Exploring Self-Harm In Young People With SEN

Acknowledging the emotional impact on families

When a child self-harms, it affects the entire family system. Parents and carers may feel triggered by their own past experiences, frightened for their child’s safety, or isolated as they try to navigate complex services and decisions. It’s also common to feel rejected or hurt if a child discloses to someone else first, such as a teacher or peer. These responses are natural and understandable. Acknowledging the emotional toll on families is a crucial part of offering meaningful support.

Understanding self-harm and self-injury

Self-harm and self-injury are often used interchangeably, but they can describe different experiences. Self-injury may include behaviours such as head banging, biting, or hair pulling, particularly in neurodivergent children, where the intent is not to cause harm but to communicate distress or manage sensory overload. Self-harm, by contrast, involves intentionally causing physical pain as a coping strategy. Importantly, self-harm does not always indicate suicidal intent, though it can carry serious risks and should always be taken seriously.

Who is most at risk?

Self-harm can affect children and young people from all backgrounds, but certain groups may face a higher risk. This includes young people who have experienced developmental trauma or adverse childhood experiences, those who are fostered or adopted, and young people navigating identity challenges. Neurodivergent children, including autistic children and those with ADHD, may also be more vulnerable due to sensory sensitivities, communication difficulties, social pressures, and barriers to accessing support. Understanding risk is not about labelling, but about responding early and appropriately.

Recognising signs and behaviours

Self-harm is often hidden. Children may wear long sleeves, avoid situations where their bodies might be visible, or withdraw socially. Other signs can include unexplained injuries, low self-esteem, changes in mood, increased emotional overwhelm, or avoidance of activities they previously enjoyed. Families may also notice changes in sleep, eating patterns, or increased secrecy. Recognising these signs allows adults to respond with curiosity and care rather than fear or judgment.

Understanding the function behind the behaviour

Self-harm is rarely about the behaviour itself. More often, it is a way of meeting an unmet need. For some children, self-harm provides a sense of control, emotional release, or relief from overwhelming feelings. Others may use it to shift emotional pain into physical pain, to feel something when they feel numb, or as a form of self-punishment driven by shame or low self-worth. Understanding the function behind the behaviour helps families focus on support rather than solely trying to stop the behaviour.

The self-harm cycle

Self-harm often follows a cycle. Emotional distress builds, leading to overwhelm and panic within the body. The child then engages in a behaviour that temporarily reduces this intensity. Afterwards, feelings of guilt and shame can emerge, increasing emotional suffering and restarting the cycle. Supporting children after an incident, particularly by reducing shame and increasing feelings of safety, is key to breaking this pattern.

Supporting conversations with compassion

Talking about self-harm can feel daunting. It’s important to approach conversations calmly, using empathy rather than a lot of questions which may feel to the child as an interrogation. Avoid forcing disclosure, making assumptions, or focusing only on stopping the behaviour. Instead, use curiosity, validation, and reflective listening. Let children guide the conversation where possible and reassure them that they are not judged or alone. Supporting a child also means looking after yourself, recognising when you need to pause, seek support, or regulate your own emotions.

Creating safety

Safety planning can be a collaborative and creative process. A simple, personalised “stay safe” plan helps children identify triggers, early warning signs, coping strategies, trusted people, and sources of comfort and hope. These plans work best when they reflect a child’s interests and strengths and are reviewed regularly. They reinforce the message that support is available and that difficult feelings can be managed differently over time.

Moving forward together

Self-harm is a complex and sensitive issue, however with understanding, compassion, and consistent support, families can help children find safer ways to cope. Focusing on what sits beneath the behaviour rather than the behaviour alone creates space for healing, connection, and hope for the future.

Here, Carole Anne Hudson and Bridgitte Calder, our Clinical Regional Directors, present Exploring Self-Harm In Young People With SEN.

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