Making Sense of Complex and Challenging Behaviours

An inability to understand trauma-based behaviours often sees young people ‘labelled’ in ways that can create a ‘spiral of negativity’. A trauma-informed approach orients us to be curious about what is going on for the young person rather than seeing their behaviour as separate from what has happened to them. This is one of the key messages of our latest Practice Guide: Creating a Balance between Empowerment and Limit Setting and the subject explored in this blog.

What follows is a brief attempt to apply a trauma lens to complex and challenging behaviours and explain the impact of negative perceptions and labelling of young people in Intensive Therapeutic Care (ITC). 

The Spiral of Negativity

The failure to properly recognise the impact that trauma has had on the young person can result in a ‘spiral of negativity’ (Smith, Larsen, Chartrand, Cacioppo, Katafiasz, & Moran, 2006).

A ‘spiral of negativity’ refers to the impact of negative perceptions, views and labelling of challenging behaviours when viewed without a trauma lens.

If ITC staff or other professionals view the young person (what is wrong with them) as the problem rather than what has happened to them, this can result in a downward negative spiral. The following diagram is an example of this process:


By recognising that people automatically devote more attention to negative information than to positive information (Smith, et al, 2006) and that negative perceptions, views, and labelling of young people with challenging behaviours (viewing through the wrong lens) contributes to developing a cycle of mutual distress (the young person continues to have unmet needs that cause the underlying stress impacting on their healing and recovery, and the staff also suffer from anger, resentment, ineffectiveness and frustration), ITC staff can become attuned to how their perceptions and reactions can have an effect on the therapeutic care of a young person in ITC.

Coping, Connecting and Communicating

Many of the problematic trauma responses that the children and young people demonstrate within and Intensive Therapeutic Care services are often their best attempt at coping, connecting and communicating.

A Way of Coping

Risk-taking, aggression or self-destructive behaviours (e.g. substance misuse, extreme self-harm) can be an unconscious way of coping with internal suffering such as shame and low self-esteem and of managing emotional dysregulation and fight, flight or freeze (Baker, Shaw & Biley, 2013).

A Way of Connecting

Rather than labelling young people who display complex and challenging behaviour as ‘manipulative’ or ‘attention-seeking’, ITC staff can attempt to understand the distress and fears that underlie particular ways of trying to get needs met and difficulties expressing them, and connect with them through Playfulness, Acceptance, Curiosity & Empathy (Golding & Hughes, 2009), instead of judgement and conditionality.

A Way of Communicating

Research indicates that experiencing abuse, neglect and trauma in childhood has a major effect on neurodevelopment, making our threat responses extreme and easily triggered, compromising their ability to self-soothe and their integrative capacity (Van der Kolk, 2003). Distress of this kind is hard-wired and not easily managed through the use of language. In addition, language has failed many of these children and young people in stopping abuse, particularly where ‘No’ is ignored and violation continues. Consequently, challenging behaviours can be the only means they have to express or communicate the extreme distress and lack of control they are experiencing (Based on Filson, 2013).

To learn more about how to find a balance between empowering young people and setting reasonable limits, please read our latest Practice Guide: Creating a Balance between Empowerment and Limit Setting.

Noel MacNamara
Senior Advisor, Centre for Excellence in Therapeutic Care


Baker C, Shaw C, Biley F (eds) (2013) Our Encounters with Self-Harm. PCCS Books.

Filson B (2013) Self-Injury: The Attempt to Cope, Connect and Communicate Webinar for MA Department of Public Health – Suicide Prevention Bureau and the National Association of State Mental Health Program Directors (

Golding, K. & Hughes, D. (2012). Creating Loving Attachments: Parenting with PACE to Nurture Confidence and Security in the Troubled Child Child and Adolescent Psychiatric Clinics of North America, 12: 293–317.

Smith, N. K., Larsen, J. T., Chartrand, T. L., Cacioppo, J. T., Katafiasz, H. A., & Moran, K. E. (2006). Being bad isn’t always good: Affective context moderates the attention bias toward negative information. Journal of Personality and Social Psychology, 90(2), 210–220.

Van der Kolk B (2003) The neurobiology of childhood trauma and abuse.