Author: Schools & Community Psychology Service

What is self-harm?

Self-harm is a behaviour that is done to deliberately harm oneself. Self-harm is more commonly used as a way of managing difficult emotions, by helping to regulate intense feelings.

How do I talk about self-harm?

Talking about self-harm can feel hard and create difficult feelings and worries. Research tells us that talking about self-harm does not put the idea into their head. In fact, it creates a safe space for them to be open and honest about how they feel and provide them with a safe person to turn to.

To do this, you should:

• Provide a safe and confidential space/environment.
• Listen and explain the limits to confidentiality.
• Reassure the child or young person that their feelings are important and valid, and it may help to talk about them.
• Tell the young person how courageous they are to be talking about difficult thoughts and feelings.
• Stay calm and always provide an empathic and non-judgemental approach. 
• Use the https://www.richmond.gov.uk/portus/files/professionals-risk-assessment.pdf to help you understand the context of the behaviour and to help you make an informed decision about next steps.
• Check in with them regularly to make sure the support offered is making a difference.
  

What questions could I ask?

• How are things for you right now?
• Can you say what’s bothering you? 
• What might help you? 
• What would you like to happen next?
  

How do I respond to self-harm?

Refer to the Self-Harm and Suicide Prevention Pathway to help you and your colleagues to make decisions about the support required: Children and Young People’s Self-harm and Suicide Prevention Pathway.

It is important to ensure parent’s and carer’s are involved in this process unless there are safeguarding concerns relating to the young person’s family. 

As young people should be attending an educational setting on a regular basis, schools and colleges are also well placed to support anyone who is facing emotional distress.

Are they at risk of suicide?

While self-harm is relatively common in young people, suicide is rare. Although some people who self-harm may experience suicidal thoughts, this is often not the case. Suicides are uncommon in childhood and early adolescence, but risk increases in the late teens and continues to rise into early adulthood.

The following steps can help you find out if a child or young person is thinking about suicide. 

If the child or young person says that they have had, or are currently experiencing, suicidal thoughts, you should create a personalised plan to help keep them safe: Suicide Prevention Support and Safety Plan.

Additional resources 

• Preventing self-harm and suicide in young people :: Portus
• Self-harm Support and Safety Plan Example
• Home – Calm Harm App
• Alumina | Selfharm
• Calm zone | Childline
• MindEd Hub (free online training)

ADHD is a common, lifelong neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Depending on the presentation, there are different subtypes of ADHD namely:

1. Inattentive Subtype (previously known as ADD): 20-30%
2. Hyperactive-Impulsive Subtype: 15%
3. Combined Subtype: 50-75%

As an area of neuro-diversity, ADHD can co-exist with other areas of neurodiversity such as dysgraphia, developmental coordination disorder, and a large overlap with autism (25-40%). Individuals with ADHD can also present with depression and anxiety, possibly as a result of unmet needs and difficulty adjusting to environments that cater for neurotypical children.

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ADHD and Executive Functioning

Executive Functions: Executive functions are cognitive processes that help us plan, focus attention, remember instructions, and manage multiple tasks. They are primarily located in the prefrontal regions of the frontal lobe and involve multiple connections to other brain regions.

Key Executive Functions Affected by ADHD:

1. Working Memory: The ability to hold and manipulate information over short periods.
2. Sustained Attention: The capacity to maintain focus on a task or activity over a prolonged period.
3. Organization: The skill to arrange thoughts, materials, and tasks in a structured manner.
4. Response Inhibition: The ability to control impulses and resist distractions.
5. Emotional Control: The capacity to manage emotions and respond appropriately to situations.
6. Time Management: The skill to plan and allocate time effectively.
7. Planning and Prioritizing: The ability to set goals, plan steps to achieve them, and prioritize tasks.
8. Task Initiation: The ability to begin tasks promptly and efficiently.
9. Goal-Directed Persistence: The capacity to stay focused on a goal despite obstacles and distractions.

Impact of ADHD on Executive Functions:

People with ADHD often experience a delay in the development of executive functions, making them more likely to act based on short-term rather than long-term goals. ADHD can lead to impairments in one or more executive functions, affecting memory, planning, emotional regulation, and social skills.

