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Adapting Approach for Different Attachment Needs  (2)

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Adapting Approach for Different Attachment Needs  (1)

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Zones of Regulation Toolkit for Young Children

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7 ways to support children and young people who are worried

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7 ways to support children and young people who are worried

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This May Help has been created to support parents and carers with concerns about their child’s mental health.

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This May Help has been created to support parents and carers with concerns about their child’s mental health.

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What is your concern?

This May Help has been created for parents and carers to help manage their child's mental health.

The subjects covered on this website have been chosen by parents and carers just like you, and in consultation with young people who have gone through their own mental health issues. What helped them may also help you.

On each page you'll find text for every topic along with more support films and links to other resources.

On the downloadable advice page you can download a printable version to use whenever you want.

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Advice for supporting your child's mental health | ThisMayHelp

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We are an initiative in partnership with the NHS to provide mental health support for parents of teens. Explore our videos for expert advice

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Our very own Lou Pattinson talking about all things related to our TI practice

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Our very own Lou Pattinson talking about all things related to our TI practice

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Wellbeing in Education Podcast – Episode 3 – Being a Trauma Informed School

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Sensory Processing, Coordination and Attachment. 

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Sensory Processing, Coordination and Attachment. 

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What is SAI? Sensory Attachment Intervention (SAI) is an integrative approach to the treatment of children and adults who have suffered abuse or severe neglect. Negative experiences in the womb and in early childhood impact on one's capacity to cope with stress throughout life.

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The Decline of Play and Rise in Children's Mental DisordersThere's a reason kids are more anxious and depressed than ever.

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The Decline of Play and Rise in Children's Mental DisordersThere's a reason kids are more anxious and depressed than ever.

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Rates of depression and anxiety among young people in America have been increasing steadily for the past 50 to 70 years. Today, by at least some estimates, five to eight times as many high school and college students meet the criteria for diagnosis of major depression and/or anxiety disorder as was true half a century or more ago. This increased psychopathology is not the result of changed diagnostic criteria; it holds even when the measures and criteria are constant.

The most recent evidence for the sharp generational rise in young people's depression, anxiety, and other mental disorders comes from a just-released study headed by Jean Twenge at San Diego State University.[1] Twenge and her colleagues took advantage of the fact that the Minnesota Multiphasic Personality Inventory (MMPI), a questionnaire used to assess a variety of mental disorders, has been given to large samples of college students throughout the United States going as far back as 1938, and the MMPI-A (the version used with younger adolescents) has been given to samples of high school students going as far back as 1951. The results are consistent with other studies, using a variety of indices, which also point to dramatic increases in anxiety and depression-in children as well as adolescents and young adults-over the last five or more decades.

We would like to think of history as progress, but if progress is measured in the mental health and happiness of young people, then we have been going backward at least since the early 1950s.

The question I want to address here is why.

The increased psychopathology seems to have nothing to do with realistic dangers and uncertainties in the larger world. The changes do not correlate with economic cycles, wars, or any of the other kinds of world events that people often talk about as affecting children's mental states. Rates of anxiety and depression among children and adolescents were far lower during the Great Depression, World War II, the Cold War, and the turbulent 1960s and early '70s than they are today. The changes seem to have much more to do with the way young people view the world than with the way the world actually is.
Decline in Young People's Sense of Personal Control Over Their Fate
One thing we know about anxiety and depression is that they correlate significantly with people's sense of control or lack of control over their own lives. People who believe that they are in charge of their own fate are less likely to become anxious or depressed than those who believe that they are victims of circumstances beyond their control. You might think that the sense of personal control would have increased over the last several decades. Real progress has occurred in our ability to prevent and treat diseases; the old prejudices that limited people's options because of race, gender, or sexual orientation have diminished; and the average person is wealthier than in decades past. Yet the data indicate that young people's belief that they have control over their own destinies has declined sharply over the decades.

The standard measure of sense of control is a questionnaire developed by Julien Rotter in the late 1950s called the Internal-External Locus of Control Scale. The questionnaire consists of 23 pairs of statements. One statement in each pair represents belief in an Internal locus of control (control by the person) and the other represents belief in an External locus of control (control by circumstances outside of the person). The person taking the test must decide which statement in each pair is more true. One pair, for example, is the following:

(a) I have found that what is going to happen will happen.

(b) Trusting to fate has never turned out as well for me as making a decision to take a definite course of action.

In this case, choice (a) represents an External locus of control and (b) represents an Internal locus of control.

Many studies over the years have shown that people who score toward the Internal end of Rotter's scale fare better in life than do those who score toward the External end.[2] They are more likely to get good jobs that they enjoy, take care of their health, and play active roles in their communities-and they are less likely to become anxious or depressed.

In a research study published a few years ago, Twenge and her colleagues analyzed the results of many previous studies that used Rotter's Scale with young people from 1960 through 2002.[3] They found that over this period average scores shifted dramatically-for children aged 9 to 14 as well as for college students-away from the Internal toward the External end of the scale. In fact, the shift was so great that the average young person in 2002 was more External than were 80% of young people in the 1960s. The rise in Externality on Rotter's scale over the 42-year period showed the same linear trend as did the rise in depression and anxiety.

[Correction: The locus of control data used by Twenge and her colleagues for children age 9 to 14 came from the Nowicki-Strickland Scale, developed by Bonnie Strickland and Steve Nowicki, not from the Rotter Scale. Their scale is similar to Rotter's, but modified for use with children.]

It is reasonable to suggest that the rise of Externality (and decline of Internality) is causally related to the rise in anxiety and depression. When people believe that they have little or no control over their fate they become anxious: "Something terrible can happen to me at any time and I will be unable to do anything about it." When the anxiety and sense of helplessness become too great people become depressed: "There is no use trying; I'm doomed."
Shift Toward Extrinsic Goals, Away From Intrinsic Goals
Twenge's own theory is that the generational increases in anxiety and depression are related to a shift from "intrinsic" to "extrinsic" goals.[1] Intrinsic goals are those that have to do with one's own development as a person-such as becoming competent in endeavors of one's choosing and developing a meaningful philosophy of life. Extrinsic goals, on the other hand, are those that have to do with material rewards and other people's judgments. They include goals of high income, status, and good looks. Twenge cites evidence that young people today are, on average, more oriented toward extrinsic goals and less oriented toward intrinsic goals than they were in the past. For example, a annual poll of college freshmen shows that most students today list "being well off financially" as more important to them than "developing a meaningful philosophy of life"-the reverse was true in the 1960s and 1970s.[4]

The shift toward extrinsic goals could well be related causally to the shift toward an External locus of control. We have much less personal control over achievement of extrinsic goals than intrinsic goals. I can, through personal effort, quite definitely improve my competence, but that doesn't guarantee that I'll get rich. I can, through spiritual practices or philosophical delving, find my own sense of meaning in life, but that doesn't guarantee that people will find me more attractive or lavish praise on me. To the extent that my emotional sense of satisfaction comes from progress toward intrinsic goals I can control my emotional wellbeing. To the extent that my satisfaction comes from others' judgments and rewards, I have much less control over my emotional state.

Twenge suggests that the shift from intrinsic to extrinsic goals represents a general shift toward a culture of materialism, transmitted through television and other media. Young people are exposed from birth to advertisements and other messages implying that happiness depends on good looks, popularity, and material goods. My guess is that Twenge is at least partly correct on this, but I will suggest a further cause, which I think is even more significant and basic: My hypothesis is that the generational increases in Externality, extrinsic goals, anxiety, and depression are all caused largely by the decline, over that same period, in opportunities for free play and the increased time and weight given to schooling.
How the Decline of Free Play May Have Caused a Decline in Sense of Control and in Intrinsic Goals, and a Rise in Anxiety and Depression
As I pointed out here and here-and as others have pointed out in recent popular books[5]-children's freedom to play and explore on their own, independent of direct adult guidance and direction, has declined greatly in recent decades. Free play and exploration are, historically, the means by which children learn to solve their own problems, control their own lives, develop their own interests, and become competent in pursuit of their own interests. This has been the theme of many of my previous posts. (See, for example, the series of posts on "The Value of Play.") In fact, play, by definition, is activity controlled and directed by the players; and play, by definition, is directed toward intrinsic rather than extrinsic goals

By depriving children of opportunities to play on their own, away from direct adult supervision and control, we are depriving them of opportunities to learn how to take control of their own lives. We may think we are protecting them, but in fact we are diminishing their joy, diminishing their sense of self-control, preventing them from discovering and exploring the endeavors they would most love, and increasing the odds that they will suffer from anxiety, depression, and other disorders.
How Coercive Schooling Deprives Young People of Personal Control, Directs Them Toward Extrinsic Goals, and Promotes Anxiety and Depression
During the same half-century or more that free play has declined, school and school-like activities (such as lessons out of school and adult-directed sports) have risen continuously in prominence. Children today spend more hours per day, days per year, and years of their life in school than ever before. More weight is given to tests and grades than ever. Outside of school, children spend more time than ever in settings in which they are directed, protected, catered to, ranked, judged, and rewarded by adults. In all of these settings adults are in control, not children.

In school, children learn quickly that their own choices of activities and their own judgments of competence don't count; what matters are the teachers' choices and judgments. Teachers are not entirely predictable: You may study hard and still get a poor grade because you didn't figure out exactly what the teacher wanted you to study or guess correctly what questions he or she would ask. The goal in class, in the minds of the great majority of students, is not competence but good grades. Given a choice between really learning a subject and getting an A, the great majority of students would, without hesitation, pick the latter. That is true at every stage in the educational process, at least up to the level of graduate school. That's not the fault of students; that's our fault. We've set it up that way. Our system of constant testing and evaluation in school-which becomes increasingly intense with every passing year-is a system that very clearly substitutes extrinsic rewards and goals for intrinsic ones. It is almost designed to produce anxiety and depression.[6]

School is also a place where children have little choice about with whom they can associate. They are herded into spaces filled with other children that they did not choose, and they must spend a good portion of each school day in those spaces. In free play, children who feel harassed or bullied can leave the situation and find another group that is more compatible; in school they cannot. Whether the bullies are other students or teachers (which is all too common), the child usually has no choice but to face those persons day after day.

The results are sometimes disastrous.

A few years ago, Mihaly Csikszentmihalyi and Jeremy Hunter conducted a study of happiness and unhappiness in public school students in 6th through 12th grade.[7] Each of 828 participants, from 33 different schools in 12 different communities across the country, wore a special wristwatch for a week, programmed to provide a signal at random times between 7:30 am and 10:30 pm. Whenever the signal went off participants filled out a questionnaire indicating where they were, what they were doing, and how happy or unhappy they were at the moment.

The lowest levels of happiness by far (surprise, surprise) occurred when children were at school, and the highest levels occurred when they were out of school and conversing or playing with friends. Time spent with parents fell in the middle of the range. Average happiness increased on weekends, but then plummeted from late Sunday afternoon through the evening, in anticipation of the coming school week.

As a society we have come to the conclusion that children must spend increasing amounts of time in the very setting where they least want to be. The cost of that belief, as measured by the happiness and mental health of our children, is enormous.

It is time to re-think education.
Another Way
Anyone who looks honestly at the experiences of students at Sudbury model democratic schools and of unschoolers-where freedom, play, and self-directed exploration prevail-knows that there is another way. We don't need to drive kids crazy to educate them. Given freedom and opportunity, without coercion, young people educate themselves. They do so joyfully, and in the process develop intrinsic values, personal self-control, and emotional wellbeing. That's the overriding message of the whole series of essays in this blog. It's time for society to take an honest look.

In my last post I invited readers to submit their stories of self-directed education, and many of you have responded. That invitation is still open, but please respond soon. Over the next several weeks I will post essays about how children learn to read through their self-directed play and exploration, how and why they learn math, and how they develop special interests and skills that lead eventually to careers.

Stay tuned.

Notes

[1] Twenge, J., et al., (2010). Birth cohort increases in psychopathology among young Americans, 1938-2007: A cross-temporal meta-analysis of the MMPI. In press, Clinical Psychology Review 30, 145-154.
[2] For references, see Twenge et al. (2004).
[3] Twenge, J. et al. (2004). Its beyond my control: A cross-temporal meta-analysis of increasing externality in locus of control, 1960-2002. Personality and Social Psychology Review, 8, 308-319.
[4] Pryor, J. H., et al. (2007). The American freshman: Forty-year trends, 1966-2006. Los Angeles: Higher Education Research Institute.
[5] Examples of such books are Hara Estroff Marano's A Nation of Wimps and Lenore Skenazy's Free Range Kids.
[6] Consistent with this claim is evidence that the more academically competitive the school, the greater is the incidence of student depression. Herman, K. C., et al. (2009). Childhood depression: Rethinking the role of school. Psychology in the Schools, 46, 433-446.
[7] Csikszentmihalyi, M., & Hunter, J. (2003). Happiness in everyday life: The uses of experience sampling. Journal of Happiness Studies, 4, 185-199.

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The Decline of Play and Rise in Children's Mental Disorders

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Rates of depression and anxiety among young people in America have been increasing steadily for the past 50 to 70 years. Today, by at least some estimates, five to eight times as many high school and college students meet the criteria for diagnosis of major depression and/or anxiety disorder as was true half a century or more ago.

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A video from Dr Andrew Curran, a top Neurobiologist, who gives a powerful insight into the development of a young person's brain.

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Researchers doubt the certain mental disorders are disorders at all 

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Researchers doubt the certain mental disorders are disorders at all 

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What if mental disorders like anxiety, depression or post-traumatic stress disorder aren't mental disorders at all? In a compelling new paper, biological anthropologists call on the scientific community to rethink mental illness. With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances. And ADHD could be a way of functioning that evolved in an ancestral environment, but doesn't match the way we live today.

Adaptive responses to adversity

Mental disorders are routinely treated by medication under the medical model. So why are the anthropologists who wrote this study claiming that these disorders might not be medical at all? They point to a few key points. First, that medical science has never been able to prove that anxiety, depression or post-traumatic stress disorder (PTSD) are inherited conditions.

Second, the study authors note that despite widespread and increasing use of antidepressants, rates of anxiety and depression do not seem to be improving. From 1990-2010 the global prevalence of major depressive disorder and anxiety disorders held at 4.4% and 4%. At the same time, evidence has continued to show that antidepressants perform no better than placebo.

Third, worldwide rates of these disorders remain stable at 1 in 14 people. Yet "in conflict‐affected countries, an estimated one in five people suffers from depression, PTSD, anxiety disorders, and other disorders," they write.

Taken together, the authors posit that anxiety, depression and PTSD may be adaptive responses to adversity. "Defense systems are adaptations that reliably activate in fitness‐threatening situations in order to minimize fitness loss," they write. It's not hard to see how that could be true for anxiety; worry helps us avoid danger. But how can that be true for depression? They argue that the "psychic pain" of depression helps us "focus attention on adverse events... so as to mitigate the current adversity and avoid future such adversities."

If that sounds unlikely, then consider that neuroscientists have increasingly mapped these three disorders to branches of the threat detection system. Anxiety may be due to chronic activation of the fight or flight system. PTSD may occur when trauma triggers the freeze response which helps animals disconnect from pain before they die, and depression may be a chronic activation of that same freeze response.

Labels matter

Labels are something we internalize to define who we are and what we are capable of. All too often, labels limit us. And that's why reconsidering how we label anxiety, depression or ADHD is important. Does someone have depression, a medical disorder of their brain, or are they having a depressed adaptive response to adversity? Adversity is something we can overcome, whereas a mental disorder is something to be managed. The labels imply very different possibilities.

Consider how we label ADHD. A generation ago boys with ADHD were labelled as "bad boys" and were given penalties or detentions. Now we help kids with ADHD understand that they have a "learning difference." Instead of detention, we try to provide support in a variety of modalities. When we do, the behavior problems often disappear. That label change to learning difference is vital, because it gives space for kids with ADHD to be "good kids" and to succeed. Yet ADHD is still "attention deficit and hyperactivity disorder."

In Finland, where substantial physical activity is part of the school day, rates of ADHD are also very low. Meanwhile, in the U.S. children are asked to sit still for the majority of the day. Elementary school students often get only 15-20 minutes of recess a day, a far cry from the 60-90 minutes their parents had. Coincidentally, ADHD rates in the U.S. have gone up over the last 15 years.

