There is a great deal written on this subject but very little in relation to children and young people with complex needs.

Anyone interested can find a wider discussion on this in our book Supporting the Emotional Well-being of Children and Young People with Learning Disabilities: A Whole School Approach.

Here we outline a support framework with the focus on what special schools and their class teams can do to support emotional well-being and to protect children and young people against mental health difficulties now and into the future– to make them Emotionally Able.

Historical Approaches

The approaches to supporting the emotional well-being and mental health of children and young people who have severe and complex learning needs are equally unclear. There does not appear to be a clear distinction between what we mean by supporting emotional well-being and mental health and addressing challenging behaviour. The earliest approaches were in terms of establishing the ‘correct’ behaviour, later a more cognitive approach was used. It is only now that we are beginning to see the importance of recognising the emotional and mental health needs of children and young people with complex needs. When I began working in this field 40 years ago my more experienced colleagues were just starting to come to terms with the recognition that children with complex needs were more than simply an unfinished jigsaw, whereby if only you can find the correct pieces you can work towards completing it.

However today we are now coming to terms with how children with complex needs need a range of support that will help them achieve their own rich and fulfilling life. An important element of that is providing support that will nurture their emotional development. As part of my work with my co-authors of our book we identified 3 key areas for support when creating a support framework for children with complex needs – RELATIONSHIPS, ENGAGEMENT and FEELING POSITIVE. With the most fundamental of these being RELATIONSHIPS.

The Importance of Relationships

For any child relationships are important from birth, particularly their attachment relationships. It is through these relationships that they come to understand their world and feel safe within it. This is particularly the case for children with complex needs for whom the world can readily be a confusing and frightening place to be.

In our book we look at the importance of Attachment theory and when viewed within developments within neuroscience, particularly Polyvagal theory, we can begin to gain further insight into how to support the emotional needs of children with complex needs.

In this and subsequent blogs I will talk about how we can use the two theories to try to understand and explain what support we can offer and how effective it can be.

Two Supportive Theories

Attachment theory describes how all children are born totally dependent upon others for their safety and survival. We can therefore see that relationships are very important and influence their physical and emotional development.

Polyvagal theory describes the importance of the connections in the brain and nervous system in understanding their world and how to regulate their emotions to feel safe within it.

As any child experiences the world their brains build links across different areas of the brain and throughout their nervous system. It is estimated that by the end of their first year, children are making one million connections between the cells in their brain per second (though not all of these will remain).

It is through these connections and their experience of attachment relationships that infants begin to learn to form their internal world and regulate their behaviour and emotions.

It is important to recognise that this becomes more difficult when a child or young person with complex learning and/or developmental needs (CYP) finds their world to be a stressful and confusing place to be. When they are not able to connect positively and find support through their relationships with others, as can often be their experience, it is much more difficult to feel safe and secure or to form positive attachment relationships.

Taken together these two theories can offer a great deal in terms of understanding the emotional and mental health needs of this very vulnerable group.

Underlying Assumptions

At the outset there are certain important assumptions to acknowledge before we begin to identify what kinds of support to offer:

1. ALL children are children first and experience the same range of emotions as all other children.
2. ALL children and young people need to feel safe and secure to learn and grow whether or not they have any developmental difficulties.
3. How much support is needed to feel safe and secure will vary from individual to individual.
4. How well these needs are met will depend on their positive attachment relationships.
5. The more complex a child’s developmental difficulties the more they will rely upon these attachment relationships.

Feeling Safe and Secure

If we accept these assumptions when working with CYP with complex needs, the relationships they have with others is our starting point in understanding what feeling safe and secure means for them.

Every CYP is different and the way in which we support their emotional and mental health needs has to be able to connect and communicate in ways that support and reinforce their sense of safety to prevent feelings and emotions becoming overwhelming.

Generally, as children grow, they connect events and emotions and learn to communicate these to others. However, when they have severe development difficulties their ability to positively communicate their emotions depends heavily on those who care for them, i.e., the adults they have formed attachment relationships with.