Supporting children with their executive function skills, as well as the impact of the environment on their capacity to keep up with school life, is a key area of our EP role and a prerequisite for the child’s overall academic progress and emotional wellbeing.

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7 x top tips for schools to consider are:

What is Exam Anxiety?

Exam anxiety is an intense feeling of stress or pressure related to taking exams. Children and young people who are experiencing exam anxiety may exhibit some of the following symptoms: 

Exam anxiety is common and a normal response to the stress of exams but too much anxiety can impact the ability of children and young people to learn and retain information, and interfere with studying and revision.  

Source: https://www.psychologytools.com/self-help/anxiety

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Why do we experience Exam Anxiety?

Some common reasons why children and young people might feel exam anxiety include:

• Fear of Failure: This may stem from high expectations, negative past experiences and/or concerns about the consequences of failing that lead to intense pressure to perform well. 

• Not Feeling Prepared: This could be due to poor time management or ineffective study or revision techniques. 

• High Stakes: Important exams such GCSEs and A-Levels can increase anxiety due to their significant impact (e.g. not getting the entry requirements for a specific course). 

•  Lack of Confidence: This could include negative perceptions and self-doubt about their abilities and negative self-talk (e.g. “I’m going to fail.”)

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How can we support Exam Anxiety?

Children and young people can find exams a lot to cope with, but there are ways that we can support them to improve their wellbeing during this time.

1. Foster a Supportive Environment: Create a classroom environment that encourages open discussion about exam anxiety and stress. Through this open discussion children or young people will feel able to seek help if needed and supported.

2. Encourage Positive Self-Talk:  Help students identify and challenge negative thoughts about their abilities and the exam outcome. Encourage them to rethink these negative thoughts these with positive affirmations and rational thoughts. This is known as ‘reframing’ thoughts. Examples of reframing thoughts include:

“I’m so anxious in exams, my mind always goes blank” can be reframed to “I am confident that I can manage any difficulties that might occur during the exam”

“If I don’t get the highest grade on this exam I’m a failure” can be reframed to “The result of this exam does not define my abilities or worth”

3. Listen and Normalise anxiety:  Listen to the child or young person about their concerns to validate their emotions. Reassure them that feeling anxious because of exams is common and can be a normal response to stress. This reassurance can help reduce feelings of isolation in someone experiencing anxiety.

4. Promote Healthy Habits: Educate the importance of regular sleep, healthy eating, and physical activity during revision and exam seasons. These factors can significantly impact children and young people’s ability to manage stress, improve general wellbeing and perform at their best during exams.

5. Model Calm Behaviour: As adults we can demonstrate calm and confident behaviour towards exams. The child or young person’s perceptions of a situation can be influenced by your attitudes and reactions therefore having a positive impact on how they view exams. Use positive language such as, “You have worked hard and are more than ready to take this exam”.

6. Promote Relaxation and Mindfulness Techniques: In order to help students manage their physical responses to anxiety, you can teach them: 

• Deep breathing exercises such as 4-7-8 or ‘box’ breathing 
• Progressive muscle relaxation or body scanning techniques 
• Mindfulness exercises to be ‘in the moment’ such as the 5-4-3-2-1 grounding exercise
• Journalling to help them process their thoughts and worries

7. Manage Procrastination and Avoidance Behaviours. Exam anxiety often drives procrastination as a temporary relief but ends up promoting greater anxiety. Strategies such as breaking down revision into manageable chunks, prioritising tasks, encouraging progress checking and celebrating small successes can help. 

Child development does not take place in a vacuum, instead, the context around the child impacts their actions and development. Schools are uniquely placed to influence children’s development due to their key role in their lives and the time spent at school. 

One way of viewing child development is through the Bioecological Model of Human Development (Bronfenbrenner & Morris, 2007). This model considers the impact of social contexts, structural conditions and political factors on children’s school experiences and the role they play in mediating their development (Bronfenbrenner & Evans, 2000). It highlights the importance of the environmental factors around a child that influence their development from those closest to them (family, teachers) to more indirect factors (government education policies).

