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Why language matters: how ‘toxic trio’ is unhelpful and inaccurate

Last updated: 27 Mar 2023 Topics: Blog

From the NSPCC's Library and Information Service specialists

The term ‘toxic trio’ is used by some professionals to refer to the co-occurrence of parental domestic abuse, parental substance misuse and parental mental illness in a child’s life. To some, the presence of this ‘trio’ signals that a child may be experiencing abuse or neglect.

But is this really the case?

Research1 and case reviews do identify parental domestic abuse, substance misuse and parental mental illness as three factors that are frequently present in the lives of many children who experience abuse or neglect.2 However, their families’ lives are often a lot more complex than the term ‘toxic trio’ suggests.

What are the issues with the term ‘toxic trio’?

Lack of evidence

Although the term was originally used to describe three factors commonly present in case reviews2, the grouping together of these specific factors means that ‘toxic trio’ consequently leads to being misunderstood as:

  • if any of these factors are present, a child will experience abuse
  • if none of them are present, a child is safe.

But the evidence doesn’t back this up. A 2020 study from the National Children’s Bureau, the University of Kent and the University of Cambridge found that there was little robust research or evidence to quantify whether a combination of the three factors resulted in an increased risk of abuse or neglect.3

Unclear for practice

Practitioners need clear, informed definitions for good practice. Yet, combining parental domestic abuse, substance misuse and parental mental illness under the phrase ‘toxic trio’ strips them of nuance. It minimises the impact of these risks, and others, on the child’s safety and welfare.

Each of these three factors is complex and often look different in each family. They are also very different from each other.

  • Domestic abuse is a form of child abuse, it is not just a ‘risk factor’.
  • Substance misuse covers a wide variety of contexts around alcohol and/or drug use. With proper management and support, a parent with a substance misuse problem can be supported to safely care for their child.
  • Mental illness is an umbrella term for many diagnoses that can all exhibit differently and require different support at different times. Many parents with mental health problems do give their children safe and loving care, without their children being negatively affected in any way.

Too narrow

By focusing on the ‘toxic trio’ in isolation, it risks overlooking other factors present in a family’s life such as:

  • availability of appropriate support and services
  • parental adverse childhood experiences
  • cultural or language barriers
  • disability
  • poverty.4

Instead of focusing on the ‘toxic trio’, it is more helpful to consider how the below factors interact with each other and how this might impact a child’s safety and wellbeing:

  • a family’s history
  • barriers to support
  • potential risk factors
  • protective factors.

Negative and harmful

As highlighted above, the word ‘trio’ narrows focus down to individual risks. This might lead to insufficient consideration of the wider context of a child’s lived experience.

‘Toxic’ stigmatises families by labelling their situation and struggles as something poisonous or unpleasant. It dehumanises vulnerable families and might prevent them from getting the help they need. This leads to the question: should such a term have a place in the language we use to talk about safeguarding and child protection?

How can you reframe your practice?

Rather than combining factors into a catch-phrase, name individual factors and their impact on a child. Expanding your language beyond the ‘trio’ allows you to better explore the lived experience of the child and family you are working with.


Sidebotham, P (2019) Toxic terminology [Accessed 21/02/2023].
Dickens, J et al (2022) Serious case reviews 1998 to 2019: continuities, changes and challenges London: Department for Education (DfE)
Dickens, J et al (2022) Serious case reviews 1998 to 2019: continuities, changes and challenges London: Department for Education (DfE)
Skinner, G.C.M. et al (2020) The 'Toxic Trio': how good is the evidence base?: summary London: National Children's Bureau.
Webb, M.A. et al (2014) Living with adversity: a qualitative study of families with multiple and complex needs Belfast: Barnardo's

Key points to take away

  • The concept of the ‘toxic trio’ of parental domestic abuse, substance misuse and mental illness meaning a child will experience abuse is not robustly evidenced by research.
  • It is negative, stigmatising and fails to account for full range of adversities and barriers families can face.
  • The factors within the ‘trio’ cover a broad spectrum of concerns that can impact families in different ways. Practitioners should be supported to evaluate the bigger picture and respond to the specific individual needs of families and children.