ADHD is not a disorder, the study authors argue. Rather it is an evolutionary mismatch to the modern learning environment we have constructed. Edward Hagen, professor of evolutionary anthropology at Washington State University and co-author on the study, pointed out in a press release that "there is little in our evolutionary history that accounts for children sitting at desks quietly while watching a teacher do math equations at a board."

If ADHD is not a disorder, but a mismatch with a human environment, then suddenly it's not a medical issue. It's an issue for educational reform. And that is a compelling thought, given the evidence that kids' focus and cognition are improved by physical activity. Still, we need to take this study with a grain of salt. There is a large body of research showing other biological factors when it comes to ADHD. For instance, there is evidence that premature birth increases rates of ADHD later.

Social reform or medical treatment?

Study author Kristen Syme, a recent WSU Ph.D. graduate, compares treating anxiety, depression or PTSD with antidepressants to medicating someone for a broken bone without setting the bone itself. She believes that these problems "look more like sociocultural phenomena, so the solution is not necessarily fixing a dysfunction in the person's brain but fixing dysfunctions in the social world."

It's a fair criticism of the way we treat mental illness. But the stated goal of the paper is not to suddenly change treatments, but to explore new ways of studying these problems. "Research on depression, anxiety, and PTSD, should put greater emphasis on mitigating conflict and adversity and less on manipulating brain chemistry."

But what about the fact that there is plenty of medical evidence for that brain chemistry? Consider a recent study done in Turku, Finland. Researchers showed that the symptoms associated with depression and anxiety are connected to changes in the brain's opioid system already in healthy individuals.

Can we reconcile brain studies like this with the biological anthropologists criticism of how we handle mental health? Actually we can. The changes in the brain associated with anxiety and depression are evident, but that doesn't mean they can't be understood as responses to adversity.

Based on this, do we need to make changes in how we treat mental health? Yes and no. When it comes to what labels we use, a change is welcome. Mental health recovery in part, depends on whether patients believe they can get better. Telling our patients that their symptoms may be tied to a healthy response to adversity could be very encouraging.

It's not news to doctors that mental health is impacted by adversity. In my own medical training, I was taught the biopsychosocial model, implying interconnected causes of these problems. But until social reform actually does remove social causes of suffering, physicians must continue to provide the standard of care to our patients. The history of medicine is a story of healers using the best treatments they had at the time, until better ones arrive.

Follow me on Twitter or LinkedIn. Check out my website or some of my other work here.

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Researchers Doubt That Certain Mental Disorders Are Disorders At All

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What if mental disorders like anxiety, depression or post-traumatic stress disorder aren't mental disorders at all? In a compelling new paper, biological anthropologists call on the scientific community to rethink mental illness. With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances.

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Childhood Trauma and the Brain | UK Trauma Council

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Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP

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The Pocket Guide to Sensorimotor Psychotherapy in Context (Norton Series on Interpersonal Neurobiology)

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Quote shared via Kindle: "The use of “talk therapy” alone falls short of accessing and resolving the manifold effects of trauma. Because ...

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Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP https://t.co/AZIJJRY4Rf

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Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP pic.twitter.com/AZIJJRY4Rf
— TraumainformedFinland (@TraumainformedF) February 8, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.entities.urls[].title
The Pocket Guide to Sensorimotor Psychotherapy in Context (Norton Series on Interpersonal Neurobiology)

# data[].attributes.attachment_link.metadata.attachment_props_source.data.entities.urls[].description
Quote shared via Kindle: "The use of “talk therapy” alone falls short of accessing and resolving the manifold effects of trauma. Because ...

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP https://t.co/AZIJJRY4Rf

# data[].attributes.attachment_link.metadata.attachment_props.original_text
Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP https://t.co/AZIJJRY4Rf

# data[].attributes.attachment_link.metadata.attachment_props.text
Wisdom of Pat Ogden. An excellent new book about #sensorimotor psychotherapy. #traumainformed https://t.co/zsHEtmYciP

# data[].attributes.attachment_link.metadata.attachment_props.entities.urls[].title
The Pocket Guide to Sensorimotor Psychotherapy in Context (Norton Series on Interpersonal Neurobiology)

# data[].attributes.attachment_link.metadata.attachment_props.entities.urls[].description
Quote shared via Kindle: "The use of “talk therapy” alone falls short of accessing and resolving the manifold effects of trauma. Because ...

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Early trauma is stored in the body via the senses, this is why therapy through the senses is effective - Sensory Project

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Early trauma is stored in the body via the senses, this is why therapy through the senses is effective - Sensory Project

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Early trauma is stored in the body via the senses, this is why therapy through the senses is effective - Sensory Project

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"Early trauma is stored in the body via the senses, this is why therapy through the senses is effective." Smith, K BPD and SI 2004 Occupational Therapists are ideally placed to work through play and via the senses to promote the development of healthy neurological pathways and structures; impacting the development of sensory motor skills [...]

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Norfolk and Suffolk NHS Foundation Trust

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Working with low mood including safety planning

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Norfolk and Suffolk NHS Foundation Trust

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Our vision is to provide appropriate training for schools, communities and organisations so that they become trauma informed and mentally healthy places for all.

This means we aim to help children and teenagers BEFORE they get mental health problems - to catch them as they are falling not after they have fallen. Towards this aim we strongly endorse the statement in the Government Green Paper December 2017 Transforming Children and Young People's Mental Health Provision, "There is evidence that appropriately-trained and supported staff such as teachers, school nurses, counsellors, and teaching assistants can achieve results comparable to those achieved by trained therapists in delivering a number of interventions addressing mild to moderate mental health problems (such as anxiety, conduct disorder, substance use disorders and post-traumatic stress disorder)". We are appropriately training school staff to take on this task.

Our objective is to bring about a whole school /organisational cultural shift where the wellbeing of all is the highest priority. We implement many interventions to ensure the relational and emotional health of all. Our interventions are evidence based with the backing of over 1,000 research studies from psychology and neuroscience.

We also believe that for schools to become mentally healthy places for all, the value of well being has to start at the very top, with organisations such as DFE, Ofsted and the Regional Schools Commissioners balancing the scales between outcomes (test scores) and emotional wellbeing. We are working to ensure that there is national recognition of the importance of monitoring the well being of schools and that Governing Bodies, Trust Boards and Directors make staff wellbeing as well as pupil well being a key performance indicator for our schools.

Practitioner Trainings

11 day and 13 days (University route) over two terms

Senior Leads Training

2 days to ensure your school is trauma and mental health informed

Whole School Inductions

Half or whole day to ensure whole school approach to mentally healthy school status

TRAUMA INFORMED SCHOOLS UK (TISUK): KEY CREDENTIALS
Key Credentials

TISUK is a registered community interest company (social work) working in association with the Centre for Child Mental Health: President Sir Richard Bowlby.

TISUK has delivered return to school training in the Covid 19 crisis to over 20,000 staff in school and community organisations across the UK and Ireland, including members of the National Education Union.

TISUK has a University of East London validated course entitled Certificate in Trauma and Mental Health Informed Schools and Communities (Level 5) and Diploma course entitled Trauma and Mental Health in Schools and Communities (Practitioner status).

Sheffield Hallam University includes a compulsory module of TISUK's training in every level and age phase of their initial teaching education. (Over 1000 trainee teachers have received the training). Professor Mark Boylan (Sheffield Hallam University) is presently working in partnership with TISUK to standardise and publish their key assessment tools.

TISUK is an approved provider for DfE funded Senior Mental Health Lead Training.

Over 5000 schools, colleges, early years settings and community settings, have received training from TISUK including: Whole school training, Senior Leads Training, Diploma (Trauma Informed Practitioner training), e-learning e.g. Supporting the Return to School, Working with Trauma in Early Years Settings, Whole School Cultural Shift to a Trauma Informed Culture, Working with Vulnerable Teenagers in Schools.

TISUK has delivered training at whole school and Diploma level in all of the 22 local authorities across Wales. (bilingual materials and training Welsh language trainers).

TISUK has delivered webinar-based training to schools, early years providers, health and community settings across the UK, including county/borough wide subscriptions in Cornwall, Lambeth, South Yorkshire and across Wales.

TISUK has delivered webinar training on Trauma in the Early years: Prevention and Intervention, to over 1500 Early years settings across South Yorkshire and 100 in Lambeth.

TISUK have worked with education teams in two Youth Offending Institutions to embed a trauma informed approach within each department, with the aim to also train the wider prison staff.

TISUK has delivered introductory Trauma Informed Schools training across West Africa, to school counsellors based in international schools.

TISUK has supported and delivered trauma informed training to Domus Solis & Gravitas Schola who evacuated a whole school community of 300 children, teachers and families from Kharkiv, Ukraine to Vilinus, Lithuania. The school has since been joined by a further 150 children from across Ukraine.

TISUK has worked in association with the Trauma Release and Wellness Centre, to deliver whole staff and senior lead training to schools in Pakistan.

TISUK has an extensive group of eminent consultants and advisors. Several of these have lived experience, and provide expert advice on how schools and communities can work to prevent gang membership, violence, homelessness, prostitution, drug and alcohol addiction.

TISUK's training is highlighted in the DfE Advice to Schools: Mental Health and Behaviour in Schools DfE-00327-2018 as supporting and promoting positive mental health.

TISUK trainings are informed by and adapted from the key components of whole school cultural change as set out by the Evidence-Based Practice Unit, Manchester University/Anna Freud Centre, (Demkowicz and Humphreys 2019). These components comprise of mental health approaches to teaching and learning; pupil/ student voice; staff and senior lead development; health and wellbeing; online assessment tool to ascertain mental health needs and provide a measurable evidence-base of impact; training key members of staff to support vulnerable children through therapeutic conversations; working with parents to support mentally healthy cultures at home.

As a result of our trainings, which were created in reponse to the major cutbacks in CAMHS, we have been thrilled to see so many schools willingly pick up the mental health baton, resulting in fewer exclusions, a reduction in staff stress-related illness and an increase in pupil attendance, attainment and in staff retention. We therefore fully endorse the 2017 Government Green Paper on Children's Mental Health Provision in stating that, 'There is evidence that appropriately trained and supported staff... teachers... teaching assistants can achieve results comparable to those achieved by trained therapists in delivering a number of interventions addressing mild to moderate mental health problems.' That said, our trained staff recognise limits of competence and know when to refer on and to whom.

TISUK has an awards scheme for those schools who wish to be formally assessed for mentally healthy and trauma informed school status.

For the equivalent of just one Pupil Premium Plus grant, TISUK can provide a menu of training options (e.g. Whole school/Senior Leads training/Practitioner Diploma) to support a whole school understanding of mental health informed practices, all designed to benefit everyone in your school (staff and pupils), and directly attributable to the PP+ allocation/spend. Interventions are all practically based, time preserving and cost effective.

Offering support for schools and settings in times of crisis. For example, offering support to students, staff and parents after the tragedy of suicide. Developing a model for whole community support.

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Our vision is to provide appropriate training for schools,communities and organisations so that they become trauma informed and mentally healthy places for all.

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The Power of Vulnerability | Brené Brown | TED

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Your Headspace Mindfulness & Meditation Experts

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We want children to be healthy & happy now & for the rest of their lives. Teach meditation for kids with Headspace, using easy exercises designed for young minds.

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Belly Breathing: Mindfulness for Children

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News

If Schools Really Care about Success for Every Student, a ‘Zero-Tolerance’ Behaviour Policy isn’t the Answer

“Inconveniently to some, children have rights” – All schools need to tackle indiscipline but such strict approaches are immoral, unjustified and frankly fraudulent

Paul Dix

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"Inconveniently to some, children have rights" - All schools need to tackle indiscipline but such strict approaches are immoral, unjustified and frankly fraudulent

Added: 15th December 2017

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If Schools Really Care about Success for Every Student, a 'Zero-Tolerance' Behaviour Policy isn't the Answer

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If you have ever taught in a school in chaos, unsupported and sinking, you will remember it keenly. It never leaves you. The visceral anger at seeing children hurt, intimidated... | Teachwire News

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Social and Emotional Learning

Restorative justice allows everyone affected by a harm to return to a calm state that is optimal for learning.

©Shutterstock/Monkey Business Images

Restorative justice (RJ) offers healthy alternatives to the traditional disciplinary approach of rules and the consequences of breaking those rules. RJ practices such as peer conflict resolution circles, reflection sheets that guide conversations with a teacher or administrator, and mediated student-student or student-adult conversations are practices that allow students and communities to feel safe and successful together.

While traditional rules-and-consequences discipline is sometimes effective in stopping detrimental behaviors, it may have negative effects on the long-term resilience and connection within the community. It's worth considering the impact that such discipline has on our nervous systems, on the relationships within our schools, and on students' identity and self-esteem, and what RJ has to offer as an alternative.

The Nervous System and Our Sense of Connection

Picture a student who has just passed a note in class or pushed a peer in the hallway and a teacher who has caught this student in the act. In this moment of rule violation and the confrontation that follows, the student, the teacher, and sometimes even nearby observers can experience a sympathetic nervous system response-muscular tension, an increase in heart rate, elevated levels of cortisol and adrenaline, and shortness of breath-also known as the "fight, flight, freeze, or submit" response. This is the body preparing to protect itself from a real or perceived threat or danger.

When a traditional rules-and-consequences approach is used to address errant behavior, the misbehaving student is often left to regulate their nervous system on their own-or not, as we see with students who transgress in the morning and then continue to act out or have a difficult time focusing throughout the day.

For an educator or administrator, it can be taxing when a student continues to act out and/or worrisome when a student begins to exhibit detrimental emotions and self-destructive behaviors. Simply punishing a behavior doesn't allow for space to inquire about the motivation behind a misstep or what's needed to repair the harm.

RJ practices help all community members involved to calm or regulate their nervous systems by focusing on authentic reconnection after a rupture occurs. When we're connected, we naturally feel safer and our nervous systems have a better chance of returning to the parasympathetic "rest and digest" mode that is optimal for learning.

RJ practices allow us to recognize how the offender, victim, witnesses, and guiding adult are all impacted by the harm that occurred, and will all benefit from a reparative or restorative process to feel safe again in the school environment.

Applied in various ways, RJ practices always ask all parties involved:

What happened?

What harm was caused?

What needs to happen to repair the harm?

Through RJ, students and adults learn about each other's perspectives and build empathy and understanding, developing a greater sense of trust in one another. The transgressing student has the opportunity to repair harm by acknowledging their wrongdoing, expressing remorse, and taking action based upon the victim's needs to repair trust. Victims are able to share their experience, offer forgiveness, and make amends. Having a chance to rebuild relationship after a misstep and to foster empathy, attunement, and accountability helps the whole community to feel safe and more connected.

No matter the level of severity of a rule violation-even when a student is asked to leave a community-the RJ process fortifies compassion and empathy for others and humanizes the experience of mistake-making.

Supporting Self-Esteem

When someone-a student or an adult-feels unsafe at home or experiences discrimination for their background, identity, or other reasons, they may come to school with an already overstimulated nervous system. This means it's easier for them to become dysregulated-to experience a sympathetic fight, flee, freeze, or submit response-during a rule violation or enforcement moment.

Psychologically, a student who breaks a rule and receives punishment may begin to identify as a "bad kid," and may be seen by their peers as someone who always get into trouble-a cycle that is sometimes repeated again and again. Through the reflective processes of RJ, this student can instead learn about the impact of their actions and reflect upon their membership in the community. They have a chance to grow self-esteem and to perceive themselves as a human who has made a mistake or bad decision and is taking responsibility for their actions.

Rather than simply doling out a punishment without guidance, RJ reminds us all that mistakes are learning opportunities for growth and that offenders have the opportunity to take responsibility for their behavior, repair the harm they have caused, and work toward a positive outcome.

A learning community that engages in connection building to repair harm becomes more resilient over time via more trusting connections between community members, increased self-awareness and compassion, and regulated nervous systems.

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How Restorative Justice Helps Students Learn | Edutopia

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Social and Emotional Learning Restorative justice allows everyone affected by a harm to return to a calm state that is optimal for learning. ©Shutterstock/Monkey Business Images Restorative justice (RJ) offers healthy alternatives to the traditional disciplinary approach of rules and the consequences of breaking those rules.

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"My first teaching practice was in a really challenging secondary school but it was brilliant because of the nature of the kids that were there.

"Ex-coal mining town, challenging cohort, kids with massive character. I just loved working with those sorts of kids."

