. Episodes of concerning behaviour might be more frequent or prolonged and cause the young person and family distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school and relationships with others.

Strong emotional responses and behaviour of concern may be in response to or indicative of the factors described in Green. More concerning behaviour may (or may not) be in response to events such as:

  • An upsetting or traumatic life event or repeated upsetting or traumatic events (e.g., bullying).
  • Feeling threatened through experiencing abusive behaviour (neglect, emotional, physical, sexual, financial).
  • Unpredictable and distressing environments (witnessing aggression/ violence).
  • A result of misusing elicit substances (e.g., drugs or alcohol).

In some cases behaviour of concern may be in response to a mental health difficulty or crisis.

What you might see or what a young person might report

As well as the features in Green, the following might also be present:

  • Resistance to doing things; requiring a lot of cajoling or persuading.
  • “fight or flight” responses such as becoming distressed or agitated, running away/ hiding or becoming verbally or physically aggressive towards others including intimidating and threatening behaviour.
  • Shutting down and becoming uncommunicative; withdrawing and not engaging with others or in activities they previously would.
  • Telling others information which is concerning and not factually correct.
  • Disrupted sleep (difficulties getting to or staying asleep, nightmares/ night terrors).
  • Persistent physical or verbal seeking reassurance.
  • Some episodes of panicking such as getting distressed, racing heart rate, quicker breathing, upset tummy, feeling sick, feeling dizzy or faint.
  • Demanding things be done in certain ways or requesting others to do things for them.
  • Engaging in impulsive, reactive or risky or potentially harmful activities such as substance usage (drugs and alcohol), risky sex (including online sexual activity), petty crime.
  • Truancy/ not attending or engaging at school/ college.
  • Families might also find themselves struggling to do things as they normally would as they may make adjustments to accommodate how the young person is feeling or responding.

Things to try, support and Next Steps

As well as the steps in Green the following might be helpful:

  • Support your young person to access self-help resources (podcasts, videos, downloads, links) on the Hampshire CAMHS website: www.hampshirecamhs.nhs.uk
  • Watch our parent/ carer workshop on how to support anxiety here: https://youtu.be/LMFQHABnH1M
  • Share concerns with your child’s school/ college. Work on a plan together so there is a consistent approach from all adult care givers.
  • Access pastoral support from school/ college. Discuss with your child’s school accessing the Primary Behaviour Service.
  • Consider accessing help from a local counselling service.
  • Seek advice, guidance and support from Young Minds Parent Helpline:

08088025544

Depending on the context and/ or the triggers and contributing factors for the emotional responses and behaviour of concern, other services may be helpful e.g., family guidance if there is family breakdown or conflict. There is a lot of information on the Hampshire CAMHS website: www.hampshirecamhs.nhs.uk.

 

High Level

Behaviour that has a significant impact, may cause harm to self or others such that a young person may need specialist support

Type and nature of situation that may impact on a young person’s behaviour

Behaviour is extreme, chronic and may cause harm to the young person directly or another (either purposefully or accidently).

Behaviour may cause significant distress to the young person and be a significant concern to their family/ network (such as school/ college). Behaviour significantly disrupts daily life such as attending school/ college, socialising.

Behaviour may be criminal in nature.

Despite trying advice in the Green and Amber stages, the young person still experiences behaviour of concern.

More extreme or concerning behaviour may (or may not) be in response to events such as:

  • An upsetting or traumatic event or repeated upsetting, threatening or traumatic events (e.g., bullying).
  • Abuse (emotional, physical, sexual, financial).
  • A result of misusing elicit substances (e.g., drugs or alcohol).
  • In some cases behaviour of concern may be indicative of a mental health difficulty or crisis.

What you might see or what a young person might report

The features in Green and Amber may be more frequent and intense plus, the following might also be present:

  • Persistent refusal to leave the house or attend/ take part in activities such as school, hobbies, interests, seeing friends.
  • Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise (ill health) as a result of this.
  • Withdrawn and uncommunicative or not wanting to be left alone at all- this may seem uncharacteristic or age inappropriate for some teenagers.
  • Becoming agitated, distressed, oppositional or aggressive towards others (including verbal and physical aggression/ violence towards others).
  • Age inappropriate sexual activity/ behaviour (particularly for young people aged 16years and under).
  • Reactive and impulsive behaviour such as running away which may place them or others in danger.
  • Criminal behaviour.
  • Families will find themselves struggling to do things as they normally would, that family functioning is disrupted and they are required to make significant adjustments to accommodate how the young person is feeling or responding

Things to try, support and Next Steps

As well as the steps in Green and Amber the following might be helpful:

  • If a young person or someone else is in immediate danger with potential for harm, you must consider contacting the emergency services (Police and or ambulance).
  • Speak with your child’s GP.
  • Speak with your child’s school/ college and the School Nursing Team and or the pastoral department.
  • Depending on the context and/ or the origins of the emotions being experienced and the nature of the behaviour of concern, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support if there are clear triggers for the behaviour of concern e.g., abuse, domestic violence etc.
  • To contact Children’s Services with concerns about the safety or wellbeing of a young person Monday- Friday 9am-5pm: 0300 555 1384 or email: childrens.services@hants.gov.uk. Out of Hours: 0300 555 1373
  • Seek advice, guidance and support from Young Minds Parent Helpline:

08088025544

  • Consider making a self-referral to a CAMHS Service.

Please note, that CAMHS may only provide an assessment and offer an intervention if the behaviour or concern is in relation to a mental health difficulty or crisis.

Watch:

  • Managing challenging behaviour
  • Managing challenging behaviour