Understanding SEMH in Children: A Comprehensive Guide

Social, Emotional, and Mental Health (SEMH) refers to a broad range of emotional, social, and behavioural difficulties that can affect children and young people.

The term SEMH was formally introduced in the Special Educational Needs and Disabilities (SEND) Code of Practice in 2014 (DfE and DoH, 2015). It replaced earlier terms such as Behavioural, Emotional and Social Development (BESD) and Emotional and Behavioural Difficulties (EBD). This change reflected a deeper understanding of children's needs and aimed to promote a more supportive approach.

The shift in terminology—notably, the removal of the word “behaviour”—was intentional. It marked a move away from focusing on disruptive or challenging behaviours, and instead encouraged professionals to look deeper, recognising behaviour as a form of communication that often signals unmet emotional or psychological needs.

SEMH difficulties can affect how children and young people:

• Regulate and express their emotions
• Build and maintain healthy relationships
• Cope with stress, adversity, and everyday life challenges

By recognising SEMH as more than just behaviour, we can create more compassionate, tailored support that addresses the root causes of a young person’s difficulties.

Children and young people with Social, Emotional, and Mental Health (SEMH) needs may display a wide range of behaviours and challenges. The intensity and nature of these behaviours can vary based on factors such as age, developmental stage, home and school environments, and any underlying or co-occurring needs.

Here are some of the most common presentations:

Emotional Needs and Behaviours

• Frequent mood swings or emotional outbursts.
• Difficulty understanding or expressing emotions.
• High levels of anxiety or persistent worries.
• Low self-esteem or feelings of worthlessness.
• Signs of depression, such as sadness, hopelessness, withdrawal, or a lack of motivation.

Social Needs and Behaviours

• Difficulty forming or maintaining friendships.
• Social withdrawal or self-isolation.
• Trouble reading social cues or understanding boundaries.
• Challenges with teamwork or group participation.
• Over-reliance on adults for reassurance or emotional regulation.

Mental Health-Related Needs and Behaviours

• Self-harming or risk-taking behaviours.
• Obsessive thoughts or repetitive actions.
• Changes in appetite or eating difficulties.
• Sleep disturbances linked to stress or anxiety.
• Expressing suicidal thoughts or persistent hopelessness.

Challenging or Dysregulated Behaviours

• Regular defiance, aggression, or oppositional behaviour.
• Refusing to follow rules or accept instructions.
• Disruption in the classroom or withdrawal from learning.
• Physical aggression (for example hitting, throwing objects).
• Verbal aggression, shouting, or use of inappropriate language.

Other Indicators

• Repeated absences or poor school attendance.
• Difficulty concentrating or completing tasks.
• Overreaction to small challenges or perceived criticism.
• Somatic complaints (for example, frequent headaches, stomach aches without medical cause).
• A strong need for control or perfectionism.

Understanding these behaviours as forms of communication—often rooted in unmet needs or emotional distress—is vital. A trauma-informed, relational approach allows us to respond with empathy, consistency, and support, rather than simply responding with discipline or behaviour management strategies alone.

By recognising the different ways SEMH needs can present, we are better equipped to offer understanding and support.

In the next chapter, we will explore some of the underlying causes of SEMH difficulties, helping us to see beyond the behaviours and respond with greater empathy.

SEMH difficulties can arise from a wide range of factors. Often, it’s a combination of influences rather than one single cause and reflects the complex interaction between a child’s biology, relationships, environments, and experiences.

Not all children or young people who experience the below will develop SEMH needs, but protective relationships, safe environments, and early intervention can make a significant positive difference (Public Health England, 2021).

Biological and Neurodevelopmental Factors

• Genetic predisposition: Family history of mental health difficulties can increase vulnerability.
• Neurodevelopmental conditions: Conditions such as ADHD, autism, or sensory processing differences may affect how a child regulates emotions or interacts with others.
• Perinatal factors: Complications during pregnancy or birth (for example, low birth weight, exposure to toxins) may impact brain development.
• Physical health conditions: Long-term illness or neurological conditions can influence a child’s emotional well-being.

Psychological and Emotional Factors

• Attachment difficulties: Insecure or disrupted attachments in early childhood can affect a child’s ability to trust others, regulate emotions, and develop a sense of safety (Bowlby, 1969).
• Trauma or Adverse Childhood Experiences (ACEs): Experiences such as abuse, neglect, domestic violence, or parental separation can lead to heightened stress responses and difficulties with behaviour and emotional regulation.
• Low self-esteem or negative self-image: Children who internalise feelings of worthlessness or failure may struggle to manage their emotions or cope with everyday challenges.

Family and Home Environment

• Parental mental health issues: Children living with parents who are experiencing depression, anxiety, or substance misuse are at increased risk of SEMH difficulties.
• Inconsistent parenting or lack of boundaries: Unpredictable or harsh parenting styles can impact emotional security and behavioural development.
• Poverty and housing instability: Economic stress and overcrowding can increase emotional strain and limit access to supportive experiences.