When Dave Whitaker talks about a school having a challenging cohort he does so with a positive sense of excitement. And he describes these pupils as being "at the top end" rather than the bottom.

Exclusive: Northern leaders urged to learn from PRUs to cut exclusions

Profile: Meet the woman making 'The Difference' for vulnerable pupils

Background: Why I turned my back on headship to work in a PRU

As the director of learning at Wellspring Trust he is now responsible for an expanding group of special and alternative provision academies with, in his words, "hundreds and hundreds of challenging kids".

Since it was set up the trust, which also operates 11 mainstream schools in the North of England, has never permanently excluded a pupil.

Now it is helping to support a project that aims to make mainstream schools more inclusive and find ways of dealing with children with challenging behaviour.

Whitaker and the Wellspring Trust are backing The Difference programme, which is just about to launch a scheme in the North allowing aspiring mainstream school leaders to gain valuable experience of pupil referral units. They will get to work in PRUs for two years to learn how they support their pupils before going on to mainstream school leadership roles.

Kiran Gill, founder of The Difference, hopes it will support leaders in schools to find ways of being more inclusive. Whitaker is a big supporter of the programme. He believes it should be funded by government because he says some pupils are not having their needs met by the way behaviour is managed in some mainstream schools.

And it is meeting those needs, of challenging pupils, that Whitaker says has been his most rewarding work in the classroom.

"Saying kids are challenging is not writing them off," he says. "It's the other way round. I love them. Loved working with them. It's the best job. The challenge is managing their personalities and their characters."

He recalls how at both his first placement at the Priory School in Barnsley and his first job at Kingstone School in the same South Yorkshire town that he had found his calling.

"When I had that job in Kingstone, I was teaching 30 kids in a class. You very rarely had a teaching assistant and there was no behaviour structure or system that was there to rescue you. When the door closed behind you you were on your own. You didn't have a behaviour structure to support you.

'I had to earn the respect of the class'

"What I had to do is earn the respect of the class, teach really, really well. And if those kids were running around on the desks I had to get them down on my own with my personality and they needed to want to get down off the desks."

He describes the experience as being daunting but he also believes it is where he learned what he considers is essential to managing behaviour - building up relationships with the pupils. And he worries that some of this is being lost in mainstream education.

"What happens now is that if a kid runs around on the desk there is a button you can press and someone comes and takes the kid out. At the risk of sounding controversial I think we are at risk of deskilling."

You can tell this is an argument he has had before because he then addresses what critics might say.

"I am not saying kids should have to put up with certain stuff. I am not saying that at all. I am not saying that teachers should have to put up with certain stuff. I am absolutely not saying that. But I learned back then how to manage a classroom by having that door closed on me and having an hour with them.

"You use relationships, you use rigour, you use routine, you use humour, you use warmth, you use all of that so that the kids are on your side and wanted to learn.

"I owed them that. I owed them good lessons and good quality teaching but when they didn't want to do it, I had to get them to want to do it and do it for me and that for me is where my relational-based behaviour management started."

Whitaker grew up in Pontefract in West Yorkshire, and has spent his working life teaching in Barnsley, a once industrial town now most famous for its mining past. He describes himself as having "an angle" on working with children who might struggle at school because he was a disaffected pupil himself.

"I was not disaffected in terms of being massively challenging - it just didn't rock my boat. When people say can you remember those brilliant teachers you had, I can safely say that I didn't have one and I didn't have anyone inspiring me as I went through school."

Whitaker went on to higher education where he describes himself as having fun and making lifelong friends. But he didn't have a clear idea of what to do next.

And while he never knew exactly where a degree in geography and outdoor pursuits would take him, it is fair to say he didn't have in mind working for a water utility company mapping out sewers across Yorkshire.

"Because I did geography people thought I could read maps but it was not exactly inspiring and it made me realise I needed to do something different with my life."

So Whitaker returned to education, did a PGCE at Sheffield University and found his calling. After starting work at Kingstone School he quickly became involved in pastoral support work and leading the school's work in special needs.

From there he moved into the special educational needs sector, joining Springwell School as deputy head as it changed from being a PRU to a special school for pupils with social, emotional and mental health needs.

Then, as the government began rolling out the academies programme, Springwell decided to go it alone as an academy trust.

"We thought really hard about it and we were really inventive with the name Wellspring," Whitaker says. "We just switched the name Springwell around.

'We didn't want to be like a hero school'

"We didn't want the trust to have the same name as the founder school. We felt we didn't want to be like a hero school.

"We didn't want to do that thing where the trust carries the name of the first school because it's not fair on all the other schools that are in the trust. We wanted equal partners and what I would say now is how much I value the leaders of our alternative provision, special schools and our mainstream schools. They are the heartbeat of our trust."

Today that trust runs 22 schools, including 11 alternative or special schools, and has supported 80 more mainstream school across the country. As it happens Springwell was not even the first school in the trust. A complicated PFI deal held up academy conversion and meant that Wellspring's first school was actually at a mainstream primary school - the Forest Academy in Barnsley.

Its head Mark Wilson became the chief executive of the trust and Whitaker, who was the head of Springwell School, became executive principal. As the trust has grown he has become director of learning responsible for the 11 special and alternative provision schools .

He is keen to stress that the same ethos runs through all of its schools, that of having "unconditional positive regard" for the pupils.

Whitaker takes great pride in explaining how Wellspring has never permanently excluded a pupil, and how a mainstream secondary it took on in Grimsby is "on-rolling pupils" who have previously been electively home-educated.

Inclusion is fundamental to the way he sees education.

"What you have got to do is try to work out what they are doing and get them to do it in a different way," he says. "Not by punishing them - it breeds resentment, it damages relationships. You tell me a school where detentions work for the majority of children who are having them.

"You show me a school where fixed-term exclusions are not always the same kids getting excluded and racking them up time and time again.

"You look at detention statistics for a secondary school and it will be the same kids week after week who don't bring the pen, don't bring the pencil, don't do their homework. But what we have got to think is if detention is an intervention, interventions are supposed to work.

"If you have an intervention that was aimed at teaching children how to write and six months later they weren't learning how to write you would scrap that intervention, and yet we have an intervention in the detention system which is embedded in thousands of schools that clearly doesn't work for a big chunk of children, but we still put them through."

As such Whitaker is on one side of an increasingly polarised debate about how behaviour should be managed in schools. But he takes issue with the idea that his schools are soft or do not have high expectations.

"Being unconditionally positive and not being punitive does not mean you do not have high expectations," he says.

"I am expecting them to behave well even though you are not going to get something for it, and I am not going to punish you if you don't. I want you to do it because you know it's the right thing to do. We have to teach them that.

"Now, I am not saying our schools don't use rewards and I am not saying across the trust we don't have detentions but it is not the be all and end all and we have not got behaviour systems that revolve around it."

He is keen to point out that the approach he promotes is not just a nice theory, it actually works for Wellspring pupils.

"At the two Springwell schools in Barnsley, one is alternative provision, one is a SEMH (social, emotional and mental health) special school. They have both got "outstanding" for behaviour. They both use relational-based practice.

"They don't have a punitive or reward-based approach and yet the behaviour is judged "outstanding" by Ofsted in both of them."

Whitaker believes that this approach needs more recognition nationally.

"What I am saying is that a lot of the behaviour programmes that are out there that are championed and advocated don't necessarily do the work that schools are crying out for with some kids, and therefore their only option is exclusion.

"Some schools have systems that say, 'the children have to learn how to respond'.

"I would argue that is OK for a lot of children but there are those children who have had adverse experiences, cognitive impairment, they behave in a different way so therefore you cannot have the same behaviour system.

"If you have two children at two different stages of reading you do not give them the same book. But we don't do always do that in behaviour."

Drivers of exclusion

It is worth pointing out that with just one mainstream secondary, Wellspring is not measured in accordance with Progress 8 scores in the same way that many schools criticised for high exclusion rates are. Whitaker accepts this wholeheartedly, and says this is why there needs to be a culture change in terms of how schools are held to account.

He believes the accountability system, a lack of funding and a lack of expert knowledge in dealing with challenging pupils is driving exclusion.

His trust hopes to be able to do something about the latter.

"What we are is saying let us support schools for that top end of children that sometimes you run out of ideas with."
Dave Whitaker will be speaking at The Difference IncludED conference in Sheffield on 9 November, which will explore how schools can be become more inclusive
CV: Dave Whitaker

Educated at Hemsworth High in Hemsworth, West Yorkshire

Read geography and outdoor pursuits at Bedford College of Higher Education

PGCE at Sheffield University.

Teacher at Kingstone School in Barnsley

Headteacher at Springwell School, Barnsley

Executive principal at Springwell Special Academy and Springwell Special Alternative Academy, Barnsley

Director of learning , Wellspring Trust

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How to teach challenging pupils and never exclude them

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"My first teaching practice was in a really challenging secondary school but it was brilliant because of the nature of the kids that were there. "Ex-coal mining town, challenging cohort, kids with massive character. I just loved working with those sorts of kids."

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Visual of the brain and the three functions

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How trauma impacts four different types of memory

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How trauma can affect your window of tolerance,.

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How can you cope with feeling angry?

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A group of children describe what they do when they feel angry and how these strategies help them to calm down. Some of the children are able to describe how their anger feels. A role-play illustrates that there are alternatives to letting anger take over. A 'traffic lights' system can help to think through angry moments.

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How can you cope with feeling angry? - KS2 PSHE and Citizenship - BBC Bitesize

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A group of children describe what they do when they feel angry and how these strategies help them to calm down. Some of the children are able to describe how their anger feels. A role-play illustrates that there are alternatives to letting anger take over.

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A set of graphics by Janae Elisabeth, informed by Dr. Stephen Porges, Deb Dana, Peter Levine, Justin Sunseri, Stanley Rosenberg, Bessel van der Kolk, Pete Walker, Melody Beattie, D.W. Winnicott, Janet Lansbury, and neurodiversity activists.

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A set of graphics by Janae Elisabeth, informed by Dr. Stephen Porges, Deb Dana, Peter Levine, Justin Sunseri, Stanley Rosenberg, Bessel van der Kolk, Pete Walker, Melody Beattie, D.W. Winnicott, Janet Lansbury, and neurodiversity activists.

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Introduction

This evidence summary seeks to address the following questions relating to adverse childhood experiences (ACEs) and interventions within the education system:

1. How may ACEs impact young people's educational experiences?

2. How can schools best support young people with ACEs?

3. What kinds of approaches have been effective in creating the conditions for positive educational outcomes?

About the evidence presented below

We drew on a wide range of evidence, including academic research in the fields of social work, healthcare, psychology, early years and education in relevant databases (e.g. ASSIA, ProQuest Public Health, SCIE Social Care Online, Social Services Abstracts) and recommendations from specialist organisations (e.g. CELCIS, Scottish Adverse Childhood Experiences Hub). We searched the academic databases, Google Scholar, search engines and key websites using a broad range of terms including variations on concepts including adverse childhood experiences, child behaviour, early life adversity, educational attainment, mental health, outcomes, wellbeing, and trauma informed approaches.

There is relatively little robust research into what works to support attainment, wellbeing and other educational outcomes for young people with ACEs. In an evidence summary of the role of health and wellbeing interventions in schools for NHS Health Scotland, White (2017) found a lack of research studies, conducted in the UK and Ireland, examining health and wellbeing interventions in a school setting that report educational outcomes. The research that has been conducted tends to focus on what works under particular circumstances, rather than what will reliably work anywhere ( Dyson et al. 2010). Howarth et al. (2016) go further, suggesting that in relation to psychoeducational interventions, "there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes" and to "explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date".

The focus of this review was to identify evidence around ACEs and trauma-informed approaches to education and how ACEs can impact educational outcomes. Although we were unable to identify many studies that specifically identified ACEs as a reason for poor attainment and other educational outcomes, this may be due to the methodological difficulties associated with controlling for a wide range of variables in this context.

In our evaluation of the evidence we found that papers reporting on the impact of interventions tended not to rigorously establish causality between activities to support young people with ACEs and any positive outcomes identified. In some instances claims were made about the degree of confidence that researchers had in this connection, but overall there is a lack of ability to determine that existing programmes and activities based around ACEs and trauma-informed practice definitely do result in positive educational outcomes. However, we found qualitative studies that discussed positive student and teacher perceptions of interventions and evidence to suggest activities are well-regarded and do have an impact on the perceptions of the overall school environment.

Despite the limitations of the evidence presented below, a better understanding of what impact ACEs may have on children's behaviour, social and emotional development, and physical and mental health can help people working with children in an educational context to address challenges appropriately and lead to more positive educational outcomes, regardless of whether or not individual children can be identified as 'having' ACEs.

Accessing resources

We have provided links to the materials referenced in the summary. Some of these materials are published in academic journals and are only available with a subscription through the The Knowledge Network with a NHSScotland OpenAthens username. The Knowledge Network offers accounts to everyone who helps provide health and social care in Scotland in conjunction with the NHS and Scottish Local Authorities, including many in the third and independent sectors. You can register here.

Background

There has been a recent interest in approaches to education that support young people with Adverse Childhood Experiences (ACEs), including trauma informed and attachment approaches. For example, the Welsh Government has recently announced that training to help children who face early childhood trauma is to be offered to all schools in Wales. Teachers will be taught how to support pupils who have adverse experiences such as family breakdown, bereavement or physical, sexual or substance abuse. Public Health Wales worked with Cymru Well Wales, Barnardo's Cymru and the NSPCC will create the training package. ( BBC News 12 March 2018). Web of Science analytics indicate that between 2010 and 2017, references to adverse childhood experiences have increased tenfold at a steady pace, suggesting a significant growth in discourse around the concept.

Scottish context

Concerns around ACEs have been picked up by policymakers across education and social care in Scotland. The University of Glasgow Adverse Childhood Experiences Research Centre suggests that children who suffer difficult early experiences, such as illness, neurodevelopmental problems, neglect or abuse can develop mental health problems that can burden them throughout their lives, holding them back in social development, family life, education, the workplace, and even their physical health. Similarly, Health Scotland argues that when children are exposed to adverse and stressful experiences, it can have long-lasting impact on their ability to think, interact with others and on their learning. Dodds (2017) provides a set of slides giving the context to the 'ACEs journey' in Scotland so far linking to key policy documents.

There is currently an evidence gap in the Scottish context, with a lack of clarity around the prevalence specifically of ACEs among the general population ( Fabiani 2018) and a lack of evidence about the efficacy of interventions, the relationship between ACEs and poverty, and the social justice implications of applying the ACEs lens to individual and social disadvantage.

Scottish Government: Getting It Right For Every Child (GIRFEC)

A key policy or approach relating to ACEs in Scotland is Getting It Right For Every Child (GIRFEC) ( Scottish Government 2018). It connects ACEs like parental drug and alcohol abuse, parental incarceration, physical or sexual abuse or neglect, to poorer physical and mental health in adulthood, risky health behaviours, violence and homelessness.

The document states that the Scottish Government will "embed a focus on preventing ACEs and supporting the resilience of children and adults in overcoming early life adversity across all areas of public service, including education, health, justice and social work". There is a heavy emphasis on prevention of ACEs and mitigation of their impact. Interventions include:

Measures to reduce parental incarceration by moving to a presumption against short sentences

More support for children and families in the very earliest years, through expansion in Health Visitor numbers and roll-out of Family Nurse Partnerships

The expansion of high quality early learning and childcare, including action to increase take-up of provision for 2 year olds

Investment in projects and services which support parents and families to cope better, keep children safe and prevent children going into care

Providing funding direct to schools to tackle the attainment gap

In this document, the Scottish ACEs Hub directly connects ACEs to the school context and argues that tackling ACEs will support educational attainment through improving the mental health and wellbeing of young people through schools' improved understanding of the behavioural outcomes of early adversity and resulting developments around learning to be a supportive and inclusive environment for learning. It emphasises the importance of understanding child development and how early childhood adversity can impact on biology, relationships and the ability to learn.

This review draws together some evidence around effective school-based interventions that have demonstrable impact on outcomes for children with ACEs.

In this set of videos from the Transforming Children's Services Conference in 2016, several speakers provide their perspectives around and insights and lessons from case studies across Scotland. Speakers include John Swinney, Louise Morpeth, Michael Little, Kenneth Ferguson, Ian Miller and John Fyffe.

