Please ensure Javascript is enabled for purposes of website accessibility Impact of Behavioural Difficulties on Families - Impact on Urban Health
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Children's mental health

No Timeouts: understanding the impact of behavioural difficulties on children and families

We commissioned this ethnographic research to help us better understand the reality of life for children and families affected by behavioural difficulties.

Introduction

Images do not depict the families involved

Content warning: The issues raised and experiences shared in this report are upsetting and potentially triggering. They include domestic abuse, violence, racism, extreme emotional distress, and trauma.

All children deserve the opportunity to be healthy and happy, no matter where they grow up. That includes having strong, positive mental health.  

The prevalence and extent of mental health problems in young people is well publicised. Particularly in the context of the pandemic, and now the cost of living crisis. Despite this, there is still relatively little awareness that for some children, anxiety, distress, and trauma is communicated through their behaviours and interactions with others. So called behavioural difficulties are widely misunderstood and carry huge stigma, something we see play out in school exclusion rates and the limited support offered to families. As with so many health-related issues behavioural difficulties are strongly linked to inequality. Children growing up in inner-city areas like the London Boroughs of Lambeth and Southwark, especially those forced into poverty, are over three times as likely to experience behavioural difficulties. And the families affected often find support hard to access, unsuitable for their circumstances, and clouded in judgement.  

No child should be defined by the way they respond to distress. We commissioned this ethnographic research to help us better understand the reality of life for children and families experiencing mental health and behavioural difficulties. The current lack of this kind of experience-led research is striking when you note how little literature there is that looks at behaviour from the perspective of parents, siblings, grandparents, or of children themselves. Our children’s mental health programme aims to make it possible for all children to have strong, positive mental health, by tackling the inequalities many families face when young people experience behavioural difficulties. We will listen and work closely with families and community-led organisations to make inner-cities a place where all children can thrive

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About the research

During the early part of 2021, eighteen families living in the London boroughs of Lambeth and Southwark took part in research conducted by teams from Renaisi and Close-Up Research. 

This provided in-depth insight into the lives of each family. The research explored their understanding of their child’s behavioural difficulties, relationships with school, impact on wider networks, and experiences of support. 

This ethnography prioritises the experiences of families. They are best placed to talk about the realities of day-to-day life when a child has behavioural difficulties and are experts on what works and what doesn’t. Yet their views are often completely absent from research and literature. Because so many families feel judged or shamed there can be a reluctance to share experiences, so we are incredibly grateful for their honesty and the emotional labour involved in taking part in these interviews. 

We were particularly keen to hear from families who were already accessing some form of support, as we need a clearer understanding of what is currently working in the boroughs, and what needs to change.

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Understanding behavioural difficulties

All children will display challenging behaviours at some point in their lives. However, the behavioural difficulties experienced by the young people in this research are more extreme, frequent and persist, and have a huge impact on their lives and the lives of those around them. One of the aims was to explore parents and children’s own interpretations of the behavioural difficulties and the ways they navigate daily life. 

Families’ descriptions of their children’s behaviour revealed the extent of the challenges they were facing. The most commonly occurring behaviours were: 

  • Physical: banging head against the wall, running across the street, kicking doors and walls, throwing things. 
  • Verbal: screaming, shouting, swearing, using rude, abusive or racist language. 
  • Aggressive or violent acts towards other family members: hitting, punching, biting, kicking, pinching. 
  • Controlling and manipulative behaviour: lying, using guilt, threats and blackmail directed towards other family members. 
  • Breaking possessions or things inside the house: furniture, tyres on a car, smashing TVs, tablets. 
  • Aggressive acts towards teachers and classmates: biting, hitting, fighting, threatening to severely hurt others. 
  • Difficult behaviour at school: disrupting class, refusing to stay in class, leaving school during the day. 

I don’t know how to describe it… You can see the difference even physically between when he’s in one of them rages to when he is not” (Family 6)

“I’ve got an angry head and you upset me, you telling me to do stuff I don’t want to do” (Child, Family 4)

“Sometimes I get mad and it feels like I’m shaking” (Child, Family 6)

Impact on families and wider networks

Living with a child who has behavioural difficulties can be extremely distressing and have a significant impact on the whole family.  

Some families talked about issues with money, jobs and housing making things even more difficult. Not being able to afford specialist childcare, do nice things as a family, have any time off for respite, or live in a secure home with enough space all adds to the huge stress faced every day. 

Some mums reported having to give up work all together, to home school and care for children with behavioural difficulties full time. And low quality, cramped housing is undoubtedly an ongoing risk factor.  The main impact of this lack of space is that family members have nowhere to go for privacy or if they need to be alone. Where the home environment is uncomfortable, families’ wellbeing suffers which only adds to stress and behavioural difficulties. 