School and Social Factors

• Bullying or peer rejection: Negative peer experiences can lead to anxiety, withdrawal, or challenging behaviours.
• Academic pressures or undiagnosed learning needs: Struggling in the classroom without the right support can lead to frustration, low self-worth, and emotional outbursts.
• School exclusion or lack of belonging: Feeling misunderstood or unsafe at school can intensify SEMH needs and further isolate a child.

Cultural and Societal Influences

• Discrimination and marginalisation: Racism, ableism, homophobia, or other forms of discrimination can deeply affect a child’s sense of identity and safety.
• Lack of access to support services: Delayed or limited access to mental health support can allow problems to escalate.
• Social media and online environments: For some young people, exposure to unrealistic standards, cyberbullying or harmful content online can contribute to anxiety, low mood or dysregulation.

It is important to remember that while these factors can contribute to SEMH difficulties, early support, secure relationships, and positive environments can play a key role in helping children and young people build resilience and thrive.

Understanding the possible causes of SEMH difficulties is only the first step. In the next chapter, we will explore how these needs can be recognised early, and how timely support can make a lasting difference.

SEMH needs can be identified through a combination of observation, assessment, and collaboration. Early identification is key to providing timely support and reducing the risk of long-term challenges.

Identification of SEMH needs is an ongoing process which relies on noticing patterns over time, working in partnership, and using assessment tools and child voice to build a holistic understanding.

Observing Behaviour and Emotional Signs

• Frequent outbursts, aggression or defiance.
• Withdrawal or social isolation.
• Excessive worry, fear, or sadness.
• Poor concentration or impulsivity.
• Changes in eating, sleeping or personal hygiene.
• Risk-taking behaviours or signs of self-harm.

School-Based Monitoring and Assessment

• Assess – Plan – Do – Review cycle to track concerns and interventions.
• Special Educational Needs Coordinators (SENCOs) support staff in identifying and responding to needs.

Input from Multi-Agency Professionals

• Educational Psychologists – assess cognitive, emotional and behavioural functioning.
• CAMHS (Child and Adolescent Mental Health Services) – offer formal mental health assessments, diagnoses, and treatment for moderate to severe needs.
• Speech and Language Therapists – when communication difficulties contribute to emotional regulation issues.

Listening to the Pupil and Family

• Children and young people should be given regular opportunities to express how they feel and what support they may need.
• Parents/carers share observations about behaviour at home, developmental history, and family context.
• Open, supportive dialogue helps build a fuller picture of the child’s needs and experiences.

Formal Identification of SEMH as a Special Educational Need (SEN)

If SEMH needs significantly affect a pupil’s learning and daily functioning, they may be identified as having SEN under the category of SEMH. This can lead to:

• SEN Support in school (for example tailored interventions, pastoral care).
• An Education, Health and Care Plan (EHCP) if needs are complex and long-term.

Identifying SEMH needs is only the first step. In the next chapter, we will explore practical strategies for supporting children and young people to thrive emotionally, socially, and academically.

Children with SEMH needs often experience overwhelming emotions, difficulties with behaviour, and challenges in social relationships. They are not being “naughty” — their behaviour is often communication of an unmet emotional need. With the right support, children can build resilience, confidence, and skills to thrive.

Build Strong, Trusting Relationships

• Show consistent care, patience and understanding.
• Be a safe adult: reliable, non-judgemental, and calm even when behaviour is challenging.
• Use relational approaches — connect before you correct.
• Celebrate small successes and notice positive behaviours.

Provide Structure and Predictability

• Clear routines and expectations help children feel safe.
• Use visual schedules and simple instructions.
• Prepare children for changes (for example, explain transitions ahead of time).
• Keep consequences fair, consistent, and focused on restoring relationships, not punishment.

Teach Emotional Literacy

• Help children name and understand their feelings (“It looks like you’re feeling really frustrated right now.”).
• Model your own emotional regulation (“I’m feeling a bit stressed, so I’m taking a deep breath.”).
• Use tools like feelings charts, emotion wheels, and calm corners.

Support Self-Regulation Skills

• Deep breathing
• Grounding exercises (for example, 5-4-3-2-1 senses)
• Movement breaks
• Mindfulness or sensory strategies

Offer time and space when a child feels overwhelmed, but remain available and supportive.

Personalise Support

• Tailor strategies to the child’s individual needs and triggers.
• Some may need quiet time, others may need active movement.
• Flexible seating, sensory tools, and personalised goals can help.

Listen to the Child’s Voice

• Ask children how they feel and what helps them.
• Involve them in planning their support wherever possible.
• Empower them to use coping strategies and make choices.

Involve Families and Work Together

• Share successes and strategies with parents/carers.
• Provide consistent approaches between school and home where possible.
• Respect family knowledge and cultural background.

Use Targeted and Specialist Support

• Small group interventions (for example, social skills groups, nurture groups).
• 1:1 mentoring or key adult support.
• Referral to professionals such as:
  • Educational Psychologists
  • School counsellors
  • Child and Adolescent Mental Health Services (CAMHS)

Focus on Strengths

• Every child has talents, interests, and hopes.
• Focus on what’s strong, not just what’s wrong.
• Encourage hobbies, friendships, leadership opportunities, and success experiences.