The origin of ACEs

The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997. Around 17,000 mostly white, middle class college-educated people in Southern California completed surveys about their childhood experiences and current health status and behaviours, and received physical exams ( Centers for Disease Control and Prevention (CDC) 2016). The findings of this research resulted in the development of the 'ACE Pyramid', which represents the conceptual framework for the ACE Study and the study's findings identify a link between childhood experiences, and adult health and wellbeing outcomes:

Defining ACEs and trauma

According to Corcoran and McNulty (2018), adverse childhood experiences are "traumatic events (e.g., sexual abuse, physical abuse, emotional abuse) or chronic stressors (e.g., neglect, parental separation) that are uncontrollable to the child".

The original ACE questionnaire used the following categories and refer to the respondent's first 18 years of life, which fall under the wider categories of abuse, neglect, and household challenges:

Abuse

Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.

Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.

Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.

Household Challenges

Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother's boyfriend.

Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs.

Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide.

Parental separation or divorce: Your parents were ever separated or divorced.

Criminal household member: A household member went to prison.

Neglect (Collected during Wave 2 only)

Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support (Items were reverse-scored to reflect the framing of the question).

Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it (items were reverse-scored to reflect the framing of the question), you didn't have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.

A distinction is made between stressful life events and adverse childhood experiences. The former is associated with undesirable life events such as parental divorce or illness of a loved one whist the latter to the experience of more severe very traumatic life events, such as being or seeing someone else physically or sexually abused or being caught in a fire, that can be associated with post traumatic stress disorder ( Parkinson 2012).

However, there are some concerns with the categories selected for ACEs criteria, and authors such as Mersky et al. (2017) suggest the need for a more systematic approach to conceptualising and measuring ACEs. Similarly, there is no consensus on the use of terms associated with trauma in childhood, which makes efforts to both implement and study trauma-informed approaches to care challenging ( Maynard et al. 2017). Some researchers have also challenged the validity of retrospective adult reporting of ACEs ( Hardt and Rutter 2004), which is the method the original studies and many others since have been based on.

Impact of ACEs

The original ACE study ( CDC 2016) found the following:

The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course. As the number of ACEs increases so does the risk for the following:

Alcoholism and alcohol abuse

Chronic obstructive pulmonary disease

Depression

Fetal death

Health-related quality of life

Illicit drug use

Ischemic heart disease

Liver disease

Poor work performance

Financial stress

Risk for intimate partner violence

Multiple sexual partners

Sexually transmitted diseases

Smoking

Suicide attempts

Unintended pregnancies

Early initiation of smoking

Early initiation of sexual activity

Adolescent pregnancy

Risk for sexual violence

Poor academic achievement

The theory behind ACEs is that adverse childhood experiences lead to neurobiological impacts and health risks, which in turn lead to long-term social and health problems. The greater the neurobiological impacts and health risks, the more serious the lifelong consequences to health and wellbeing. ( Kahn and Vezzuto 2015)

Impact of trauma on educational outcomes

In a systematic review of the effects of trauma-informed approaches in schools, Maynard et al. (2017) outline existing evidence of the impact of trauma on educational outcomes:

In a systematic review specifically examining school-related outcomes of traumatic event exposure, Perfect and colleagues (2016) identified 44 studies that examined cognitive functioning, 34 that examined academic functioning and 24 that examined social-emotional-behavioural functioning. Their findings suggest that youth who have experienced trauma are at significant risk for impairments across various cognitive functions, including IQ, memory, attention and language/verbal ability; poorer academic performance and school-related behaviours such as discipline, dropout and attendance; and higher rates of behavioural problems and internalizing symptoms.

Other studies suggest that ACEs increase the risk of behaviour and learning problems in children ( Burke et al. 2011; Freeman 2014; Hunt et al. 2017; Iachini et al. 2016), as well as physical and mental health outcomes in later life ( Crouch et al. 2018).

Limitations and concerns

As discussed above, Mersky et al. (2017) and others have expressed concern about the definition of ACEs and the items identified within the ACEs framework. Coyne (2017) argues that the ACE checklist is "a collection of very diverse and ambiguous items that cannot be presumed to necessarily represent traumatic experiences". He also argues that the methods used to research the impact of interventions are limited, suggesting that "claims about the efficacy of trauma-focused treatment are not borne out in actually examining effects observed in randomized controlled trials".

Other researchers have raised the issue that the impact of ACEs is not necessarily the same across all young people. Although some research suggests that the higher the number of ACEs experienced, the worse the life outcomes, some researchers suggest that this data is not reliable due to evidence to suggest, for example, that young BME people are less likely to report mental health problems than young white people ( Garland et al. 2005). Additionally, girls are more likely to demonstrate mental health problems than boys ( Cauffman et al. 2007). Furthermore, there is a lack of clarity around the specific impacts of specific ACE categories on young people. For example, Murray et al. (2012) found that "[t]he most rigorous studies showed that parental incarceration is associated with higher risk for children's antisocial behavior, but not for mental health problems, drug use, or poor educational performance." This indicates a potential need for a better understanding of what challenges young people with different ACEs are more likely to experience in order to effectively design programmes of support in schools.

Evidence

A significant body of research exists causally connecting adverse childhood experiences to poor educational outcomes. For example, Cook et al (2005) suggest:

By early elementary school, maltreated children are more frequently referred for special education services. A history of maltreatment is associated with lower grades and poorer scores on standardized tests and other indices of academic achievement. Maltreated children have three times the dropout rate of the general population. These findings have been demonstrated across a variety of trauma exposures (eg, physical abuse, sexual abuse, neglect, exposure to domestic violence) and cannot be accounted for by the effects of other psychosocial stressors such as poverty.

Recent doctoral research by McDowell (2017) identified that young people who had multiple ACEs were less likely to care about doing well in school and less likely to do all required homework than children who had no ACEs.

However, a significant amount of research fails to demonstrate that ACEs are the cause of negative educational outcomes and therefore are not able to demonstrate that these experiences are not confounders of an underlying causal element such as poverty. The studies presented below demonstrate a causal link between ACEs and impacts including educational outcomes.

Studies measuring the effectiveness of interventions to mitigate against ACEs

The interventions summarised below include trauma-informed, attachment aware and ACE approaches to interventions to support young people in the school environment and with educational attainment.

This study examines the effectiveness of three community-based trauma treatments with 842 child welfare involved children and young people to assess whether participation in treatment predicted positive child outcomes for the different models. Key findings include that trauma treatment was associated with significant improvements in child behaviour problems, post-traumatic stress symptoms, strengths and needs; results differed by treatment model, with optimal outcomes for children receiving Attachment, Self-Regulation and Competency (ARC) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT).

This mixed-methods study looks at the impact of an Attachment Aware Schools Programme run by Bath and NE Somerset Council, Bath Spa University and Kate Cairns Associates between October 2015-July 2016. The training included part-time continuing professional development with sessions at Bath Spa University, e-learning, consultant support for planning and evaluation and completing a practical project. Participants in the training were 25 participants from 16 schools (6 secondary, 7 primary, 1 middle and two special schools), who were mainly teachers, with two teaching assistants and two family support workers (with a social work background). In addition to impacts on the recipients of the training, the study aimed to identify any improvement in children's educational progress, well-being, and attendance (including exclusions).

Using surveys, documentary analysis, data analysis, observation and interviews, the researchers found evidence to suggest that the training had an impact on whole staff understanding of attachment, the meaning behind behaviour and emotional well-being.

The authors report that attainment in the schools for the 'vulnerable students' targeted by the scheme increased in the year since the programme ended. However, only six of the ten schools provided attainment data for these students which means the extent of the impact is unclear. Additionally, it is not clear if the change in attainment can be attributed to this specific programme or if these six schools were also investing in other activities that may have supported student attainment, for example. The authors argue that the general attainment data for all the schools in the programme supports a positive trend in increasing attainment. However, due to changes in measuring attainment across the years included in the data, it is not clear whether the schools have seen an increase in attainment, and if this potential impact is due to the Attachment Aware Schools programme. The authors identify several other Programmes running alongside the Attachment Aware Programme, such as Thrive, Place 2B, ELSA and Mindfulness.

Students and teachers reported positive changes to the school environment, student behaviour and student well-being, which were viewed as interconnected. The pre- and post-intervention surveys of teachers from the six out of 16 returned sets of data indicated reductions in emotional problems, conduct problems, hyperactivity and peer problems. Pro-social behaviour scores increased.

Attendance data indicates a reduction in attendance across 10 of the 16 schools. However, the authors suggest some schools also saw reductions in persistent absences. There is also a lack of a clear picture about attendance of looked after children, and the proportion of unauthorised absences within the attendance data.

Despite the limitations of the methodology and analysis of the data available, this report is an example of the potential impact of attachment informed schools in the UK and connects qualitative evidence from participants to quantitative findings which may provide useful insights.

This evaluation aims to: provide an independent assessment of the outcomes of the Attachment Aware Schools Programme in developing knowledge and understanding of the effects of trauma and neglect on attachment and
learning and attitudes towards practices for vulnerable pupils in schools. Findings indicate that the programme contributed to staff understanding of attachment theory and emotion coaching. As with Dingwall and Sebba's report described above, any improvements in educational outcomes and pupil attendance cannot definitely be attributed to the programme under study. However, the report includes feedback from pupils about their perceptions of the school environment following intervention that may be of relevance.

This evidence synthesis focuses on programmes or intervention with the aim of improving behavioural, mental health or social and educational outcomes for children exposed to domestic violence and abuse. The authors state:

The evidence for clinical effectiveness of the studies included in the review was limited, and where an effect was found there were improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes...

There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.

This article explores the relationship between the extent of childhood adversity, adult health risk behaviors, and principal causes of death in the United States. It provides a selective review of the ACE Study and related social science research to describe how effective social work practice that prevents ACEs and mobilizes resilience and recovery from childhood adversity could support the achievement of national health policy goals.

The authors argue that social work responses to adverse childhood experiences may contribute to improvement in overall health. They outline prevention and intervention response strategies with individuals, families, communities, and the larger society.

Rose, J et al. (2015) Emotion coaching - a strategy for promoting behavioural self-regulation in children/young people in schools: a pilot study. The European Journal of Social and Behavioural Sciences, 13(1), pp.1767-1790(Open Access)

This study explores the effectiveness of using emotion coaching in professional practice within community settings. emotion coaching techniques to promote a more relational and skills-based approach to supporting children's behaviour.

Two year pilot used mixed methods. Participating institutions included 1 secondary, 4 primary schools, 4 children's centres and 1 youth centre for Part 1 of the pilot (year 1) and 1 secondary school and 5 primary schools for Part 2 of the pilot (year 2).

Participants included senior and junior teaching staff, teaching assistants, school support staff, Children's Service staff including health and social care services, early years practitioners, youth workers and youth mentors, and some parents. Participants were trained in emotion coaching techniques (the training phase) and supported via four network/booster meetings (the action research phase) to adopt, adapt and sustain emotion coaching into their practice over a period of one year for each setting pre- and post-impact psychometric questionnaires with all participants, exit questionnaires with all participants, pre- and post- training behaviour indices and oral recordings of the network/booster meetings and focus group discussions.

Findings focus on the emotion coaching in schools and report changes in behavioural and socialisation practices. Quantitative analysis identifies a reduction in the number of call-outs (incidents where children are called out of the classroom), exclusions (external exclusion from school), and consequences (sanction applied), and an increase in rewards for pro-social behaviour. Results indicate a positive impact on professional practice, adult self-regulation and improvements in children/young people's self-regulation and behaviour. The authors suggest that emotion coaching promotes children's self-awareness of their emotions, positive self-regulation of their behaviour and generates nurturing relationships. However, the paper does not indicate that children's perspectives were included in analysis and findings are therefore limited to teachers' self-reporting of their behaviour before and after the training. It is also not clear if the training was the causal factor for the improved quantitative outcome measures.

This report summarizes the final findings of an evaluation of community-based initiatives in Washington State that were intended to prevent child maltreatment and exposure to toxic stress, mitigate their effects, and improve several child and youth development outcomes.

The study focused on outcomes identified by the initiatives that were believed to be successful, and sought to validate sites' perceptions of effectiveness by examining changes in related outcomes with rigorous evaluation methods.

The study found that 6 (of the 11) evaluated activities were associated with positive and statistically significant changes in targeted outcomes. The remaining five activities either had inconsistent findings or had limited or no outcomes data available. Where positive changes were identified, these related to the following outcomes:

Resolving barriers to regular school attendance

Reduction of in-school suspension

Increase of school rewards for pro-social involvement

Decrease in student reporting of low commitment to school

Improvements in reading proficiency in some year groups

Reducing teenage drinking

Reduction in "negative maternal behaviors"

Examples and recommended practice

This section focuses on examples of trauma, attachment and ACEs informed approaches to education and documents that make good practice recommendations.

The quality of school attended is important for young people's health and wellbeing, and schools play a critical role in the development of children and young people's social networks and their experiences of social relationships ( Dodds 2016). Research indicates that the school setting can offer protection against adversities ( McPherson 2013 in Dodds 2016).

The six key principles of a trauma-informed approach include safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues ( SAMHSA, 2014 in Maynard et al. 2017). Maynard et al. (2017) emphasise that A trauma-informed approach "can include trauma-specific interventions, but trauma-specific interventions alone are not seen as sufficient for achieving optimal outcomes or to influence service systems".

The ACEs lens can be applied in different ways, including primary prevention and through 'ACE-aware/informed' services. In the context of this review, educational interventions are conceptualised as secondary interventions rather than primary prevention.

Depending on the severity of ACEs they could be conceptualised as traumatic. We have therefore also provided resources relevant to trauma-informed education.

This website has a list of resources including videos and journal articles that may have useful information.

The attachment aware approach is based on the idea that "[e]ducators must establish attachment-like relationships with their students, particularly with challenging and vulnerable children and young people, in order to improve their chances of learning and achieving." The Bath Spa website provides information about how the approach has been used in schools, including its use by teachers dealing with behavioural, academic and truancy issues, case reports.

Key research findings from the project include:

Nurturing adult attachments provide children with protective, safe havens and secure bases from which to explore and engage with others and their environment (Bowlby 1988)

Early care-giving has a long-lasting impact on development, the ability to learn, capacity to regulate emotions and form satisfying relationships (Siegel 2012)

Attachment is crucial to children's psychological welfare and forms the basis of personality development and socialisation (Bowlby 1988)

Teachers, youth workers and significant adults in a child's life can provide important attachments for children (Bergin and Bergin 2009, Riley 2010)

The National Institute for Health and Care Excellence (NICE) 2015 guidelines on children's attachment indicate the importance of attachment issues in schools.

Potentially relevant videos about attachment aware schools include:
Why do we need attachment aware schools? How do we create an attachment aware school? Making a difference through everyday practice
This non-statutory advice clarifies the responsibility of the school, outlines what they can do and how to support a child or young person whose behaviour - whether it is disruptive, withdrawn, anxious, depressed or otherwise - may be related to an unmet mental health need. It includes recommendations for practice including positive classroom management and small group work, social skills development, peer mentoring and support from external bodies.

Forster, M et al. (2017) Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents. Addictive Behaviors, 68(1), pp.30-34 (Available with NHS Scotland OpenAthens username or author copy)

This study explores whether student-teacher relationships can help prevent the use of nonmedical use of prescription medication by young people with ACEs. Using a survey of 104,332 8th, 9th and 11th grade students in Minnesota in 2013, the research suggests that cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives. However, this is not based on a causal relationship between student-teacher relationships and drug (non)use. Although there is evidence to suggest that caring bonds with adults support healthy development, the authors acknowledge that there is "scant research investigating whether positive, caring student-teacher relationships have compensatory effects for youth raised in dysfunctional familial environments".

This book offers an introduction to therapies produced as a result of the popularity of attachment studies. These therapies can be divided into two categories: those that are 'attachment-based', in that they use evidence-based attachment assessments in their development, or 'attachment-informed', in that the theories of attachment have been integrated into the practice of existing schools of therapy. The book reviews the field and provides a range of interventions for children, adults and parents.

This presentation provides a clear overview of the types of childhood trauma and the background theory to the recommendations around how educators can create a trauma-informed school with a multi-tiered system of support services.