Bioecological Model of Human Development

The Bioecological Model is marked by four key aspects: process, person, context, and time (Tudge et al., 2022).

• Process – this focuses on the interactions between people and their environment, which take place over time. Some examples that are relevant to school include CYP and staff relationships or interactions, staff training and teaching
• Person – this relates to the individual child and further details are included in the diagram below.
• Context – this describes four interrelated systems that mark the environments that influence development and are further explained below. 
• Time – this relates to changes in the environment throughout the child’s lifetime, for instance, changing cultural attitudes, historical events, and life transitions like moving abroad.

How can the Bioecological Model be applied in school settings?

This Model is flexible and provides a way of thinking about how individual traits and surrounding environmental factors influence and interact with one another as part of an ongoing process of child development.

The example below shows how the Model has been applied in the case of a Year 6 boy who is experiencing literacy difficulties.

References

Bronfenbrenner, U., & Morris, P.A. (2007). The bioecological model of human development. In W. Damon & R.M. Lerner (Eds.), Handbook of child psychology. Vol. 1: Theoretical models of human development (6th ed., pp. 793–828). John Wiley. 

Bronfenbrenner, U. and Evans, G. W. (2000), Developmental Science in the 21^st Century: Emerging Questions, Theoretical Models, Research Designs and Empirical Findings. Social Development, 9(1), 115-125. https://doi.org/10.1111/1467-9507.00114

Tudge, J. R. H., Merçon-Vargas, E. A., Liang, Y., & Payir, A. (2022). The Importance of Urie Bronfenbrenner’s Bioecological Theory for Early Childhood Education. In L. E. Cohen & S. Waite-Stupiansky (Eds.), Theories of Early Childhood Education: Developmental, Behaviorist and Critical (2nd ed.). Routledge.

The article below discusses the benefits and impact on becoming an Attachment Aware school based on Amy’s doctoral research thesis titled: An Exploration of the Views and Experiences of Designated Teachers in Creating an Attachment Aware School. To view the thesis in more detail please click here:

An exploration of the views and experiences of Designated Teachers in helping to create an Attachment Aware School | BPS

What was your research about?

During the pandemic 5 primary schools in southwest London took part in a pilot project to become Attachment Aware schools.  The Designated Teachers (responsible for children who are looked after CLA) played a key role in facilitating the project. The Designated Teachers were all interviewed at the end of the year to reflect on their views and experiences. Key themes emerged from analysing the interviews (using Interpretative Phenomenological Analysis).

What is an Attachment Aware School?

An Attachment Aware school is a school that takes a relational approach to supporting its students. This type of school is often supported by Educational Psychologists and Virtual schools in order to create systemic changes to support children and young people who may have experienced trauma or disruptions to forming secure attachments, such as CLA. Many Local Authorities have some version of this approach although terminology used may vary such as Trauma informed Practice (TIP), Attachment Aware Schools (AAS) etc.

What motivated schools to become an Attachment Aware school?

• A desire to support the needs of children in the school (the project took place at the start of the pandemic and so there was an increase in mental health needs).
• It’s free, there was no cost to schools.
• It fitted in with the ethos of the school and other relational approaches used.
• A desire to learn evidence-based approaches. 

One of the Designated Teachers stated:

“The main thing for us was to…to help with any behaviour issues and to make sure that we’re approaching it in a way that dealt with the initial underlying problem rather than just firefighting…”

How did the Attachment Aware Schools approach develop within the schools? 

Schools worked over the year to develop systemic and environmental factors. Schools developed behaviour policies, transformed the environment (to create accessible calm spaces), provided staff with training based on trauma and attachment theory as well as developed restorative approaches to responding to behaviour.

What were some of the changes that occurred in the schools after becoming an Attachment Aware School?

The Designated Teachers reflected on physical/environmental and systemic changes that were occurred:  

• The attitude of staff towards children, resulting in improved relationships and behaviour.
• Changes in children’s interactions (with their peers) and staff,
• Improved relationships between the schools and parents/carers
• Nurturing and inclusive environment were created, such as calming spaces (that children could use to regulate their emotions)

Which children benefited from the Attachment Aware school approach?