Parents and caregivers play a vital role in helping children with Social, Emotional and Mental Health (SEMH) needs to feel understood, valued, and supported. You are often the most consistent and trusted people in a child's life — and your relationship can make a huge difference.

Build a Safe, Trusting Relationship

• Show unconditional love and acceptance, even when behaviours are challenging.
• Provide consistent routines, clear boundaries, and predictable responses.
• Be a safe base for your child: someone they can return to when the world feels overwhelming.

Help Name and Manage Emotions

• Talk about feelings openly: “It’s okay to feel angry — let’s find a way to show it safely.”
• Teach and model healthy coping skills (for example, breathing exercises, talking about worries, drawing or movement).
• Help your child recognise when they are starting to feel overwhelmed and what strategies might help.

Advocate for Support

• Work closely with your child’s school, SENCO (Special Educational Needs Coordinator), and any professionals involved.
• Share insights about what works at home.
• Ask questions about support plans (like SEN support, EHC Plans, or school-based interventions).
• Don’t be afraid to request additional help if needed — you know your child best.

Provide Practical Support at Home

• Create calming spaces your child can use when they need to regulate emotions.
• Use visual aids like feelings charts, routine boards, or reward charts if helpful.
• Break tasks into manageable steps and praise efforts, not just outcomes.

Look After Yourself Too

• Caring for a child with SEMH needs can feel overwhelming at times — and it's okay to seek support for yourself.
• Parent support groups (online or in-person) can offer advice, understanding, and a sense of community.
• Taking time for your own wellbeing is not selfish — it strengthens your ability to support your child.

Help Build a Supportive Community

• Encourage safe social connections — through clubs, hobbies, extended family, or trusted friends.
• Celebrate your child’s strengths, talents, and individuality.
• Help them feel they belong — in their family, school, and wider world.

Remember: Your understanding, patience, and love are powerful tools.

Every small step you take builds your child's confidence and resilience.

Parenting a child with SEMH needs is a journey. You don't have to do it alone — support is available, and small changes can make a big difference over time.

No parent has all the answers, and no journey is perfect. What matters most is that your child feels loved, accepted, and supported — even through the difficult days. Your presence, belief, and willingness to keep going will help your child find their way.

Social, Emotional and Mental Health (SEMH) difficulties in childhood are not just short-term challenges — they can have important long-term effects if left unrecognised or unsupported. However, with the right help, children with SEMH needs can grow into healthy, resilient, and successful adults.

Without Effective Support, SEMH Needs Can Lead to

Educational Impact

• Struggles with concentration, attendance, and relationships with teachers can lead to:
• Lower academic achievement.
• Increased risk of school exclusion.
• Limited qualifications or missed learning opportunities.

Employment Challenges

• Difficulties with emotional regulation, communication, or managing stress can later affect:
• Job attainment and stability.
• Workplace relationships.
• Financial security.

Mental Health in Adulthood

• Early emotional difficulties often continue into adult life if unsupported, increasing the risk of:
• Depression.
• Anxiety disorders.
• Substance misuse.
• Self-harm or suicidal thoughts.

Relationships and Social Outcomes

• Struggles with trust, emotional connection, and managing conflict can impact:
• Friendships.
• Romantic relationships.
• Family life, including future parenting.

Risk of Involvement with the Criminal Justice System

• Without support, ongoing difficulties with emotional regulation and behaviour can increase the risk of:
• Antisocial behaviour.
• Encounters with the youth or adult justice systems.
• Social exclusion.

With Early and Ongoing Support, Positive Outcomes Are Possible

Academic and Career Success

• With tailored support, children with SEMH needs can:
• Re-engage with learning.
• Achieve qualifications.
• Build successful careers.

Strong Mental Health and Resilience

• Skills like emotional literacy, coping strategies, and self-advocacy can:
• Reduce the risk of adult mental health issues.
• Build self-esteem and independence.
• Promote lifelong emotional well-being.

Positive Relationships

With early relational support and modelling, children can grow into adults who:

• Form trusting friendships.
• Maintain healthy partnerships.
• Build supportive families of their own.

Contribution to Society

Many individuals who experienced SEMH challenges use their lived experience to:

• Support others (for example, through teaching, social work, advocacy).
• Inspire change in mental health awareness and inclusion.

With the right understanding, early help, and ongoing support, children with SEMH needs can overcome challenges, realise their strengths, and contribute positively to their communities. Every step of encouragement, every relationship built, and every act of belief in a child’s potential can make a life-changing difference.

Every child with Social, Emotional and Mental Health (SEMH) needs, deserves to be understood, supported, and valued.

While the journey can bring challenges, it is also full of opportunities — opportunities to build resilience, strengthen relationships, and help young people thrive.

Whether you are a parent, caregiver, educator, or professional, your compassion, consistency, and belief in a child’s potential can make an enormous difference.

By working together, listening deeply, and responding with empathy, we can create the safe, nurturing environments children need to grow into confident, capable adults.

Small steps matter. Every connection counts.

Together, we can unlock the strength within every child.