BESD: Behavioural, Emotional & Social Difficulties
As SEN provision has evolved, social attitudes and the descriptive language used to describe conditions has likewise been adjusted and updated. Unfortunately, this is rarely a linear process and as the 2013 BMA Board of Science1 report ‘Growing up in the UK’ acknowledges, different agencies will explain the behavioural, emotional and social difficulties (or BESD) of children with SEN in markedly different ways:
‘Psychiatrists … distinguish between normal and abnormal groups of children, and think of the abnormal group as having disorders … produced by an interaction of biology and environment.
Teachers … tend to use an undifferentiated category of ‘emotional and behavioural problems’… primarily caused by adverse environmental factors, in particular problems in the family context, (and) essentially amenable to improvement through education.
Social workers … regard labelling children as a stigmatising process which is best avoided, and prefer to explain children’s problems in social terms.’
You can read more about Social and Emotional Development here.
Though this diversity of emphasis can ‘breed misunderstanding and inhibit communication’, modern thinking tends to view behavioural, emotional and social difficulties (BESD) as part of a mental-health continuum which, as the diagram below (based on DfE guidance) indicates, begins with an essentially childish non-compliance which falls within the boundaries of normal development:
Problem behavioural difficulties conceptualised as a continuum
(from Department for Education2 1994c: 7)
Frequency of BESD and mental health problems
Published statistics on BESD rely on school figures, and DfE3 estimates for 2013 show BESD as the ‘primary need’ for 24.5% of the total number of 5-16 year olds identified at School Action Plus. As regards mental health for school-age students, the latest government figures4 available date back to 2004. The diagram below shows these statistics as data percentages for the most common conditions, split between boys and girls.
The concept of Behavioural Difficulties, both social & emotional
Attempts to understand BESD at a theoretical level and to prescribe interventions have used a variety of approaches, but three primary domain pathways have emerged as the most productive ways to explain and conceptualise BESD problems:
Biological approaches which examine brain data alongside vision, hearing and other sensory activity.
Cognitive approaches which explore affective factors and assess a child’s intra-personal state.
Behavioural approaches which focus on any behaviours which can be observed.
In practice, those working with children with BESD mostly tend to use a combination of these methods. In addition, some practitioners have found it helpful to think of BESD in terms of systems theory which accepts the complexity of BESD and therefore specifically sets out to explore the interactive nature of all elements within the environment of the individual child.
Looking at BESD from a scientific perspective, Bauer & Shea5 report that many researchers believe there is a ‘significant relationship’ between physical illness and mental health. Similarly, genetic predispositions, malnutrition, and allergies have also been implicated as influencing BESD. Furthermore, advances in medical technologies have pinpointed some reduced blood flows within the brain, and have also resulted in the development of drug treatments to correct chemical imbalances. Such drug therapies have been used with some success notably to alleviate attention deficit hyperactivity disorders (ADHD), leading many to cite subsequent improved functioning as evidence of a biological basis for BESD.
Cognitive theories believe thought processes influence how a child perceives and interacts with the world. As the following examples demonstrate, each theorist will emphasise different aspects of cognitive functions:
Rogers‘ work6 on children with low self-esteem found that a child with a poor self-concept was not ‘fully functioning’ because their ‘ideal self’ – how they wished to be – was not in balance with their ‘actual behaviour’ – how they really behaved.
Heider’s work7 on attribution theory explained how a child may attribute the actions of others to internal factors – such as personality traits – whilst making external attributions – for example, blaming the environment – to account for his own actions. Kelly’s Covariation Model8 develops this idea, offering insights on how children can be influenced by constant exposure to the opinions and attitudes of significant others.
Festinger’s theory9 of cognitive dissonance explains how children look for consistent models to establish their beliefs and attitudes. According to Festinger, a powerful need to reconcile conflicts in this area can sometimes result in irrational and maladaptive behaviours.
