A number of my adolescent clients are labelled as “attention seeking” by (mostly) well-meaning adults. The behaviours I hear about are described as silly, fake, dramatic, made-up, chaotic, untrue, acting-out and fantastical. They include lying, stealing, “imaginary” physical ailments, acts of self-injury and suicidal actions. Attention seeking is perceived as a disparaging term, which belittles the behaviour and suggests that both it and the individual who is behaving that way shouldn’t be taken too seriously. Yet the arrival of the attention-seeking adolescent in my clinic suggests that, finally, they have been taken seriously by their confused and perhaps exasperated adult.

When I’m presented with an “attention-seeking” adolescent, I often ponder aloud why they might feel the need to do something that risky or that dangerous or that nonsensical for attention. In doing so, I’m encouraging a dialogue about what their behaviour might mean, because, as I say time and again, all behaviour is a communication. I cannot stress that point enough.

Just as a distressed baby cries louder and longer until their carer responds, the troubled adolescent will escalate their efforts to be noticed, upping the ante and heightening the risk in their efforts to have their needs met. And just as the non-verbal baby relies on an attentive adult to decipher their cries and respond accordingly, so too the “attention seeking” adolescent relies on adults to help them work things out, because often they don’t have the words to verbalise their distress either.

There isn’t a ready-made formula for deciphering adolescent behaviour, so we must pay close attention and make sense of it together. I acknowledge the behaviour without judging the individual and express my curiosity about what it might mean from a position of “not-knowing”. The not-knowing bit is powerful because young people are often in that position too: not knowing why they did whatever they did, not knowing how to express their needs, and not knowing what will make them feel better. It can be reassuring to have someone join them there, in the not-knowing position, rather than preach from a position of superiority or demand they tell us “why”: “Why did you cut?” “Why did you steal?” “Why are you lying to us?” When adolescents respond to those questions with “I don’t know”, it’s often true, consciously at least.

I don’t know either, why this young person has taken an overdose, or that young person steals, or the other one cuts their arms with a razor, or another has stomach aches all the time. But I do know this: Adolescents need to be attended to, and they need us to help them to know what is unknown and what is being communicated through their behaviour or “acted out” unconsciously.

There might be clues in the behaviour itself, and so I might wonder aloud about stealing as a communication that the young person feels they don’t have enough – not of the thing that’s been stolen (that’s often immaterial), but of something; maybe love, maybe care, maybe attention. Or if they’re stealing from someone in particular, perhaps a sibling or a stepparent, that could be a communication that they feel the person has taken something from them – again, not whatever they have stolen, but something less tangible – and so they take something in return.

In exploring self-injurious behaviour, I might say something like, “You’re showing me that you are hurting”. I’ll take a similar approach with a young person who has stomachache when, according to their adult “there is nothing wrong with them”. There is something wrong, it just isn’t obvious what, and the cause might not be physiological. These young people are telling us they are in pain and whether the pain is self-induced, physical, psychological or a combination, they are communicating a need to be taken care of and responded to with kindness and compassion.

Attention-seeking behaviour demands our attention. It is a vital communication from a young person about their needs, and it’s our job to listen.

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