Is this Social Emotional and Mental Health needs, bad behaviour or a communication breakdown?

Children’s behaviour can be very puzzling; why would a boy prefer to hang upside down over the chair in silence than do an assessment, or play with Lego? Why did two eleven-year olds (who can use words) have a ‘conversation’ in screeches while taking turns to scribble on a chalk board? There are often a multitude of possible explanations, some of which are to do with communication. At best, not being able to understand this sort of thing is amusing, at worst it can evoke strong negative emotions in us including disgust, anger or fear, especially when the behaviour becomes violent. We want to understand ‘why?’ and help children and young people to behave in ways that will be acceptable to society. We might even want to avoid such troubling situations.

However, children and young people who have Speech Language and Communication Needs (SLCN) are at greater risk of social emotional and mental health difficulties (SEMH), so Speech and Language Therapists (SLTs) are very likely to meet children and young people who have trouble managing their emotions and their behaviour, whether or not SEMH is their specialism. It’s therefore important for us to understand why children and young people with SLCN might have skills gaps that can impact on their behaviour. We need to know how to respond and how we can support them to develop language and communication skills that can support positive emotional and behavioural development.

It’s sadly still the case that children and young people who have SEMH often have unrecognised SLCN, so SLTs also have a role in identifying and supporting them as well as developing services for them. SLTs should be part of multidisciplinary teams working to understand children and young people with SEMH and the extent to which behaviour problems are communication breakdowns, but this is a work in progress.

The role of SLTs in this area is still emerging. What can SLTs contribute to services for children with SEMH? What can only SLTs contribute and what should SLTs not do? These are questions many of us are facing on a regular basis. The Royal College of Speech and Language Therapists have recently published guidance on working with children and young people who have SEMH which includes relevant research and which attempts to address these issues 1.

“To understand all is to forgive all”?

Gaining insight into why children and young people might have complex needs including SEMH and SLCN is often the first step towards helping them change and perhaps helping others’ perceptions of them change? Children and young people might have both SEMH and SLCN for a variety of reasons, including individual, family, socio economic and wider community factors 2. Recent research is also giving us fascinating insights into how SLCN and SEMH might co-occur or influence each other 3 and different trajectories for groups of children and young people, who have both SEMH and SLCN 4 5. This underlines the fact that these children and young people are all different, with varying strengths needs and risk factors which we need to understand.

SLT’s assessments of children and young people are often important in helping others recognise that sometimes behaviour arises because they can’t do something (for example understand instructions) rather than because they are choosing not to, these ideas are discussed further in the RCSLT’s new behaviour and communication fact sheet 6.

To exclude or include?

Currently, when exclusion of those who are different seems to be favoured, how can we develop effective, inclusive, collaborative SLT services for children and young people who experience SEMH and SLCN? How can we build in the necessary time and flexibility? This can be a challenge given current limitations on SLT services, but many SLTs are aiming to address this issue in creative ways and its important to share these ideas rather than ‘reinventing the wheel’. This is often a topic of discussion at RCSLTs SEMH Clinical Excellence networks 7 and on Basecamp, you might want to join this conversation?

What do Speech and Language Therapists need to do this work?

Often SLTs are working to develop services for children and young people with SEMH and SLCN in actual or relative isolation, so opportunities for professional networking, peer support and supervision are essential. Again, the growing network of SEMH Clinical Excellence networks is helping SLTs find what they need. The RCSLT has also worked with these SEMH CENs to produce a variety of resources and factsheets which are useful evidence-based resources for influencing work 8.

There is an urgent need to strengthen the evidence base of effective ways to help children and young people with SEMH develop their language and communication skills, so what are you waiting for?

What next?

Find out more about children and young people who have both SEMH and SLCN and how to support them at the An introduction to working with children and young people who have Social, Emotional and Mental Health Needs (SEMH) and Speech, Language and Communication Needs (SLCN) course. We’ll consider the research and take the opportunity to think with colleagues about how to use these ideas to effectively support our clients.

Show references

  1. https://www.rcslt.org/members/clinical-guidance/social-emotional-mental-health
  2. Patalay P, Fitzsimons E. (2016) Correlates of Mental Illness and Wellbeing in Children: Are They the Same? Results From the UK Millennium Cohort Study (PDF). Journal of the American Academy of Child & Adolescent Psychiatry, 55(9), 771–783.
  3. Hannah, H., Brewer, R., Catmur, C., and Bird, G. (in press). The role of language in alexithymia:moving towards a multi-route model of alexithymia. Emotion Review.
  4. Forrest, C. L., Gibson, J. L., Halligan, S. L., & St Clair, M. C. (2018). A longitudinal analysis of early language difficulty and peer problems on later emotional difficulties in adolescence: Evidence from the Millennium Cohort Study. Autism & Developmental Language Impairments, 3, 239694151879539.
  5. Conti-Ramsden, G., Mok, P., Durkin, K., Pickles, A., Toseeb, U., & Botting, N. (2018). Do emotional difficulties and peer problems occur together from childhood to adolescence? The case of children with a history of developmental language disorder (DLD). European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-018-1261-6
  6. https://www.rcslt.org/speech-and-language-therapy#section-7
  7. https://www.rcslt.org/help-and-support/clinical-support-and-networks#section-3
  8. https://www.rcslt.org/fact-sheets-on-speech-and-language-therapy