Schools have a statutory duty of care to support CLA by the Designated Teacher and supported through the Virtual School. Although, a key aspect of Attachment Aware Schools is to support the needs of CLA the research found the scope of children who could benefit from such an approach was wide ranging.  The research found that children who were anxious, have special educational needs or who were described as shy also benefited from the approach.

Another Designated Teacher stated the wider benefits:

“I do think that Attachment Awareness helps because if children aren’t emotionally ok, they’re not gonna learn”.

Did the research identify any potential barriers?

Potential barriers identified through this research in implementing the approach ranged from:

•  Training e.g. the time taken to train staff, embed the new approach and train staff due to staff turnover.
• Some staff found that the approach was counter to how they may have been raised and so there was some cognitive dissonance between the relational based approach and the punitive approach that they were more familiar with. However, once staff saw the difference that the approach could make to children displaying challenging behaviour, they were then more likely to use the approach.

How does this research fit within similar research in this area?

Research in this area is growing and provides noteworthy evidence of wide-ranging improvements. Some larger scale studies have illustrated positive improvements:

Rose and Gilbert (2017) conducted a large-scale study involving 40 schools over 2 years. This research provided hard and soft indicators of improvements ranging from increases in academic performance, staff confidence and increase self-regulation of students. 

• Academic improvements in reading, writing and Maths,
• Increase in attendance,
• Improvements in staff-wellbeing; in relation to an increase in staff confidence in responding to challenging behaviour and staff becoming more reflective in their practice.

Kelly (2020) involved 77 educational establishments (primary, secondary, specialist and Pupil Referral Units). Evaluation from the research suggests all participating schools had a positive impact by for example developing ethos change within the schools and more informed pedagogical practice to support Children who are Looked After and other vulnerable learners. 

Additionally, the Alex Timpson Attachment and Trauma Aware Programmes in Schools (2022) reviewed the impact of training from 305 schools across 26 Local Authorities.  Some of the findings highlighted, a reduction in the use of sanctions, a positive impact on students, and increase in staff awareness of how behaviour e.g. how behaviour displayed relates to the child communicating a need. 

How can I get my school involved in something similar?

• Attachment Aware Schools are a whole school approach. It is important that everyone is on board with the aims of using such an approach. Raise awareness within the school and speak to the head teacher about potential benefits of using such an approach. 
• Schools can contact their local Educational Psychology service or Virtual School for more information to find out how the approach is being delivered within their local area.

Becoming withdrawn, having emotional outbursts, difficulties sleeping, feeling unwell and changes in appetite are all common responses after experiencing a bereavement. 

As adults, our natural response is to try and make things better for young people and take away these uncomfortable feelings. But grief is a natural part of life and it is important that young people are able to process the loss they have experienced with the support of the adults around them. 

So how can we support children through bereavement? 

1. Listen, empathise and allow space for children to ask questions – Listen to the child or young person and validate their emotions. Avoid trying to fix things or make things better. Remind the child or young person that it is normal and okay to feel sad or angry. 

2. Use clear language when talking about death – children often interpret information literally so using phrases such as ‘they are in a better place’ or ‘passed away’ can be confusing. Although it can feel difficult, research shows that it is helpful to use clear language such as ‘death’ and ‘died’. For younger children, we might explain that ‘their body stopped working’. 

3. Encourage the child or young person to talk about the person who has died – we sometimes avoid talking about the person who has died because it feels painful, but this can be a helpful way of processing the loss. Ask the child or young person questions about the person who has died e.g. ‘What was your favourite thing to do together? What is your favourite memory?’ 

4. Support the child or young person to continue engaging in important activities and connecting with others – maintaining a sense of routine and stability can be helpful during times of change and during a bereavement. Where possible, support the child or young person to continue engaging in activities they enjoy. Sometimes children or young people experience guilt when they have moments of feeling happy after a bereavement. Remind the child or young person that it is okay to feel happiness and enjoyment even though something sad has happened. 

5. Be sensitive and non-judgmental to differing cultural, religious and spiritual beliefs – ask children and young people what has been discussed at home and what their beliefs are. Explain that everybody has different beliefs about what happens after death and that there is no right or wrong. 