‘Sense of Safety’ is a fundamental concept in Polyvagal Theory that describes the physiological responses that contribute to how a child understands their world and particularly from the point of view of a child with complex needs.

As a child’s internal world begins to form both cognitively and physiologically, understanding how a child responds physiologically is important in knowing how they ‘decide’ how safe they feel. Much of what happens physiologically takes place without awareness and forms patterns of responding from a child’s earliest days. Polyvagal theory provides us with a view of the physiological structures and systems that have been identified and how they influence our patterns of responding to make us feel safe.

An important question from a child’s earliest days is “Am I safe with you?” and over time there is the added question “Can I trust you to keep me safe?” For some CYP with complex needs these may be questions they are constantly seeking answers to.

How a child expresses a need for ‘safety’ is different for every child, as they each bring a different set of life experiences and a unique internal world view. When there are concerns about a child’s behaviour, it is important to understand this as we respond to their emotional well-being and their need to feel safe.

We begin to seek answers to our previous questions:

• Am I safe with you?
• Can I trust you to keep me safe?

We can then ask ourselves more specific questions:

• What do they feel positive about in school?
• What is challenging for them in class and around school?
• Where is this evident in their learning and progress?

As we answer these questions, we begin to build an understanding of the child and their individual world view in order to know how to offer support.

If we accept a child’s initial underlying drives as unconsciously driven, we can avoid any assumptions about a child’s behaviour. We can avoid any ‘shoulds’ or ‘should nots’. For example, it is not helpful to assume a child:

‘Should be able to …’

‘Should not be allowed to get away with…’

The way they respond is mediated by their life experiences and the support and understanding within their attachment relationships. This can be seen at its most positive in a child who is resilient coping with unexpected change and disappointment and having positive outcomes in their daily interactions. Whereas at the other extreme you may have a child who is driven by a sense of survival and getting through the day by ‘whatever means they know how’.

An example of a ‘Safe’ response

This example is a very familiar experience for many adults working with children and one they may have to deal with many times throughout a school day. It is also one that highlights aspects of Attachment Theory in everyday experience.

A child comes to you in the playground distressed and upset having fallen and hurt their hand. Whether or not there is any visible injury, when you see they are upset you show concern, you offer genuine sympathy and acknowledgement about how they feel. This helps the child to feel connected to another person in a moment of distress.

When this is done sensitively and with compassion this is a positive experience of attunement. The child knows the way they are feeling has been ‘felt’ by someone they have connected with. Through repeated experiences, whether short or longer encounters, a sense of safety and trust begins to develop between the adult and the child, whereby a child can begin to feel ‘understood’.

When attunement takes place there is recognition of the upset feelings of another and empathy with those feelings enabling the potential for growth and change to take place.

To do this the adult can observe what a child is feeling through their behaviour such as eye contact, body language, use of voice, etc. but importantly, reflecting on how this feels for the child.

Here we have reached a stage where the adult has given their full attention to the distressed child. They ‘see’ the upset of the child and can name the emotions they appear to be experiencing (attunement).

They can share with the child their understanding of how upset the experience has made them feel (empathy).

It is from this that the adult can begin to help the child process their feelings and emotions and regulate their response – co-regulation.

An adult’s questions and statements can begin the co-regulating, calming process by asking questions like:

• Can I see where you have hurt yourself?
  • That does look sore.
  • I can see this has made you sad.
• What can we do to make you feel better?

Then offer some suggestions:

• Will it help if I rub it?
• Shall we go and wash it?

After some attention and activity:

• Would you like to stay with me for a little while?

Or

• Would you like to go and play?

For the child who has difficulty regulating themselves it poses the question ‘can things be better than I expect them to be?’ After each positive interaction like this their answer becomes ‘Yes’.

It is through these three key concepts of Attachment theory a child can begin to feel ‘known’ by the adult and safe from overwhelming emotions and experiences as they learn to regulate themselves.

In my next blog I will describe how the unconscious drives a child experiences can be understood through Polyvagal theory and how important this can be when supporting children and young people with very limited language and communication skills.