Reframing Our Language in Paediatric Disability: Understanding Behaviour as Communication

In healthcare, the language we choose profoundly affects how we perceive, understand, and respond to our patients. For children with disabilities, and especially those with limited verbal skills, the term “behavioural issues” is often used to describe actions that may appear disruptive or difficult.

Yet, this label risks reducing complex behaviours to simple “misbehaviour,” leading us to overlook the essential fact that all behaviour is communication. When children lack the verbal skills to discuss their feelings, particularly in the context of past trauma or overwhelming current situations, behaviour often becomes their primary way of expressing their needs, emotions, and distress.

Behaviour as Communication: A New Perspective

Every behaviour, especially in children with limited verbal skills, is a form of communication—a signal about their inner state. Rather than seeing a child’s behaviour as an obstacle or disruption, we as healthcare professionals must view it as an opportunity to understand the child’s experiences and challenges. Children communicate through behaviour for many reasons, including:

• Sensory Overload or Discomfort: Children with sensory processing issues might react strongly to stimuli others would find negligible. External experiences like bright lights, loud sounds, or certain textures, can trigger overwhelming feelings, leading to behaviours that may seem disruptive but are attempts to manage their sensory experience.

• Unmet Needs: A child unable to communicate that they’re hungry, thirsty, tired, or uncomfortable due to pain or a full bladder may act out in frustration, trying to convey that something is wrong. Their behaviour becomes a vital clue for caregivers to address what they cannot say directly.

• Emotional Response to Trauma: For children with a history of trauma, current situations can trigger intense emotional responses. If a child has experienced past trauma, they may be hyper-aware of their environment, and situations that others would consider safe can feel threatening, like someone blocking their exit from a room, leading to protective, defensive or seemingly irrational behaviours.

• Desire for Control: Children often crave some level of control, especially in new or confusing situations. A child’s behaviour may reflect a need to feel safe and in control of their environment when they’re unable to communicate this need directly.

When we label these behaviours simply as “issues or problems,” we risk overlooking the underlying messages the child is trying to convey.

Moving from “Behavioural Issues” to Understanding Responses

By shifting from “behavioural issues” to terms that reflect what may be happening physiologically—like “sensory response,” “stress response,” or “emotional response”—we remove the judgment and create a more factual, objective description of what’s happening. This language reminds us that these actions are symptoms, they are responses rooted in a child’s sensory, emotional, and psychological world. This in turn encourages us to investigate, not judge.

The Role of Healthcare Professionals: Deciphering Behaviour as Communication

As clinicians, it’s our responsibility to decode these messages, especially when children don’t yet have the verbal skills to explain their feelings. This requires not only a compassionate mindset but also a practical framework:

1. Observational Skills: Observing a child’s actions, triggers, and the environment provides insight into possible causes. Are there patterns to their responses? Does a particular stimulus consistently lead to the same response? Observation can reveal recurring needs that can be proactively addressed.

2. Creating a Safe, Predictable Environment: For children with heightened sensitivities or histories of trauma, predictability and routine offer reassurance. A calm, structured environment minimizes potential triggers and helps children feel more in control.

3. Supporting Communication: If verbal communication is challenging, healthcare providers can use visual aids, picture boards, or sensory tools to help children express themselves. Providing ways to communicate that don’t rely solely on verbal skills can greatly reduce frustration and help children feel heard.

4. Collaborating with Families: Families can offer invaluable insights into a child’s history, preferences, and potential triggers. Working closely with families allows healthcare professionals to craft an individualised approach that recognizes the child’s unique ways of communicating.

5. Compassionate Response: Instead of viewing a child’s behaviour as something to “correct,” we must respond with compassion and patience. Calming, comforting, and supporting a child in distress helps them feel safe, valued, and understood.

Treating with Empathy: Meeting the Child Where They Are

Recognising behaviour as communication transforms how we approach and care for children. When we see a child’s actions as a message rather than a misdeed, we’re empowered to respond with empathy and understanding. This approach ultimately allows us to treat not only the symptoms but also the underlying causes.

In summary, by shifting our language from “he has behavioural issues”, to neutral observational terms like “he displays stress responses,” or “he exhibits sensory triggers,” our approach can be more insightful and humane. This shift reminds us that our role is not to judge but to listen, decipher, and treat the child and the behaviour with respect.

For ourselves, making this shift opens our eyes to a whole new way to support and understand each child. It allows us to unravel the underlying causes of behaviours, which are too frequently rooted in distress, and empowers us to help children feel safe, valued, and truly understood. Let’s commit to creating a healthcare environment that understands and responds to the whole child and sees every behaviour as a form of communication and every child as someone with a voice worth hearing.