Developmental understanding of death

Stage	Age Range	Conceptualisation
1	3 – 5	Death is not a permanent condition. The dead are less alive – similar to being very sleepy, i.e. they can still breathe and eat. The dead may wake up after a while. A dead person can come back to life.
2	5 – 9	Death is final. The dead stay dead. Death is irreversible but not inevitable. There is the possibility of escaping from death if one is clever or lucky. Some children at this stage of development picture death in the form of a person: sometimes an angel, a clown, shadowy death-man, or skeletal figure. Moving things are viewed as alive and non-moving as dead. Only bad people or people who have accidents die.
3	10+	A more realistic, adult like view of death emerges. Death is not only final, but it is also inevitable, universal, and personal. Everybody dies, whether mouse or elephant, stranger or parent. No matter how good or clever or lucky.

Helpful books for talking about loss:

Masking is defined as the efforts made by individuals to minimise the appearance of differences. Similar to autism, masking lies on a spectrum, with great variation between autistic young people both in strategies used, and the extent to which they do mask. 

What does masking involve, why does it occur and what are the consequences?

For the autistic young people that are masking, research tells us that this can involve hiding emotions (happiness, sadness, anxiety), suppressing anything that might suggest they are different (sensory differences, motor difficulties, academic difficulties), copying or mimicking voices, and, in some cases, either suppressing or completely changing parts of their personality in order to present as ‘more’ neurotypical.  

Autistic young people may engage in masking as a response to negative social experiences, such as bullying, and the fear of being judged as different or strange, which in part may result from having a stigmatised diagnostic label. 

Autistic young people also report masking as a strategy to fit in and be ‘more’ neurotypical, something which may inadvertently be exacerbated by social skills interventions. Interventions that focus on improving specific social skills (e.g., eye contact) may indirectly perpetuate a harmful narrative which suggests that the way autistic young people communicate is not ‘correct’ and that they should change their communication style to ‘fit’ in, leading to further attempts to mask.  

While masking can lead to short-term success in social situations, it often results in exhaustion/ autistic burnout, identity loss, and has been linked with school avoidance as well as mental health issues such as depression and anxiety. In addition, due to hiding difficulties. those who mask a lot more are more likely to be missed or considered less needy of support by school and support services.

Do all autistic young people mask?

Research highlights that not all autistic young people engage in masking. For those that don’t, what appears to make the difference is having an absence of negative social experiences (e.g., bullying) and having supportive family, school environments and friends who provide them with instances (not always) where they can feel able to be themselves. In particular, research shows that the freedom for an autistic individual to be themselves, is more likely to occur when they have opportunities to interact with other neurodivergent individuals. 

So, what can you as a school do? 

Dynamic assessment (DA) is an area of EP work that is less known to schools but can be incredibly valuable in revealing ways that a child can learn best and the type of support/ mediation they would require to further develop their thinking skills and perform at their best. 

Dynamic assessment approaches (unlike static intelligence tests) are built on the belief that one can learn far more about a child’s cognitive development, and any barriers to their learning, by working with the child in a dynamic and facilitative way as opposed to assessing their unassisted performance and compare it to an age-related norm. Dynamic assessment approaches analyse learner’s cognitive skills of a learner in relation to the task at hand and identify where meaningful input is needed to optimise performance. 

There are ways school staff can use principles of dynamic assessment to scaffold learning. One basic element of DA is analysing where a learner’s struggle may be by breaking down the cognitive skills required in any given task into three areas:

It is very common for children to appear unable to access a task because of difficulties in the input phase or because they have trouble presenting the product of their thinking. Analysing and supporting cognitive skills such as systematic planning, improving speed and accuracy as well as thinking about what is needed as the end product before launching into action, may be a very useful focus for school intervention / LSA support. There are ways to support these skills through every day activities and with good scaffolding questions such as:

“Where shall we start? What should we look at, first or second?”

“If you were to plan your trip to a supermarket, what system would you use? How can you do the same for this maths problem, piece of writing etc?” 

If you would like more ideas of how to support the development of cognitive skills (alongside curriculum support you are already providing), please do not hesitate to contact our service. We can offer dynamic assessment input for individual children as well as training for support staff in using DA principles in their every day practice.