This background and plan for a systematic review into the impact of trauma-informed approaches in schools includes several excerpts that may be of relevance, including:

A trauma-informed approach in schools is designed to create a systematic model for schools to decrease the impact of trauma on students (Wiest-Stevenson & Lee, 2016) and more appropriately address academic, behavioral and socio-emotional problems by recognizing and responding to student behavior from a trauma-informed perspective. This is done through a multi-level approach intended to improve the school environment through implementing trauma-informed policies and procedures; increase the ability of school staff to recognize and more effectively respond to students through professional development; and prevent, mitigate and reduce trauma-associated symptoms through evidence-informed practices, leading to improved student academic, behavioral, and socio-emotional outcomes.

While schools may be implementing trauma-informed approaches, it is unclear to what extent or how much variation there is in what schools are implementing, how much emphasis they are putting on various components (e.g., workforce development versus organizational change versus practice changes) and whether schools may implement trauma-informed approaches differently based on the characteristics of their students, neighbourhood, country or other contextual factors.

The results of this systematic review have not yet been published, but will be shared on the Campbell Collaboration webpage for the study when they are available.

A limitation of the systematic review is that it does not intend to include qualitative research, which means that impact that cannot be recorded using quantitative measures will not be captured.

This study of 29 students in seventh and eighth grade in the US examined the impact of the RAP Club, sessions led by teachers that incorporate psychoeducation, cognitive behavioral (CBT), and mindfulness strategies to focus on several areas:

Identifying stress

Awareness of emotional states

Using a mindful approach

Communication skills

Problem solving skills

Distress tolerance skills

The research found that the trauma-informed group activity improved teacher-rated emotion regulation, social and academic competence, classroom behavior, and discipline, but that student self-report outcomes did not differ between students who attended the sessions and the control group.

Methodological limitations of this pilot study include small sample size, a volunteer sample, limitations to the randomization process, and no long-term follow-ups. The teachers who rated the children's changed behaviour were also aware of the intervention taking place (but had limited knowledge of what the programme entailed).

This guideline covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.

Recommendations include:

Schools and other education providers should ensure that all staff who may come into contact with children and young people with attachment difficulties receive appropriate training on attachment difficulties

Health and social care provider organisations should train key workers, social care workers, personal advisers and post-adoption support social workers in the care system, as well as workers involved with children and young people on the edge of care, in:

Recognising and assessing attachment difficulties and parenting quality, including parental sensitivity

Recognising and assessing multiple socioeconomic factors (for example, low income, single or teenage parents) that together are associated with an increased risk of attachment difficulties

Recognising and assessing other difficulties, including coexisting mental health problems and the consequences of maltreatment, including trauma

Knowing when and how to refer for evidence-based interventions for attachment difficulties

The guidelines also provide recommendations for attachment-focused interventions and effective methodologies for designing and evaluating the impact of these interventions. Specific recommendations are provided for designing and evaluating interventions in a school setting.

This website discusses the role of schools and strategies for trauma-informed care in schools. It provides examples, including UCSF Healthy Environments and Response to Trauma in Schools (HEARTS) project, which recommends the following strategies for teachers:

1. Recognize that a child is going into survival mode and respond in a kind, compassionate way. When you notice that a child might be having a difficult time, start by asking yourself, "What's happening here?" rather than "What's wrong with this child?" This simple mental switch can help you realize that the student has been triggered into a fear response, which can take many forms.

2. Create calm, predictable transitions. Transitions between activities can easily trigger a student into survival mode. Some teachers will play music, ring a meditation bell or blow a harmonica to signal it's time to transition. The important thing is to build a routine around transitions so that children know: a) what the transition is going to look like, b) what they're supposed to be doing, and c) what's next.

3. Praise publicly and criticize privately. For children who have experienced complex trauma, getting in trouble can sometimes mean either they or a parent will get hit. And for others, "I made a mistake" can mean "I'm entirely unlovable." Hence, teachers need to be particularly sensitive when reprimanding these students.

4. Adapt your classroom's mindfulness practice. Mindfulness is a fabulous tool for counteracting the impact of trauma. However, it can also be threatening for children who have experienced trauma, as the practice may bring up scary and painful emotions and body sensations.

This 1-hour webinar produced by NYSUT looks at the latest research on trauma among school children, exploring trauma's prevalence and impact on childrens' behavior, relationships, and learning. Elements of a trauma sensitive school approach are offered along with resources for implementation.

Findings in this report aim to inform the potential benefits to mental health in Wales of developing resilience both in children and adults to mitigate at least some of the detrimental impacts of experiencing ACEs. It includes recommendations of actions that can be taken to support young people to develop resilience.

This short report provides a potentially useful and clear outline defining trauma, identifying the potential impact of trauma and considering the benefits of multilayered systems of support (MTSS). The authors emphasise the potential benefits of an MTSS approach for all students:

Schools have an opportunity to provide a range of supports to students who experience stress or trauma through an MTSS approach. More specifically, these approaches can help all students feel safe, supported, and connected, including those with undisclosed trauma histories.

This paper has been produced to inform thinking about the impact of adverse childhood experiences and how to use the Pupil Equity Funding to reduce the attainment gap. It highlights key factors that play a role in children achieving their potential.

Steele, H and Steele, M (2018) Handbook of attachment-based interventions. London: Guilford Press

This book examines science-based interventions that have been effective in promoting attachment security. Focuses on strengthening caregiving relationships in early childhood and working with children and parents who have been exposed to trauma and other adverse experiences. Includes interventions for school-age children, at-risk adolescents and couples, with an emphasis on father involvement in parenting. Describes the approaches and how they are informed by attachment theory and research, how sessions are structured and conducted, special techniques used, the empirical evidence base for the approach, and training requirements. Includes illustrative case material. (Summary from NSPCC)

The Trauma and Learning Policy Initiative argues that trauma-sensitive schools help children feel safe to learn. They define the core attributes of a trauma sensitive school to include:

A shared understanding among all staff

The school supports all children to feel safe physically, socially, emotionally, and academically

The school addresses students needs in holistic ways, taking into account their relationships, self-regulation, academic competence, and physical and emotional well-being

The school explicitly connects students to the school community and provides multiple opportunities to practice newly developing skills

The school embraces teamwork and staff share responsibility for all students

Leadership and staff anticipate and adapt to the ever-changing needs of students

The website provides several reports, research outputs and other potentially relevant resources.

This evidence briefing conducted for NHS Health Scotland and Education Scotland examines the effectiveness of health and wellbeing interventions in a school setting to potentially reduce inequalities in educational outcomes.

Several potentially effective types of intervention are identified and the methods of delivery that have been found to work well are highlighted. Key findings include:

Programmes that fit the needs and context of the class or school and are easy to carry out are more likely to be implemented well

The quality of implementation of social and emotional learning programmes was important for positive outcomes

International review-level evidence suggests that universal social and emotional learning programmes can have positive impacts on wellbeing and educational outcomes. However, findings from studies conducted in the UK and Ireland were mixed.

Offering healthy, nutritious lunches at school tended to have beneficial effects on educational outcomes.

There was inconsistent evidence that breakfast clubs, where children were provided with a nutritious breakfast at school, have an impact on educational outcomes.

A number of studies reported beneficial effects such as lower anxiety levels and improved concentration which have been linked to positive learning-related behaviours

However, a limitation of the studies included in the review is that there is a lack of evidence around the effect of interventions on children and young people from different socio-economic or ethnic backgrounds. There is also a general lack of longitudinal research so it is not clear if the effectiveness of the interventions is long-lasting.

References

Bartlett, JD et al. (2018) The impact of a statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma. Children and Youth Services Review, 84(1), pp.110-117 (Open Access)

Bath Spa University (no date) Attachment aware schools project (website)

Burke, N et al. (2011) The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), pp.408-413 (paywalled and author manuscript)

Cauffman, E et al. (2007) Gender differences in mental health symptoms among delinquent and community youths. Youth Violence and Juvenile Justice, 5(3) , pp.287-307 (paywalled)

Centers for Disease Control and Prevention (2016) About the CDC-Kaiser ACE Study (website)

Corcoran, M and McNulty, M (2018) Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective wellbeing. Child Abuse & Neglect, 76(1), pp.297-309 (paywalled)

Crouch, E et al. (2018) Examining exposure to adverse childhood experiences and later outcomes of poor physical and mental health among South Carolina adults. Children and Youth Services Review, 84, pp.193-197 (Open Access)

Dartington Social Research Unit (2016) Transforming Children's Services Conference (set of YouTube videos)

Department for Education (2016) Mental health and behaviour in schools

Departmental advice for school staff (pdf)

Department for Education (2015) Promoting the health and well-being of looked-after children: statutory guidance for local authorities, clinical commissioning groups and NHS England (pdf)

Dingwall, N and Sebba, J (2018) Evaluation of the attachment aware schools programme: final report. Rees Centre, University of Oxford (pdf)

Dodds, S (2016) Health and early years, children and young people: a GCPH synthesis (pdf)

Dyson, A (2010) Narrowing the gap in educational achievement and improving emotional resilience for children and young people with additional needs. Centre for Excellence and Outcomes in Children and Young People's Services (C4EO) (pdf)

Fancourt, N and Sebba, J (2018) The Leicestershire virtual school's Attachment Aware Schools Programme: evaluation report (pdf)

Forster, M et al. (2017) Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents. Addictive Behaviors, 68(1), pp.30-34 (paywalled or author copy)

Freeman, PC (2014) Prevalence and relationship between adverse childhood experiences and child behavior among young children. Infant Mental Health Journal 35(6), pp. 544-554 (Open Access)

Garland, A et al. (2005) Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), pp.1336-1343 (author manuscript).

Hardt, J and Rutter, M (2004) Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. The Journal of Child Psychology and Psychiatry, 45(2), pp.260-273 (paywalled)

Holmes, P and Farnfield, S (2014) The Routledge handbook of attachment: implications and interventions (ebook available through NHS Scotland)

Howarth, E et al. (2016) IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis. Public Health Research, 4(10) (Open Access)

Hunt, T et al. (2017) Adverse childhood experiences and behavioral problems in middle childhood. Child Abuse & Neglect, 67(1), pp.391-40 (paywalled)

Iachini, A et al. (2016) Examining adverse childhood experiences among students repeating the ninth grade: Implications for school dropout prevention. Children & Schools, 38(4), pp. 218-226 (paywalled)

Kahn, P and Vezzuto, L (2015) Understanding and responding to Adverse Childhood Experiences in the school setting. Orange County Department of Education, Center for Healthy Kids & Schools (pdf)

Kalmakis, K and Chandler, G (2015) Health consequences of adverse childhood experiences: a systematic review. Journal Of The American Association Of Nurse Practitioners, 27(8) pp.457-465 (Open Access)

Larkin, H et al. (2014) Social work and adverse childhood experiences research: implications for practice and health policy. Journal of Prevention & Intervention in the Community, 40(4), pp.263-70 (author manuscript)

Larkin, H et al. (2012) Mobilizing resilience and recovery in response to Adverse Childhood Experiences (ACE): a restorative integral support (RIS) case study. Journal Of Prevention & Intervention in the Community, 40(4) pp.335-346 (paywalled)

Maynard, BR et al. (2017) Effects of trauma-informed approaches in schools. Campbell Collaboration review (pdf)

McDowell, N (2017) The association between adverse childhood experiences and educational outcomes among children ages 6-17. Thesis, Georgia State University (pdf)

McPherson K et al. (2013) The role and impact of social capital on the health and wellbeing of children and adolescents: a systematic review. Glasgow Centre for Population Health (pdf)

Mendelson, T et al. (2015) Brief report: Moving prevention into schools: The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43(1) pp.142-147 (paywalled)

Mersky, J et al (2017) Rethinking the measurement of adversity: moving toward second-generation research on Adverse Childhood Experiences. Child Maltreatment, 22(1), pp.58-68 (paywalled)

Murphy, A, Steele, H, Bate, J, Nikitiades, A, Allman, B, Bonuck, K, Meissner, P, & Steele, M (2015) Group attachment-based intervention: Trauma-informed care for families with adverse childhood experiences. Family & Community Health: The Journal Of Health Promotion & Maintenance, 38(3), pp.268-279 (paywalled)

Murray, J et al. (2012) Children's antisocial behavior, mental health, drug use, and educational performance after parental incarceration: A systematic review and meta-analysis. Psychological Bulletin, 138(2), pp.175-210 (Open Access)

National Institute for Health and Care Excellence (2015) Children's attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care. NICE Guideline 26 (pdf)

Nead, K (2016) Adverse Childhood Experiences (ACEs) and Trauma-Informed Care (TIC): critical insights for navigating school health. Thriving Schools (website)

NYSUT and Co-Ordinated Care Services Inc. (2015) Webinar: Trauma Sensitive Schools: transformational school climate change (YouTube video)

Parkinson, J (2012) Establishing a core set of national, sustainable mental health indicators for children and young people in Scotland: final report. NHS Health Scotland (pdf)

Public Health Wales (2018) Sources of resilience and their moderating relationships with harms from adverse childhood experiences. Report 1: mental illness (pdf)

Rose, J et al. (2015) Emotion coaching - a strategy for promoting behavioural self-regulation in children/young people in schools: a pilot study. The European Journal of Social and Behavioural Sciences, 13(1) pp.1767-1790(Open Access)

Rossen, E and Cowan, KC (2013) The role of schools in supporting traumatized students. Principal's Research Review, 8(6), pp.1-7 (pdf)

Scottish Adverse Childhood Experiences Hub (2017) Tackling the attainment gap by preventing and responding to Adverse Childhood Experiences (ACEs) (pdf)

Scottish Government (2018) Getting it right for every child (GIRFEC) (website)

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Trauma and Learning Policy Initiative (no date) Trauma sensitive schools (website)

Verbitsky-Savitz, N (2016) Preventing and mitigating the effects of ACEs by building community capacity and resilience: APPI cross-site evaluation findings. Mathematica Policy Research (pdf)

White, J (2017) Evidence summary: reducing the attainment gap - the role of health and wellbeing interventions in schools. Edinburgh: NHS Health Scotland (pdf)

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This evidence summary seeks to address the following questions relating to adverse childhood experiences (ACEs) and interventions within the education system: How may ACEs impact young people's educational experiences? How can schools best support young people with ACEs? What kinds of approaches have been effective in creating the conditions for positive educational outcomes?

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As a child, Raven Kaliana was trafficked by her own parents. She survived and now works as a puppeteer.

Raven wants to show people, through her art, that healing is possible. Her latest show is called Love vs Trauma.
Filmed and edited by Britt Yip; Produced by Vibeke Venema

# data[].attributes.attachment_link.description
As a child, Raven Kaliana was trafficked by her own parents. She survived and now works as a puppeteer. Raven wants to show people, through her art, that healing is possible. Her latest show is called Love vs Trauma. Filmed and edited by Britt Yip; Produced by Vibeke Venema

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Attachment theory was created in the mid-20th century by the British psychologist John Bowlby.

Bowlby drew his evidence from his clinical psychiatric work with children who had been evacuated from the cities during the Second World War.

Many of his claims have since been challenged, particularly that the mother is the only source of security in the first three years, and that recovery from poor maternal attachment in infanthood is unlikely.
Quick read: Quick listen: Want to know more? How attachment theory helps behaviour Why attachment-aware teaching matters for every child EYFS: Why 'you're OK' is the worst thing to say to an upset child
However, his concept of the internal working model (IWM) remains at the heart of modern attachment theory.

The IWM concept describes a process whereby children, through their early relationships, construct an IWM of what to expect from other people, and of their own level of "lovability".

In summary, stable and loving relationships create an IWM that says "other people are nice and I am lovable", whereas troubled and fragmented relationships create an "other people are unkind and I am not lovable" IWM.

Attachment theory: the cortisol question

Recent neurological research has added to this paradigm with the finding that young children placed under stress exhibit cortisol dysfunction. In healthy physiology, cortisol has a regular cycle, rising to a peak as the person awakens from sleep.

It falls steadily throughout the day, reaching its lowest point prior to the onset of sleep; it then rises steadily in the later stages of sleep, and peaks at the point of waking.

Cortisol levels, additionally, rise in response to external stressors. This is commonly described as "fight or flight" response, which is managed by the body's hypothalamic-pituitary-adrenal (HPA) system. Levels of cortisol return to baseline when the situation is resolved.

Over the first two decades of this century, a variety of studies have been undertaken to research stress caused to children in combinations of daycare and family home-based care, finding a complex set of evidence.

The studies indicate that when children experience ongoing stress due to early insecure relationships with adults that destabilise their emotional equilibrium, this sets in motion a problem with stress management that may eventually become toxic to that individual.

