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The Inner World of Social, Emotional, and Mental Health (SEMH) Needs

SEMH Needs

Takeway: Many ‘problem behaviours’ in children are a sign of deeper issues that need to be resolved. They’re a sign of unmet social, emotional, and mental health (SEMH) needs. The bad news is that these issues won’t magically sort themselves out. But the good news is that skilled practitioners have an array of tools and techniques to help your child work through her challenges.  

Physical challenges are easy to understand. But challenges of the mind are more nuanced.

If a child has a broken arm, it’s something we can see and understand. We know she’s going to need help while getting dressed, taking notes in class, eating her food, and so on. It’s easy to have compassion for what she has to go through. But what about if she has issues with anxiety or depression, instead? You can’t ‘see’ these things. All you’ll see is perhaps an agitated child with mood swings. Or a child who’s always getting into fights. Maybe she becomes closed off and emotionally detached? If we don’t look close enough, we’re likely to assume that she’s just being troublesome. But obviously, that’s not the whole story.

Troublesome behaviours are a sign of an inner struggle. They’re a sign of Social, Emotional and Mental Health (SEMH) needs.

SEMH is a term that was coined in 2014, and it marked a change in the way we address problem behaviours. Earlier, the mental health component of the term was ignored. The focus was on the behaviour itself, so terms like Emotional & Behaviour Difficulties (EBD) were popular. Now, we look beyond the behaviour, at the deeper inner struggles that accompany social and emotional difficulties. So, if a child is being a bully, what are the psychological factors at play? Is she being neglected at home? Or perhaps she’s being bullied herself? When we focus on the behaviour (the bullying), we see a problem-child. But when we focus on the inner struggle (perhaps a feeling of neglect and abandonment?), we’ll notice SEMH needs that we can learn to support. And missing these needs has a cost. Because without the right support, children find it harder to gain the confidence and positivity they need to build resilience.

The term SEMH covers a range of issues that fall into three main buckets.

Children with SEMH needs usually has the following challenges:

1. Social challenges

Some children struggle to form meaningful relationships. They’ll have problems making and keeping friends, or even getting along with the adults in their lives. Often there’s a developmental difference like autism spectrum disorder that drives this struggle. And being aware of this difference makes it easier to devise a plan of action.

2. Emotional challenges

Emotional challenges show up in many ways. Some children may struggle to accept and process changes in their lives. A new daily routine, for example, might make them extremely uncomfortable. Other children may find it hard to understand what they’re feeling and thinking, and so can’t tell anyone what they want or need. This will, in turn, frustrate or distress them, causing them to act out or withdraw.

3. Learning challenges

  • Some children struggle to start, focus on, and complete tasks. This makes it hard for them to learn anything, which then starts affecting other parts of her life. For example, if a child has attention issues, she might lose interest in what her teacher is saying and start distracting a classmate. Now, she’s both missing out on the lesson and being a ‘nuisance’ in class — for which she’ll likely be punished.
  • Other children might have speech, language and communication needs (SCLN). So, they might have problems understanding language (i.e., decoding what people say to them) and using language (i.e., stringing together words and sentences to tell stories or get their point across. A common example of this is developmental language disorder (DLD).

So what are some ways in which children act out?

You might notice your child gets more withdrawn and sullen than usual. Or she seems to get anxious — wetting the bed, having sleep difficulties, refusing to go to school, or developing mysterious aches and pains that doctors can’t spot the cause of. She might go the other way and throw tantrums, become aggressive, get into fights, and start being disruptive in class. If she’s older, she might begin smoking, doing drugs, stealing, setting fires, vandalising property, etc. Alternatively, she might develop an unhealthy relationship with food (often in the form of an eating disorder), which you’ll notice as a drastic change in weight. And in some cases, she might react more disturbingly, by cutting or burning herself as a way of coping with emotional pain, anger, and frustration.

The thing is these behaviours don’t sort themselves out without support from informed adults.

Most children with an SEMH-needs diagnosis test below-average at school. And only about a third of adults diagnosed with SEMH needs at school have received any type of qualification since then. This is not a case of children without potential. That’s what makes it so heartbreaking. All of them can be happier than they are if they just get the right support.

The good news is that we can support these children.

1. A professional can make an SEMH assessment.

Theoretically, any parent can spot problem behaviours and try to locate their causes. But often, you’ll be biased because there’s so much emotion involved. After all, your child is suffering, you don’t know why, and you want her to get better. Here’s where a psychologist can help. She’ll have the training to connect cause and effect, and a psychological toolkit to help address the underlying issues.

2. Based on the initial assessment, she’ll set up a care plan for your child.

There’s an impressive array of therapies to choose from. For example, cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), Lego therapy, mindfulness therapy, etc. Also, she can teach your child about stress/anxiety management and anger management. The type of care she’ll provide will depend on her conversations with you and your child.

3. Meanwhile, there are things you can try out yourself.

While the psychologist helps your child via formal sessions, there are some complementary changes you can make at home.

  • Set up a peaceful environment. Many children calm down when their surroundings are set up right. So, you can remove distractions (like TVs) from the room your child studies in, make sure she has an uncluttered desk, and try to make the room as noise-proof as possible.
  • Work around her attention span. If she has to do something tough, try and give her a fun activity immediately after. The more you alternate tough and easy tasks, the less likely she’ll give up.
  • Let her practise making choices. When she acts out (e.g., not doing homework), try and give her the choice of doing something else (e.g., cleaning their room). Just the fact that there’s another option, however unsavoury, lets her feel less controlled.
  • Reward/penalise her behaviour consistently. She needs to know there’s a simple, clear system in place that reacts to what she does. Good behaviour gets rewarded and bad behaviour gets penalised — no exceptions. And the quicker you respond, the better. For bad behaviour, try not to get into long discussions and debates. It helps if you deliver the penalty (e.g., ‘no internet for the rest of the day’) and move on.

Do you suspect your child might have unmet social, emotional, and mental health (SEMH) needs? Consider consulting a specialist.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have psychologists and therapists who can help assess your child and offer guidance and support.

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