Behavioural difficulties perspectives
Behavioural theory adopts the standpoint that observed BESD behaviours have been learned by the child, and that the success of any subsequent interventions can be gauged by observed changes. Once again, theorists have offered nuanced versions of behaviourism, with some of the major theories listed below:
Pavlov’s early animal experiments10 showed how easily ‘behavioural conditioning’ could occur in humans.
B.F. Skinner’s work11 on ‘operant conditioning’ demonstrated the principle of ‘reinforcement’ – the idea that any behaviour which gets rewarded will tend to be repeated by the child, whilst unrewarded behaviours will wither away.
Bandura’s social learning theory12 explained how a child’s behaviour is learned via his environment through a process of observational learning.
Following Freud‘s doctrines, the psychodynamic approach to BESD holds that the reasons for dominant behaviours are grounded in the unconscious, and that childhood is the time when these are in the process of formation. Furthermore, the unconscious mind is also believed to be where conflicts occur. For example, the conflict which can occur where a child feels a teacher – the temporary, in-school ‘parent’ – is proposing views entirely contrary to those of a home parent or caregiver.
If you want to learn more about preparing a child for school, have a read of our Back to School Anxiety article.
BESD intervention strategies
Behaviourist BESD strategies are very common in educational settings with positive reinforcement to encourage desirable behaviours, and the ignoring of undesirable responses to ‘extinguish’ them, by far the most common approaches overall. Continually disruptive pupils are given ‘time out’ to starve them of the positive reinforcement of classmates, and punishments are used to remind misbehavers about the consequences of their actions.
One problem with behaviourist approaches can be that much of the focus is on what not to do. This can be redressed by whole-class work which models and reinforces required behaviours. In addition, a child with BESD will often receive individual support where specific behaviours are targeted in order to accordingly promote or reduce the identified behaviour.
Cognitive strategies involve counselling approaches like anger management and problem-based interventions. This work will usually have a personal-development focus with the aim of raising self-esteem, though care must be taken to only offer justifiable praise in recognition of desirable improvements and achievements. Frederickson & Cline13 note just how difficult this can be in some institutions:
‘Attempting to boost self-esteem at an individual level through positive, affirming feedback might be unlikely to have a long-term impact on a pupil who has SEN in a school context where recognition and rewards focus on the highest level of achievement, with effort or relative improvement being recognised in a more marginal or tokenistic way.’
Read more about SEN in the Early Years here.
Psychodynamic approaches include small ‘nurture groups’ with younger children, led by a trusted teacher and other adult figures. These aim to model and incorporate positive elements of home and school experience, offering:
‘… food, comfort, consistent care and support, and close physical contact seen in cradling, rocking, sensory exploration and communication by touch’14.
The common message with BESD treatments and interventions is that they should not be considered in isolation, and that the child’s parents must always be fully informed, and fully involved. Thus intervention strategies may include support for the development of parenting skills which research confirms can make such a positive contribution to a child’s well-being.
Maccoby15 and Martin’s work on parenting styles distinguished four main approaches to parenting found to influence a child’s future mental health. This method considers the likely impact, and future teenage outcomes, of different blends of the twin components of demand/control and warmth/acceptance, as represented in the following diagram:
(Inspired by Maccoby and Martin (1983))
It would be unfair to suggest family relationships depend solely on parenting styles, and it cannot be denied that the child with a relaxed temperament will be the easiest to parent in ‘authoritative’ fashion. Nevertheless, as the BMA report warns, any ‘stressful circumstances‘ in which ‘parenting is almost inevitably disrupted’ must be taken into account in the context of a truly meaningful remedial intervention:
‘There is plenty of evidence, … that parents who are warm and affectionate, in the context of clear, firm limit-setting, will have a positive impact on their children’s mental health, and that authoritative parenting can mitigate the adverse effects of other stressors. These general principles are the basis for a wide variety of parent education initiatives.’