Such toxicity then impacts on emotional functioning and cognitive functioning as well, particularly with respect to memory.

Executive function

Raised cortisol has been empirically linked to poorer executive functioning across three cognitive domains: inhibitory self-control, flexibility and emergent metacognition (the ability to reflect on one's own thoughts, as seen in this 2016 study).

Researchers have found that executive functioning develops from birth, and underpins a growing ability to focus attention, control one's own actions, resist distractions and engage in goal-directed activity, and that working memory is a component of this process.

Executive functioning has also been linked to the development of cognitive skills that promote academic ability ( Espy 2004) and mitigate against aggressive behaviour ( Ellis, Weiss, & Lochman 2009).

The strongest implication of the current evidence is the requirement for human societies to provide secure, nurturing environments for infants (if the society in question wishes to increase psychological health and economic productivity in future generations).

But in a society in which approximately a third of all children live in families experiencing the huge stresses of poverty, what use is the information above to school teachers?
Dr Pam Jarvis is an honorary research fellow at Leeds Trinity University
Attachment theory in the classroom

Here are four key points:

When considering why children may not be progressing as expected, consider emotional issues alongside cognitive, as research now overwhelmingly indicates that these are intricately intertwined.

Don't immediately assume that where children live in socioeconomically deprived environments, the only issue to consider when it comes to lack of progress is related to what Ofsted (controversially) describes as lack of cultural capital.

Contrary to the beliefs of early attachment theorists, the IWM remains open to change throughout life where emotionally supportive relationships are encountered. For example, Shonkoff et al (2015) found that supportive adult-child relationships outside the immediate family circle could blunt the impact of insecure family relationships and strengthen emotional resilience at any point in childhood. It is quite possible for such relationships to be built in professional children's services environments.

Before deciding upon an intervention strategy for a child of any age (or even an adult) consider what impact relevant options may have upon a person whose current emotional setting communicates to them that they lack lovability and that other people don't care about them.

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4 things teachers need to know about attachment theory

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Attachment theory was created in the mid-20th century by the British psychologist John Bowlby. Bowlby drew his evidence from his clinical psychiatric work with children who had been evacuated from the cities during the Second World War.

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Navigate: emotional support for parents | Disability charity Scope UK

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Navigate, Scope's online emotional support service for parents of disabled children around diagnosis.

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Center on the Developing Child at Harvard University

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New scientific research shows that environmental influences can actually affect whether and how genes are expressed. In fact, scientists have discovered that early experiences can determine how genes are turned on and off and even whether some are expressed at all. Thus, the old ideas that genes are "set in stone" or that they alone determine development have been disproven. Nature vs. Nurture is no longer a debate-it's nearly always both!

More Information on Epigenetics

Deep Dive: Gene-Environment Interaction
Learn more about the physical and chemical processes that take place as part of the creation of the epigenome.

Working Paper 10: Early Experiences Can Alter Gene Expression and Affect Long-Term Development
This in-depth working paper explains how genes and the environment interact, and gives recommendations for ways that caregivers and policymakers can effectively respond to the science.

During development, the DNA that makes up our genes accumulates chemical marks that determine how much or little of the genes is expressed. This collection of chemical marks is known as the " epigenome." The different experiences children have rearrange those chemical marks. This explains why genetically identical twins can exhibit different behaviors, skills, health, and achievement.

Correcting Popular Misrepresentations of Science

Until recently, the influences of genes were thought to be set, and the effects of children's experiences and environments on brain architecture and long-term physical and mental health outcomes remained a mystery. That lack of understanding led to several misleading conclusions about the degree to which negative and positive environmental factors and experiences can affect the developing fetus and young child. The following misconceptions are particularly important to set straight.

Contrary to popular belief, the genes inherited from one's parents do not set a child's future development in stone.
Variations in DNA sequences between individuals certainly influence the way in which genes are expressed and how the proteins encoded by those genes will function. But that is only part of the story-theenvironment in which one develops, before and soon after birth, provides powerful experiences that chemically modify certain genes which, in turn, define how much and when they are expressed. Thus, while genetic factors exert potent influences, environmental factors have the ability to alter the genes that were inherited.

Although frequently misunderstood, adverse fetal and early childhood experiences can-and do-lead to physical and chemical changes in the brain that can last a lifetime.
Injurious experiences, such as malnutrition, exposure to chemical toxins or drugs, and toxic stress before birth or in early childhood are not "forgotten," but rather are built into the architecture of the developing brain through the epigenome. The "biological memories" associated with these epigenetic changes can affect multiple organ systems and increase the risk not only for poor physical and mental health outcomes but also for impairments in future learning capacity and behavior.

Despite some marketing claims to the contrary, the ability of so-called enrichment programs to enhance otherwise healthy brain development is not known.
While parents and policymakers might hope that playing Mozart recordings to newborns will produce epigenetic changes that enhance cognitive development, there is absolutely no scientific evidence that such exposure will shape the epigenome or enhance brain function. What research has shown is that specific epigenetic modifications do occur in brain cells as cognitive skills like learning and memory develop, and that repeated activation of brain circuits dedicated to learning and memory through interaction with the environment, such as reciprocal "serve and return" interaction with adults, facilitates these positive epigenetic modifications. We also know that sound maternal and fetal nutrition, combined with positive social-emotional support of children through their family and community environments, will reduce the likelihood of negative epigenetic modifications that increase the risk of later physical and mental health impairments.

The epigenome can be affected by positive experiences, such as supportive relationships and opportunities for learning, or negative influences, such as environmental toxins or stressful life circumstances, which leave a unique epigenetic "signature" on the genes. These signatures can be temporary or permanent and both types affect how easily the genes are switched on or off. Recent research demonstrates that there may be ways to reverse certain negative changes and restore healthy functioning, but that takes a lot more effort, may not be successful at changing all aspects of the signatures, and is costly. Thus, the very best strategy is to support responsive relationships and reduce stress to build strong brains from the beginning, helping children grow up to be healthy, productive members of society.

For more information: Early Experiences Can Alter Gene Expression and Affect Long-Term Development: Working Paper No. 10.

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What is Epigenetics? The Answer to the Nature vs. Nurture Debate

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Scientific research shows that experiences can affect whether and how genes are expressed. Nature vs. Nurture is no longer a debate-it's nearly always both!

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Toxic Schools Worsening Toxic Stress: This post is the first chapter of a book. The names HAVE NOT been changed, as each individual profoundly impacted the author's growth and development. She wants their identities to remain intact. The Destructive Reign of Standardized Education, Pathology, Medication, and Behaviorism in Schools
I did not realize that my first years in public education would profoundly shape my trauma-informed journey and what I would do nearly twenty years later.

But I clearly remember the late fall of 2001.

Shannon was gentle, warm, consistent and knowledgeable and the social-emotional ambassador of the school. As a tall, lean woman, she moved effortlessly between consulting about a problem with a teacher to bending low at the knees to meet the height of a distressed child. She softened and lowered her voice to a whisper while extending her palm for the child to grasp as they made their way to her office.

Shannon made a warm and safe space in her office for calming but she also recognized that not every distressed child could instantly settle. Shannon guided escalated children to the gym for a chance to run. If sunny weather prevailed they might exit the building to briefly walk the school grounds. After an experience of dysregulation, she'd often invite a child to a game of PIG on the basketball court.

Shannon got it.

Just these three things; crafting and cultivating warm and calming space, playing and moving with children, building relationships of safety through unconditional positive regard with a gentle touch or softened voice are foundational practices of being trauma-informed. These early experiences with Shannon served as the bedrock for what would later be defined as trauma-responsive practice.

I had the privilege of being assigned to Shannon because she was beloved by our professor, Honey Vickers. Dr. Vickers felt confident I would learn a lot from Shannon - which is why she approached me near the end of the fall semester to inquire about my interest in applying for an unexpected school counselor vacancy.

The legendary veteran in the job, Ellen Scarpitti, was abruptly retiring mid-year.

I eagerly replied, "yes!"

Ellen Scarpitti was a pioneer of sorts at Drew-Pyle Intermediate School (grades 4-6) in Wilmington, DE. She was well connected and her office reflected her scattered and far-flung resources. Wiggling through her filing cabinets, stacks of books and piles of curriculum tool kits, she shuffled through a cramped front office and lead me to vacant chair in the back. The stark contrast to Shannon's calming office ignited an inner state of disarray.

Ellen spoke much like her office looked - in tangents and half-thoughts. She rambled a million words a minute in crescendoing volume. She burst with a fiery compulsion to recount every student need, every teacher request, every parent struggle.

I could not absorb nor record her asides fast enough. Just sitting there among the clutter and darkness, I felt my insides swell with a growth of urgency. There was no time for me to ease into this position. I needed to burst onto the scene in mid-sprint. I needed to hit the ground and grab everything in her wake.

Scarpitti functioned far more as a social worker than a school counselor. She spent her days tirelessly connecting children and families to resources. I did not realize that I too would function as she did - haphazardly attempting to plug the cracks of a broken system.

Naiveté, idealism, and white privilege kept me from seeing that I too would soon be drowning in a sea of grave unmet human needs and overdeveloped mammalian survival instincts.

Drew-Pyle sat in the heart of one of the toughest neighborhoods in the city of Wilmington, DE. High volumes of drug trafficking, gun violence, unemployed kids "packing heat" roamed the streets. Simply put, the school dangled at the edge of managed chaos. But I was determined to bring a sense of calm and peace to the school.
I began with my off ice space.

But despite my best effort to replicate what Shannon showed me, the overwhelm loomed large.

My first days at Drew Pyle were fraught with frantic teacher calls about aggressive behavior, referrals from the school nurse regarding chronic somatic complaints, daily consultations with the assistant and building principal about new strategies for disciplining "repeat offenders." These kids were "out of control" and I was operating with a set of misguided assumptions.

It was also the early days of "No Child Left Behind" legislative implementation and the administration was grappling with how to increase academic performance amidst the conditions it faced. I struggled to devise and implement a comprehensive school counseling program in order to support high academic performance. Moreover, I was desperate to proactively respond to the never-ending barrage of requests for more student support. I tried to hold space to replicate what I witnessed Shannon do with such ease.

Attempting to follow in Shannon's footsteps, I provided weekly group counseling sessions in anger management and social skills. I taught bi-weekly classroom guidance lessons in Second Step (a curriculum for teaching empathy) and character education. I revamped and led the student assistance referral team process, collecting pre and post data on intervention plans.

But it didn't seem to be working. It wasn't getting better. In fact, the demand for my support was growing which made the problems feel like they were worsening. I was desperate for more solutions than what I had learned or tried in graduate school.
He cannot initiate a task and sustain focus.
This kid has got to have ADD or ADHD. He cannot control his impulses.
He struggles with building and sustaining peer relationships.
"What IS WRONG with this kid?"
Although I could not formally diagnose or label children, I did, in my mind and in my consultation with adults. I bordered on colluding with others about our pathological suspicions. We would commiserate:

I circulated more forms of the Connor's Scale (a widely used screening tool for ADHD/ADD) than I could count. I referred countless children to their primary care provider. Truthfully, I was also hoping they'd prescribe medication.

And the docs delivered on that hope. They prescribed tons and tons of medication.

I never felt good about medication but I was desperate to help teachers better manage their classrooms and to help kids gain more self-control.

Mr. Klatzkin, the building principal, was a traditionalist. He arrived at 6:00am each morning for quiet time before most staff and ahead of student arrival. Upon the approach of the first bus, Klatzkin stood at the entrance and greeted every student by name. I would stand with him.

"Good morning!"

"Have a great day!"

These were common salutations I offered the children. I didn't greet them by name.
Klatzkin knew.

"Emily, you must learn of their names." I shuddered under his expectation - there were 650 of them; one of me.

Years later in a training with Eric Mann, a well known educational consultant and expert in NH, Mann would reiterate this early lesson in the importance of "seeing kids."

Mann implored, "you may not realize it, but one of the most profound things you can do for kids that aren't 'seen' at home is to 'see them' at school. Every morning, greet each student by name, look them in the eyes and genuinely express your joy to have them with you at school."

Klatzkin did just this. He built initial rapport with students through his earnest effort to know every student by name.

I recall many of the teachers complained that Klatzkin wasn't "harsh" enough. Several teachers lamented that students mis-behaved because they were "allowed" to get away with bad behavior. But Klatzkin was a traditionalist and he daily suspended students for all kinds of misbehavior.

Disrespect. Cursing. Fighting.

Klatzkin would win over a few "repeat offenders" and that relationship would result in improved behavior. But I wanted to find another way to address the behavioral issues preventatively; that was my training.
Less than a mile from me, my husband was working in a similar school environment as a school psychologist. He was in his second year and experiencing modest success with decreasing suspension rates and discipline referrals through PBIS - Positive Behavior Support and Interventions.

He had been guiding his school in the promise of a "new day" in public education - PBIS and MTSS (Multi-Tiered Systems of Support). We both trained with nearly the same faculty in the School of Education at the University of Delaware. Delaware had a premier school psychology program - considered one of the best in the nation. The faculty widely publish and comprise some of the best known thought leaders in the field.

We attended graduate school during the explosion of diagnoses in autism spectrum disorders, ADHD/ADD, and anxiety. Behavioral approaches to addressing challenging classrooms was gaining credibility and momentum. Our training required the use of "evidence-based" interventions long before that was considered best practice.

The University of Delaware had an on-site fertile training ground known as The College School. It was a school designated for children that experience mild to moderate disabilities. They were piloting what would later be considered "evidence-based" behavioral interventions. These classroom-wide interventions constituted the infancy stage of Positive Behavioral Interventions and Supports (PBIS).

The prevailing assumption underlying PBIS was that students "mis-behaved" because they lacked the motivation to behave properly and they were "un-informed" about what proper behavior "looked like." If explicitly taught to behave, they would.

I heard often, "these kids don't know how to act!" "Them mommas ain't got no sense."

First assumption, these children mis-behaved because no one modeled "good behavior." Second assumption, children learn to behave if provided direct instruction in proper behavior.

The goal of PBIS was to set clearly stated and definable behavioral expectations in observable terms. When children behaved in accordance with the expectations, they were reinforced with extrinsic rewards - tickets and tokens. The underlying premise is the belief that behavior can be explicitly taught like other core subject matter.

There was no acknowledgement about the role of the mammalian self in this set of guiding assumptions. All behavior was viewed as a reflection of "conscious choice" and served a specific purpose or function. The plausible functions were defined as avoiding a task, seeking to gain attention (often negative attention), or to gain something desired.

Surviving did not make the list of possibilities. Getting basic human needs met (i.e. food, sleep, shelter, warmth) did not make the list. Thwarting perceived danger or threat did not make the list. Seeking safety did not make the list. Building a relational connection did not make the list. Reacting to environmental stimuli did not make the list. Expending pent up energy in the body did not make the list. Engaging in developmentally appropriate sensory experiences did not make the list.

In fact, the only acknowledged functions were thinly veiled descriptions of manipulation. To posit "avoiding a task" as a function of behavior lends itself to a different interpretation than saying a child lacks the confidence or skill or developmental capacity to complete a task. It doesn't acknowledge the strong possibility that the environment is not conducive to completing a task. It does not acknowledge the strong possibility that the expectation is developmentally inappropriate.

These purported "functions of behavior" never sat right in my body. They nagged at my insides. I could see that my students were greatly impacted by their lived experiences, but no one was talking about that.

I recall my first experience with a school psychologist conducting a functional behavioral assessment. I was thrilled to see the acknowledgement of slow and fast triggers. These "triggers" were the first reference to ACES and trauma before anyone knew those things were even a "thing."

Although the ACES study had been published three years earlier, I had never heard of it nor understood the impact of trauma on child development and behavior. The bit I understood about child development came from my graduate coursework and the work of Jean Piaget, John Bowlby, Erik Erikson and Daniel Goleman's groundbreaking book, Emotional Intelligence.

In the first edition of Emotional Intelligence (1995), Goleman speaks to the early findings in neuroscience. His work indicated that when people experience rage they are hijacked by such strong emotion they cannot access the part of the brain responsible for reason and rational thinking. They literally can't think straight.

That made sense to me.

Goleman's description of the overwhelming somatic experience of rage resonated. The blindness, the swirling inner storm that surged and spewed out. I had experienced it with great frequency in my late teens and early twenties. I could recognize its swell in students. And yet, I was trying to teach them to override it with their mind.

