Reframing Our Language in Paediatric Disability: Understanding Behaviour as Communication

From Firefly E-Newsletter on November 22

"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."