“It would probably be like easier if we had like a proper house because we live in this really small nasty flat at the moment. If we could all have our own space we could go to, where we could actually shut the door. Because if we shut the door here, it gets too damp. So a place we can lock the doors and like shut the world out. If that makes sense.” (Sibling, Family 4) 

A very common theme was the sense of loneliness and isolation parents often feel. This is linked to reduced social circles but also feeling judged, misunderstood and blaming themselves for their child’s behaviour. 

“I feel I am constantly on edge and worn out.” (Family 13) 

“He’s only ever been in his seven years of life being to three birthday parties. And we know there have been birthday parties, people being given out invitations and he’s come home and said my friend’s having a party, but I didn’t get invited.” (Family 4) 

“Sometimes you just want to have someone empathise with you, say to you… I understand.” (Family 10) 

Parents talked about their children’s strengths and positive traits, as well as those that were challenging, and were anxious about their child being labelled, given up on or treated differently. That isn’t to say that some of the behaviours described in interviews weren’t extreme and don’t have a huge impact on the mental health and wellbeing of the whole family. Many of the parents who took part in the research talked about how hard day to day life is, and how they wished the severity of their situation could be understood without the judgement. 

“He’s very, very cuddly and can be incredibly cute and sweet.” (Family 2)

“She is very lively, very funny. She used to be like the nursery rhyme, you know, when she’s good, she’s very, very good.” (Family 5) 

“He will tell me I’m the worst person in the world, he hates me and doesn’t want me around.” (Family 8) 

Experiences of support 

Many parents talked about how daunting it is to access support, not knowing where or how to start. Besides the fear of judgement, permanently labelling their child, or even having children taken away, some parents felt they had to convince professionals that their child needed help in the first place.   

Feeling stigmatised and mistrusted was common and many parents feel that their children are being written off, that they aren’t really listened to, and that support is not as effective as it could be. 

They described complicated and slow systems that required them to piece support together, going through the same steps with multiple people, and a sense that they’d be able to access help much quicker if they could pay for it. While attempting to navigate all this over months and even years lots of children’s mental health continued to get worse. 

“If they get to a wall and they can’t go no further, they’d shut your case.” (Family 4) 

There were very mixed experiences of support from Children and Adolescent Mental Health Services (CAMHS), schools, and social workers, largely dependent on individual teachers and health care professionals taking the time to get to know the child and family. 

“They always take me seriously because they saw his behaviour in the school. So they know what kind of behaviour he does develop when he gets angry.” (Family 7 

“Their attitude was that they are higher than me. They are better qualified. I’m just a single mum with two kids and one is playing up.” (Family 4) 

“Even though that I am not from the white background… I know how to protect my child, you know, and I was really clear about that. Even though we don’t have a wealth, even though we don’t have anything, but she is in that school and she should be treated equally.” (Family 11) 

Conclusion

We were incredibly moved by the insights and experiences captured by Renaisi and Close-Up Research, and struck once again by how little we had read previously from family’s perspectives. Listening to children and their families has demonstrated the huge impact that behavioural difficulties can have on people’s lives. This is in addition to the better known impact on a child’s school attainment, future employability, and links to crime, which without the broader context reduces children to statistics and feels extremely deterministic. Through these interviews, we learned about distressed children isolated from friends, singled out or excluded from school; brothers and sisters scared of what to say and do, not living at home or spending as much time with their families; and the massive impact on parents – often anxious, lonely, and trying their best with limited or no support.  

An issue of inequality 

It’s clear that this is an issue of inequality, and that things are even harder for those with fewer resources and more limited time and money. Insecure, cramped, low-quality housing, the likes of which is so common in inner city areas like Lambeth and Southwark, can make managing the family’s needs feel impossible, with no privacy, no space, and no guarantee they be able to stay in that home long-term. And lack of disposable income means many can’t plan fun or relaxing activities outside the home either, which is so important for quality family time and rest for parents. This is not to mention the huge mental and physical toll living with financial insecurity brings in itself. Families with more money are sometimes able to access specialist support quicker and in a more personalised way, but this inequality is framed as a failing on the part of less wealthy parents. 

Time to end the stigma 

The feeling of being judged and stigmatised for having a child with a behavioural difficulty, and the lack of understanding and empathy so many families face means that even if the right support was available, many wouldn’t feel safe or able to access it. In reality, families have to fight for support, which is inconsistent and very short-term, with parents piecing together any help they can find. As a result of the invaluable and incredibly honest insights shared with us by children and families, we are working with partners to tackle the inequalities, biases and discriminatory systems that make behavioural difficulties worse and leave so many without the support they deserve. We hope that by improving understanding of behavioural difficulties and the distress they cause we can reduce some of the stigma experienced by families, and challenge the unfair, often prejudiced judgements that are so damaging. We want to work with others to build nurturing, safe and compassionate models of support across schools, community-led services and any other system that plays a role in protecting the mental health of families and young people. 

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