Cognitive bias is rampant. It's literally everywhere. It's baked into the essence of what it means to be American. We speak this bias without recognition.

"Mind over matter."

"Happiness is a choice."

These idioms reflect the long-standing belief that if we put our "minds to it" we can overcome anything. These values and beliefs are further reflected in recent educational trends like encouraging "grit" and "growth-mindset." The vast majority of what I see folks doing that claims to be "trauma-informed" involves some version of cognitive bias or behaviorism.

We hold a deeply entrenched belief that children and adults possess 100% conscious control over their behavior.

How often do we say to children or loved ones or colleagues in the wake of a terrible mistake, "What were you thinking?"

Most commonly they reply, "I wasn't."
Truth be told, they weren't because they couldn't.

Advances in science in the last thirty years help us realize the fallacy of "mind over matter."

BUT, we are so tied to this belief that it highly agitates others when challenged. Bottom line, it has us wrestling with our identity as Americans.

Who are we if we aren't self-made, pulled up by our own bootstraps, masters of our own destiny?

And almost more importantly,

Do we like who we've become?

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Toxic Schools Worsening Toxic Stress: The Destructive Reign of Standardized Education, Pathology, Medication and Behaviorism

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Toxic Schools Worsening Toxic Stress: This post is the first chapter of a book. The names HAVE NOT been changed, as each individual profoundly impacted the author's growth and development. She wants their identities to remain intact.

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When Scarlett Lewis, founder of the Jesse Lewis Choose Love Movement, asks children across the United States what love looks like, they almost always turn to one another and give a hug or touch in some way. Touch is one of the strongest tools for building love and connection, and when used appropriately, it shapes bonds, builds self-esteem and encourages a positive outlook.

Touch is a vital way of connecting and providing emotional support. Yet there seems to be an increasing trend of kids and adults avoiding touch because there is a belief that it will protect vulnerable members of our society from harmful or abusive touch. It's noticeably absent from many schools, where children need touch, especially if they're being neglected at home. In fact, it's absent in the values portrayed in television and other media.

I have seen no evidence that avoiding touch provides protection. Actually, we might be creating more harm by having no-touch policies. We need to create a culture of healthy compassionate touch.

As human beings, I believe that we are more than capable of having the discussions required to create safe environments for healthy compassionate touch. In contrast to no-touch policies, I think that when we provide nurturing environments where touch can be used to soothe and console one another, we are allowing our children to experience and know what healthy touch is and model healthy boundaries. This gives a child a benchmark so they know when something does not feel right and to get help.

The Jesse Lewis Choose Love Movement (JLCL), which provides a free social-emotional learning program from preschool to 12th grade, introduces touch in a practical and easy way. As part of the JLCL Integration Program, a free Healthy Compassionate Touch (HCT) program is provided for teachers and children to learn how to recognize and use touch that is nurturing and helpful, and how to avoid touch that isn't. The program helps open a conversation how touch can be used to comfort a friend.

People implementing practices from the HCT program have found surprising results. After using HCT in her classroom for over a trimester, Mrs. Maria Elena Ventura at Granada High School in Livermore senses a difference in her students. She's a high school Spanish teacher who moved from El Salvador many years ago.

After helping to create one of the high school videos of the Healthy Compassionate Touch program, Mrs. Ventura decided to experiment. She stood at the doorway of her classroom each day prior to the start of class and offered each student a "high five" as they entered. She noticed an instant change in the students; they gave her more eye contact and were more willing to speak Spanish in class. She even felt a deeper connection with her students. They became more of a community, unified and positive.

A 2017 meta-analysis of 82 research studies involving around 100,000 students supports Mrs. Ventura's observations. The report found that students who participated in social-emotional learning programs are able to better self-regulate emotions, show empathy for others and maintain positive relationships. The Jesse Lewis Choose Love curriculum is the only program to include touch in this type of learning.

With decades of experience as a physical therapist, I see on a daily basis how touch improves body function and decreases pain. I also have noticed how precise my touch has become in being able to detect subtle changes in the body and the shifting emotional states that can go along with the physical changes. Most of us can remember a time when a safe reassuring touch helped us feel calmer, loved and nurtured. These qualities are described in depth in this article about the Power of Touch.

Because I feel strongly about this, I co-founded TouchMatters with my colleague Robyn Scherr, who is a California certified massage therapist. We're dedicated to deepening health and connection through skillful and compassionate touch. Our mission is to help everyone better understand the power of touch and how it can be used to relieve pain, heal traumas, feel a better sense of connection and to improve our communication. Healthy compassionate touch in our families and schools, and skillful touch in the medical profession, can help reduce the incidence and negative effects of adverse childhood experiences (ACEs).

Our workshop, Healthy Compassionate Touch for Everyone, provides simple hands-on techniques on how to stay present even when those around you are in distress. Through touch, we can promote relaxation and foster confidence. We tune into the unique ways our bodies communicate with us to find health and wellbeing.

You can try a simple exercise at home to foster healthy touch in your life. When someone you know has been physically or emotionally hurt, ask if you can put your hands on the place that is hurting. First, make sure you feel comfortable and settled in your own body, then gently place your hands on the part of their body that they give you permission to touch, and that you are comfortable touching. While touching the other person, simply think about something you love. This could even be the person you are touching. Picture sending that love in through your hands and inviting the support offered to help in any way possible. Children can learn this, too! This video will guide you.

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How healthy compassionate touch transforms

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When Scarlett Lewis, founder of the Jesse Lewis Choose Love Movement, asks children across the United States what love looks like, they almost always turn to one another and give a hug or touch in some way. Touch is one of the strongest tools for building love and connection, and when used appropriately, it shapes bonds, builds self-esteem and encourages a positive outlook.

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Children with additional needs often become very anxious, distressed, confused or frustrated simply because they may not quite understand the world around and how it works. They may find other people confusing too and not be able to always understand they way they are acting or what they are saying or meaning. Often this means that they have some real needs that aren't being met, and they don't always have the words to tell us what help they really need.

When this happens the world can become a very frightening place, and they may well feel threatened by things that we, as adults, wouldn't give a second thought to.When any of us become frightened and distressed, our anxiety levels ramp right up, and that causes us to move towards a state of fight and flight.

As soon as we start feeling heightened levels of anxiety, we are unable to think clearly and our communication skills deteriorate as well. All our focus is on trying to feel safe and to protect us from whatever it is that we are feeling threatened by. It's exactly the same for our children.

Is there anything that you're frightened of? Lots of us are frightened of things like spiders, or wasps, or going on planes, needles or lifts. If that's the case, others may tease us or laugh at us because to them it's irrational, but to those of us who are frightened it's very very real, and what we need in those moments is compassion, understanding and support to cope better.

When we are put into a situation where we have to face our fears, how do we cope? Some people might "control" the spider or wasp by either killing it or putting a glass over it until someone braver comes along who can sort it out properly. We may "control" the plane travel fear by ensuring we only holiday in the UK or take a ferry somewhere instead, and we can "control" needle-phobia by simply not turning up for the blood test and tuning it out completely.

Just think about anything you're frightened of and try to remember how you felt last time you had to cope with it alone. Somehow, we get through it, but it's not easy, we may not handle it in the best way, and until the perceived threat has disappeared, we are unlikely to be able to concentrate on doing anything else whatsoever.

If nobody else is around, or even if they are but they don't understand how frightened we feel, we may have to find a way of problem-solving our own way out through our fears, so that we feel safe again.

Feeling safe is a basic human need and all of us strive to do whatever we can to remove any threats that frighten us, problem-solving at a time when our own thinking skills won't be at their most effective. Our children are exactly the same.

When our children are feeling frightened, distressed, confused or threatened, their anxiety levels can quickly trigger their autonomic nervous system's response of fight or flight, which can cause them to have a violent episode or to run away from what feels frightening. In that moment they feel so intensely threatened that they are either fighting as hard as they can for their very survival or they are running away from danger as fast as their legs will carry them.

To ensure that their muscles are pumped up and ready for a quick burst of energetic fight or flight, blood is diverted away from the brain, so their thinking and communication skills are beyond their reach. If only they could say "Please help me, I'm scared" it would make everything easier, but in that moment they just can't. Instead we can try and remember to translate it for them.

However, what happens if, despite the fight and flight response, the fear is still there? Or if there are so many fears that they are completely overwhelming? Our children will try to find other ways to keep themselves feeling safe, and one of the most common ways of doing this is to become controlling.We all do it. Whenever we're feeling unsafe, unsure or insecure, we all have a tendency to try and persuade other people to do what we want.

If the world feels unsafe and unpredictable, it's human nature to do all whatever we can to control as many parts of that world as we possibly can. Controlling behaviour is a very common response to fear, feeling threatened and feeling out of control. When things don't add up or make sense to our children in the world around them, sameness feels safer, and unpredictability can feel very risky indeed.

Other people are unpredictable; a child may well seek to control absolutely everything a family member does simply to make themselves feel safer and so that they are able to function a little bit better.

Other children, their own brothers and sisters, are particularly unpredictable, especially if they are much younger. Children jump, shout, sing, talk, laugh and play in completely random ways, which can feel extremely threatening and frightening to a sensitive child who is already struggling to make some sense of the world around them. No wonder a SEND VCB child might seek to control them.

However, we adults often see this controlling behaviour and assume it comes from a place of unkindness, spitefulness and malice. Once we start thinking along those lines, we often try to address it as if it's a really unpleasant behaviour issue that needs to be quickly nipped in the bud.

Nearly always though, the child who is doing the controlling has very little concept of how their controlling behaviour is impacting on everyone else, and they are simply trying to find a way to make the world seem safer and easier to understand. They are just trying to protect themselves from what feels like real threats.

This controlling can start off very gradually, so slowly that you barely notice it escalating until you reach a point whereby the child is ruling the roost completely. By the time you realise how bad it's become you may already have got to the stage where nobody in the family dares to step out of line. They all know how quickly things can get much worse and how violent the consequences of resisting control can be.

It's incredibly easy to get into that situation; we did with Toby at the worst of our SEND VCB years in our family. However, it's much less easy to reverse it, but it is possible. With lots of time, patience and understanding, you can help your child to move towards a much happier and more equal family dynamic.

Just think too how desperately sad this whole situation is for the child at the centre of it as well. They started using controlling behaviour because they felt so unsafe and frightened. As a result, it can end up with them being in charge of the whole house and everyone in it. Just think how frightening that must feel. They haven't got the life-skills, the experience or the maturity to handle such a huge responsibility, and they can quickly become isolated from and feared by the rest of their family too. This will only increase their fears and distress, and add in a whole new sense of being unloved and lonely.

Here are some steps about how to help your child to become less controlling -

1. Understand that your child's controlling behaviour comes from a place of intense fear and distress, it's not that they want to be horrible.

2. This is true even if they say some horrible things or become violent if their family members don't always comply with their demands. They are trying to feel safe, try not to think of it as "trying to get their own way"

3. Stay calm, with a softly calming, kind and non-judgemental tone of voice

4. Try to identify what their fears or unmet needs might be. This can be hard, but just keep looking, stay curious and write everything down because you may start to see patterns

5. Look towards sensory issues, communication difficulties and a need for sameness and routine, including transitions, to help you identify what might be behind this deep distress

6. Respond to the child's distress rather than their behaviours

7. Don't expect any quick-fixes or overnight solutions. This controlling behaviour is very complex and took a long time to become established. It's likely to need a lot of unpicking and a very gradual return to how things should be.

8. Your child's sense of safety and emotional well-being needs to set the pace of this "unpicking". They may feel very alone and isolated, and as if they are apart from the rest of the family. Any change is likely to make them feel even more unsettled, even a very positive change in approach

9. Focus on building trust with your child. Your relationship with them may well need a lot of work to heal and recover

10. Never give up and always believe in your child, and your own ability to make things better. You've got this!
©Yvonne Newbold
December 2019

It's our last workshop of the year on this Saturday, 7th December, near Waterloo Station in London - and there are two to choose from or you get a slight discount to do both. In the morning we'll be looking at how to reduce violent meltdowns, and then in the afternoon it's all about how to make Christmas so much happier in families like ours. Just think how wonderful it would be if things were already beginning to get better for your family by Christmas - wow! Please click on the links to find out more or you can watch a short video where I'll tell you more about it https://www.eventbrite.co.uk/e/how-to-reduce-violent-meltdowns-tickets-77572430227

Facebook Support

If you have a child who has an additional need and who is also violent at home or elsewhere, we have a support group that you would be welcome to join. It's called The SEND VCB Project - Support Group for Families If you do, please answer the joining questions as fully as you can so that we are able to make the right decisions about whether or not the group is right for you. https://www.facebook.com/groups/421839288150939/

We also have two Facebook Pages that everyone is welcome to visit. This one, The SEND VCB Project - Public Page has a focus on children with additional needs who also have extreme behaviour, sharing information, news and wisdom about the underlying causes and what you can do to help a child https://www.facebook.com/TheSENDVCBProject/

Our other Facebook Page is called The SEND Parent's Handbook, and it is for parents and professionals who care for a child with any disability, sharing the very best articles we can find that will inform and support our community https://www.facebook.com/thespecialparentshandbook/

The SEND VCB Project

I sent up The SEND VCB Project in April 2017 to address the issue of violence in children with an additional need. SEND VCB stands for Special Educational Needs and Disabilities, Violent and Challenging (or Controlling) Behaviour. So far we know of over 400 success stories - families who have worked with their child to significantly reduce their violent behaviours. What's really lovely is how their parents tell me how happy their children are now, and how they are building really warm, loving and strong relationships with them. The bottom line is that happy children seldom hurt anyone. If you'd like to see what else we've achieved and what our future plans are, you can here https://yvonnenewbold.com/the-send-vcb-project-what-we-do-and-why-it-matters/

The Special Parent's Handbook

I've also written the book I wish someone had been able to give me on the day that Toby was born, It's called "The Special Parent's Handbook". It's packed full of everything I learnt about additional needs parenting with lots of tips, tricks and strategies so that you don't have to re-invent the wheel all by yourself.

Here's the link to order yours and please let me know if you'd like me to sign it for you

Alternatively you can order it from Amazon - here's the link to the page

Yvonne is a member of the Amazon Affiliates Program which means that if you click on an Amazon link from this website and subsequently make a purchase, she will be paid a small commission.

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What to do when your SEND child controls the whole family

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Children with additional needs often become very anxious, distressed, confused or frustrated simply because they may not quite understand the world around and how it works. They may find other people confusing too and not be able to always understand they way they are acting or what they are saying or meaning.

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Getting tough on pupil behaviour won't work

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Getting tough on pupil behaviour won't work

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Emotions Toolbox - Child Therapy Service

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This emotional regulation toolkit has been adapted from the Zones of Regulation approach. It is ideal to use in education settings and home, with young children. I have created tools to promote self-regulation and resources for any child that needs additional support:

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Learning outdoors for just one lesson a week boosts learning and behaviour in primary school children, researchers have said.

The study, commissioned by The Wildlife Trusts and carried out by the Institute of Education at UCL, is one of the largest into the effects of outdoor activities on children's wellbeing and views about nature.

The research found that children's wellbeing increased after they had spent time connecting with nature and that they gained educational benefits as well as wider personal and social benefits.

As a result, the Wildlife Trusts are calling on the Government to ensure that at least one hour per school day is spent outdoors learning and playing in wild places.

Researchers at UCL said children have "lost touch" with nature and that the benefits on the group of 450 primary school children from 12 areas in the UK were plain to see.

81 per cent of children reported having better relationships with their teachers after learning outside, 79 per cent said they had better relationships with their classmates and 79 per cent said the experience helped with their school work.

Additionally, teachers and Wildlife Trust educators were also observed by the UCL research team and interviewed about their experiences.

The outdoor activities involved children learning about nature, such as identifying plants and trees, reflecting on their important role in human lives and considering the needs of wildlife habitats.

Professor Michael Reiss, Institute of Education, UCL, said: "Each generation seems to have less contact with the outdoors than the preceding one. We owe it to all young people to reverse this trend - for their sakes, for our sakes and for nature's sake."

Nigel Doar, The Wildlife Trusts' director of strategy added: "This research shows that children experience profound and diverse benefits through regular contact with nature. Contact with the wild improves children's wellbeing, motivation and confidence. The data also highlights how children's experiences in and around the natural world led to better relationships with their teachers and class-mates.

