Agreeing terms: It’s only helpful if it’s helpful

I wonder whether it is a peculiarly British thing that we have taken so long to decide on both a name and a definition? There is the need to be inclusive and not to offend, but also a strong sense of digging in of heels at times! Which is perhaps how come we still have both a myriad of letters and words for this type of harmful behaviour, and a lack of agreement on who to include, whether it is one phenomenon or many, whether they need to be distinguished within a typology – and most recently – what the upper age range might be.

Of all the reasons that have been given for making sure we agree terminology in work in the area of child to parent violence and abuse, the one that stands out for me is that families, practitioners and policy makers all need to share – and own – the language used. If not, then we risk losing people along the way, unable to access help or to adequately explain their experience. A couple of different initials and we have lost a load of data. Failing to agree and we start to look like a divided community.

It is understood that where you come from will have a clear impact on how you think about this and how you conceptualise the behaviour. That might be to do with your family structure, life stage, any diagnosis, life events, and not insignificantly, your professional background and training. (Geography around the world is a separate layer too of course, but for the purposes of this I am going to focus on the UK). And then how do you understand the words themselves? What does the word ‘child’ mean to you – a relationship or an age? What about ‘parent’ – does it come through birth or through a relationship?

So let’s dive straight in – if your lived experience is one of intimate partner violence, or if you work within the domestic abuse field then you might quite comfortably think of this type of behaviour as child to parent abuse. Many parents talk about how it “feels” the same – like abuse. There will be similar impacts. Some children and young people may be actively copying behaviour, or being coached to behave in certain ways. The positioning of many responses within the domestic abuse sector reinforces this conceptualisation and encourages us to think of the meaning of the behaviour perhaps too in a particular way. Whether you come from this background or not, many would agree that certain behaviours are designed to coerce parents into behaving in a particular way, or to control and belittle their lives. For some parents, the ‘calling out’ of such behaviour as abusive may be a revelation, and the first time they recognise that all is not well.

But while calling out abuse can be empowering for some, if it makes other parents feel awkward or uncomfortable then does it work? Harmful, challenging, explosive – these are all descriptions that have been favoured by some, particularly those with younger children, or children with additional needs. I wonder if there is something here about the term ‘abuse’ feeling too close to ‘abuser’? It is hard to think about young children as abusers. I have heard strong arguments from both parents and practitioners that the term abuse would not be considered appropriate in this situation, that it would cause offence, that it would not even be recognised as applying to their child and so present a barrier to accessing help.

What if you are living with a child of 6 or 7 – or younger even – who regularly “melts down”, with behaviour that is physically and emotionally damaging to those around them, to property, and importantly to themselves? A child who struggles to maintain a sense of equilibrium in the face of increasing stress, triggering experiences, or any demand on their sense of order and self? Similarly with an older child who has experienced trauma, or exploitation outside of the home, or who is stuck in that long, uneasy wait for a mental health diagnosis. If ‘abuse’ doesn’t feel right, does ‘violence’ feel any better? Can we sit more comfortably with ‘aggression’?

Some years ago, mindful of this dilemma, Al Coates and Wendy Thorley conducted a survey and wrote a series of papers as they wrestled with names and terminology. They eventually settled on CCVAB, or childhood challenging, violent and aggressive behaviour, a catch-all which recognised different places people were coming from but also that the impacts of this behaviour may be the same whatever it’s genesis. And of course, one thing I always remind people is that this is not a straightforward piechart of causes and correlations. This is a messy Venn diagram, where any one child and family may be positioned in many separate places simultaneously.

Let’s step outside of the UK perspective for a moment. Just as Coates and Thorley consulted the families involved, and interestingly also from within the adoption community, a recent consultation in Canada has generated a similarly descriptive name: Aggression towards Family / Caregivers in Childhood and Adolescence (AFCCA). I met with some of the team as they started on their journey towards providing support to families. Lauri Cabral from the National Consortium on AFCCA writes this:

In Canada, we had the privilege of consulting on appropriate language with over 100 family members with lived experience (including parents, caregivers, young adults who experienced AFCCA as a child/adolescent, sibling).  This reinforced for us the importance of balancing two crucial needs.  The first need is to continue the discussion (“You can’t stop talking about this.  If you can’t even talk about it, even knowing what’s happening….well, nothing’s going to change”- young adult first voice advocate). The second need is to avoid causing harm by using language that can label, shame or stigmatize a child or their family who is seeking help.  

The language that was finally chosen tries to balance these needs.  It helps enable families to succinctly ask for help while conveying the severity of their situation.  It enables social systems and practitioners to recognize the situation and identify optimal supports for children/youth and their families.  The hope is that this language can accomplish these goals while avoiding stigmatizing or pathologizing children/adolescents and their families who need support.  So far, the feedback on this language has been positive.

So having families with lived experience on board is crucial, but this community is vast and not homogeneous by any means as we have discovered. Unless we are to arrive at an ever longer and longer list of initials, I would suggest that we will inevitably need some sort of compromise. I have been part of the violence / abuse debate for many years. I remember a discussion as long ago as 2012 as to which was the more appropriate title. I tended to prefer the term ‘violence’, but when I published my practitioners’ guide I was persuaded to use both words – violence and abuse (CPVA) to include (or appease?) both camps. We may never come to a complete agreement about this, but maybe it is time to listen to other voices, to put aside the desire to capture something perfect, and to come up with the best name we can. It’s definitely not helpful to keep putting it off!

I welcome comments which will further this discussion, and help move us all towards agreed terms and a definition which can be adopted at a national, governmental level.