"The Wildlife Trusts believe everyone should have the opportunity to experience the joy of wildlife in daily life and we're calling on government to recognise the multiple benefits of nature for children - and ensure that at least one hour per school day is spent outdoors learning and playing in wild places."

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Learning outside for just one lesson a week boosts learning and behaviour, say researchers

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Learning outdoors for just one lesson a week boosts learning and behaviour in primary school children, researchers have said. The study, commissioned by The Wildlife Trusts and carried out by the Institute of Education at UCL, is one of the largest into the effects of outdoor activities on children's wellbeing and views about nature.

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Come here to find hundreds of free educational resources for the classroom, at home, and in your community. We are a health activation program developed to empower children and parents to make healthy lifestyle choices that help prevent childhood obesity and chronic disease.

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Helping students regain their calm after misbehavior doesn't mean there are no consequences-it ensures that the right lesson is learned.

Jim West / Alamy Stock Photo

Our schools are currently seeing a dramatic increase in students of all ages carrying in anxiety, adversity, and trauma from a variety of adverse childhood experiences (ACEs). Social and emotional learning programs are critical for addressing these emotional and mental challenges, but we must also rethink our discipline procedures and policies. We need to understand that traditional discipline works best with the children who need it the least, and works least with the children who need it the most. Discipline ideally is not something we do to students-it should be a quality we want to develop within them.

For students with ACEs, traditional punishments can unintentionally retraumatize and reactivate their stress response systems. Recent research in school discipline is grounded in the neuroscience of attachment, which emphasizes the significance of relationships. Those relationships begin with an adult in a regulated, calm brain state. It takes a calm brain to calm another brain-this co-regulation is something that students with ACEs may have missed out on. Their school can be an environment where they feel safe and connected even when they make poor choices.

This doesn't mean giving students a pass for misbehavior: There are still consequences for poor choices, but regulating the feelings and sensations a student is experiencing is the initial step, one that is critical for a sustainable change in behavior.

Emotions are contagious, and when a teacher is able to model a calm presence through their tone, facial expression, and posture, students are less likely to react defensively. When the teacher listens to what is beneath the behavior, focusing on the student's feelings, this type of validation says to the child that the teacher sees them and is trying to understand. When the teacher takes deep breaths, gets a drink of water, and creates space for reflection for a minute or two, they are modeling the regulation skills they want to see from students.

Co-Regulating Behavior With Students

If I'm the teacher, co-regulation-the process of helping a student who has made a poor choice of behavior to regain their composure-begins with the awareness of my own sensations and feelings when I am disciplining the student. It entails a willingness to regulate my own brain before I act on that discipline. Personally, I try to commit to three quick routines that feel doable to calm me in a short period of time: taking three deep breaths, texting a friend or pulling an affirmation from a prepared jar, and stretching and moving for a minute.

It's much better to wait for a few minutes when we're feeling irritated and angry before we discipline, and this is also excellent modeling for students. Students read our nonverbal communication, so paying attention to our facial expression and posture in addition to our tone of voice is critical when teaching the behaviors we want to see.

Focusing on the student's sensations and the feelings that lie beneath the behavior help us to understand the root causes and patterns of a behavior we might discover when there is rising irritation and anger. I may have a minute or two to redirect-by suggesting that the student go and get a drink of water or take a couple of deep breaths to calm down with me before we talk about the problem.

Creating a friend-in-need system could be helpful so each student has a buddy or even another adult in the building to go to when they begin to feel agitated. For the friend-in-need system, teachers ask students to select one or two peers or adults at the school who they trust and feel comfortable with if they need to take a break and be in another environment or talk through those challenging moments. This is preventative discipline and a way for students to have options when they begin to feel negative. These calming strategies are taught ahead of time and become a part of our procedures and classroom agreements or guidelines.

"That must feel awful."

"You seem really angry."

"You seem really frustrated."

"What a difficult situation you're in."

Validation is powerful way to calm an agitated and angry student. It's calming to be understood and felt by another. Some things you can say to help a student feel validated:

Validation opens the door for teacher and student to discuss choices and consequences and to create a plan of action for the next time there's a conflict.

I once heard that it is critical that a teacher's brain should resemble a thermostat rather than a thermometer when it comes to disciplining a student. What does this mean? Like a thermostat, the teacher needs to maintain a steady temperature throughout a moment of conflict, with a goal of creating conversation and a plan of action with a student who understands their choices and the consequences of those actions. The teacher needs to model the behaviors they want to see and to model self-care and respect during the discipline process.

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The Role of Emotion Co-Regulation in Discipline

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Helping students regain their calm after misbehavior doesn't mean there are no consequences-it ensures that the right lesson is learned.

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Dr. Nadine Burke Harris has an ambitious dream: screen every student for childhood trauma before entering school.

"A school nurse would also get a note from a physician that says: 'Here is the care plan for this child's toxic stress. And this is how it shows up,'" said Burke Harris, who was appointed California's first surgeon general in January.

"It could be it shows up in tummy aches. Or it's impulse control and behavior, and we offer a care plan. Instead of reacting harshly and punitively, every educator is trained in recognizing these things. Instead of suspending and expelling or saying, 'What's wrong with you?' we say, 'What happened to you?'"

Burke Harris has dedicated her career to changing the way society responds to childhood trauma, which research has shown affects brain development and creates lifelong health problems.

"This involves public education, routine screening to enable early detection and early intervention, and cross-sector coordinated care," she said at a hearing on providing care in schools held by the House Committee on Education and Labor in September. "The opportunity ahead of us is about a true intersection of health care and education."

A study on youth trauma, known as Adverse Childhood Experiences, or ACES, was a landmark when it was published in 1998 by the Centers for Disease Control and Prevention and Kaiser Permanente. The study specified 10 categories of stressful or traumatic childhood events, including abuse, parental incarceration, and divorce or parental separation; its research showed that sustained stress caused biochemical changes in the brain and body and drastically increased the risk of developing mental illness and health problems.

Burke Harris first noticed this connection while treating children at a clinic in San Francisco.

"One thing that tipped me off was the number of kids being sent to me by schools -- principals, teachers and administrators -- with ADHD," she said, referring to attention deficit hyperactivity disorder). "What I found was that many of the kids were experiencing signs of adversity, and there seemed to be a strong association between adversity and the trauma they experienced and school functioning."

This finding spurred her to review the health records of over 700 of her patients. Her research team found that patients who had experienced severe trauma were 32 times more likely to be diagnosed with learning and behavioral problems than kids who had not.

Trauma in general leads to a surge in stress hormones. When this trauma goes unchecked and is sustained, it can disrupt a child's brain development, interfering with functions children depend on in school such as memory recall, focus and impulse control.

"When we talk about the effect of ACEs on learning, part of the impact is on the child's ability to sit still in class and ... be able to receive and process information," Burke Harris said.

She found that too often the children she saw at her clinic had been prescribed drugs that actually stimulated parts of the brain that did not need it -- and children did not improve as a result. If the children had been diagnosed with ACEs, Burke Harris said she believes treatment may have been as easy as teaching them how to calm themselves down.

She recalled seeing a boy, 14, who had recurrent abdominal pain. Instead of testing for ulcers, she tested for ACEs and found he scored six out of 10. His parents were going through a divorce and his father refused to see him. Burke Harris said the teen had a number of support systems in place, and she added another.

"I said, 'We are going to have you join a sports team,'" she said. "A month later his abdominal pain was gone and we didn't have to have expensive tests."

"When we are talking about addressing the root cause, science shows that safe, stable environments are healing for kids," said Burke Harris, who is also the author of "The Deepest Well: Healing the Long-Term Effects of Childhood Adversity."

"What research tells us is that sleep, exercise, nutrition, mindfulness and a nurturing environment can reduce stress hormones and enhance the ability of the brain to recover from stress," Burke Harris said. "As we're thinking about how to help students be successful, we must recognize that PE and team sports are part of a comprehensive response to address ACEs. What we put in our kids' lunches or provide in a school environment makes a difference in a child's ability to regulate stress response."

Toxic stress suffered by children because of ACEs can also result in health issues that cause absentism.

"The higher the ACEs score, the more likely a child is to miss a day in school," Burke Harris noted. "Asthma is the No 1 reason for chronic absenteeism, and kids with four or more ACEs experience a higher percentage of asthma."

In her congressional testimony, Burke Harris cited a pilot program in San Francisco in which students learn a form of deep meditation to reduce their stress.

"Not only did they see a reduction in school suspension rates and episodes of violence, but they also saw an increase in GPA and standardized tests," Burke Harris told NBCBLK.

As California's first surgeon general, Burke Harris sees herself as a leader in a national movement toward the creation of "trauma sensitive and trauma-informed" education programs that she hopes will lead to changes in school policies. She said she plans to travel the U.S. to call for a public initiative to address ACEs, which she refers to as "one of the most serious, expensive and widespread public health crises of our time."

"Ultimately, as a doctor I don't spend all day with a child," she said. "Part of treatment is recognizing that everyone in the educational environment has an opportunity to administer buffering care for kids. That's the power of a public initiative. Everyone from the superintendent to the teacher to the bus driver and the person cleaning recognizes and understands this information."

"When you have a whole community making real change," Burke Harris said, "you can have a big and lasting change."
This story appears as part of coverage for "NBC News Learn Presents: Education Now Detroit," a two-hour live community event supported by the Chan Zuckerberg Initiative. For more information, go to nbcnews.com/learndetroit.

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California's first surgeon general: Screen every student for childhood trauma

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Dr. Nadine Burke Harris has an ambitious dream: screen every student for childhood trauma before entering school. "A school nurse would also get a note from a physician that says: 'Here is the care plan for this child's toxic stress. And this is how it shows up,'" said Burke Harris, who was appointed California's first surgeon general in January.

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Buzzwords and goals come and go in every field. In the early childhood field, self-regulation has been both a buzzword and a very big goal for children for a couple of years now. I suspect that's because, as I've written previously, challenging behaviors are on the rise in early childhood settings. If only every child could self-regulate, we'd see far fewer behavior issues!

The problem is, there is often confusion about what self-regulation is and how it should be fostered.

With regard to its definition, many believe it's all about self-control. And while self-control is indeed a part of it, self-regulation specifically refers to the ability to regulate oneself without intervention from an outside source, such as another person. In the case of young children, it means adults don't always have to be telling them how to behave; they've learned to control their emotions and resist impulsive behavior on their own.

Obviously, that's a good thing; the ability to regulate oneself is something we want for every individual. But, given its definition, many are going about "teaching" it in the wrong way: insisting that children sit still or be quiet, and assuming that once children are able to meet these unrealistic expectations they will have acquired the ability to self-regulate. However, this fails to meet the primary characteristic of self-regulation: that there be no intervention from an outside source. Also, such demands are typically met with resistance - i.e., challenging behavior - because, developmentally speaking, young children weren't created to sit still or stay quiet.

So, how do we go about promoting its development?

It's quite possible this might surprise you (or maybe not, if you know my work), but one of the best ways for children to learn to regulate themselves is through movement games! As with anything else, if it's fun for them, they're much more inclined to want to do it.

For example, if you ask children to stay still, it's not likely to happen. However, if you're playing a game of Statues, where they move while the music is playing and freeze into a statue when the music is paused, they'll want to stay still - because pretending to be a statue is fun!

Similarly, moving slowly requires a great deal more self-control than moving quickly. Telling children to move slowly won't inspire them to learn how. But asking them to move like an astronaut floating in outer space - or as though they're trying to walk through peanut butter - provides incentive for them to move slowly. And, therefore, they learn how. The same applies to the ability to wait. Waiting is definitely not a young child's long suit. But if you give them a good reason to wait, they're more than happy to do it. What's a good reason to wait? How about an activity like Blast Off, where the children crouch low while you count backward from 10, with as much drama as possible? Not until you say "Blast off!" are the children to launch themselves!

Human development professor Lori Skibbe and her fellow researchers followed a group of children from preschool to second grade and used the game of Simon Says to determine the children's ability to self-regulate. They discovered that the earlier children acquired their self-regulation skills, the faster the skills developed. Their study also found that the benefits of self-regulation don't dwindle over time. Moreover, the study demonstrated that, beyond the improved behavior it offers, the ability to self-regulate also improves the young child's language and literacy development. Obviously, we have many good reasons to foster it.

I once heard a workshop leader (and I wish I could remember who it was so I could credit her) say, "We often set up environments for children that are contrary to what we know about who and what they are."

Unfortunately, it's true. Equally unfortunate is the fact that we often teach children in ways that are contrary to what we know about who and what they are. If we know that young children aren't developmentally ready to be either still or quiet, why do we ask them to do so and expect they'll comply? And if we know that joy is what inspires and motivates young children - and that movement is their preferred mode of learning - why aren't we more often taking advantage of this knowledge?

Note: This post is excerpted and adapted from my online course, " Avoid Behavior Challenges in Your Early Childhood Setting. "

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Fostering Self-Regulation in Early Childhood: Are We Doing It Wrong? - Rae Pica

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Buzzwords and goals come and go in every field. In the early childhood field, self-regulation has been both a buzzword and a very big goal for children for a couple of years now. I suspect that's because, as I've written previously, challenging behaviors are on the rise in early childhood settings.

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Your brain really wants to keep you alive. It is a major preoccupation, literally of life and death importance. And with good reason - the people in the past who did not detect danger got gobbled up by the wolves or bears. You are alive because your ancestors' brains noticed the predators, and turbocharged their muscles to get away faster than their neighbors. The system is quick and complex, and it kept them going, eventually resulting in you being born.

Our skill at reacting to dangers that we can see applies to more than snakes or tigers. It is also how we have set up our healthcare system. We put enormous effort into it, with the US spending 3.5 trillion dollars a year on healthcare. We have MRI machines of staggering complexity, and hospitals filled with smart and highly trained people.

What Are the Invisible Killers?

But there is a problem. All that technology and expertise is focused on what we can see. A physical injury is obvious, we can look at the broken bone or the blood. Bacterial infections can be spotted pretty fast and we can see the evil little microbes under a microscope. Our healthcare system addresses these very well. They also happen to have been the biggest cause of early death in the 19 th century. 150 years ago, what usually killed people was smashed limbs, or disease. Thankfully, we have excellent interventions to deal with them.

That was then. This is the 21 st century, and things have changed dramatically. Of the ten leading causes of early death, physical injuries and infections are 5 th and 8 th on the list. They actually are the least of our worries. Something else, something we cannot see, yet is very powerful, is pushing us to an early grave.

We need to know what that is. If we zero in on what shortens our lifespans, then we can address it. We can take action to live long, robust lives. We can employ bright, passionate people to strengthen our bodies, and lengthen our years.

But we are not. Not in the slightest. Although the research papers have been pouring out by the thousands during the 21 st century on the single biggest cause of early death, all that knowledge is pretty much ignored. Passed by. The doctors don't know about it, you don't know about it, the hospitals don't measure it, the insurance companies won't pay to treat it - nothing. It melts a few brain cells when you think about it. The single largest cause of early death is ignored by our expensive and sophisticated healthcare system.

Which is why you are lucky to be reading this article. You will learn how these invisible injuries occur, and the many ways they shorten a person's lifespan. And once you understand what they are, you can take action. You can take a simple assessment to see if you have the risk factors, and then you can address it. You can treat this hazard with interventions that not only are safe, but effective. Multiple studies show that these treatments are powerful enough to rewrite your DNA. More on that later.

Where the Invisible Injuries Come From

First of all, we need to understand the injuries that our healthcare system cannot see. And some of the most advanced minds in medicine tell us to begin our journey in an unexpected place. The cardiologists in the American Heart Association are grappling with "the greatest public health burden in the United States . . . cardiometabolic outcomes, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease." Every week, physicians watch more Americans die from these conditions than any other. And the older that people get, the higher their risk rises. But the American Heart Association points us to the opposite end of the lifespan. It says that intervening with children who experience trauma is a more appropriate way to address this huge cause of early death.

Well, that is a surprise. Cardiologists say that we should focus on abuse and neglect to kids, in order to reduce diabetes and heart attacks in 70 year olds. The nature of the invisible injuries, the ones that our healthcare system ignores, is revealed. They are psychological injuries. Physical, sexual and emotional abuse. Emotional or physical neglect. Having a parent with a substance abuse problem, a major mental health issue, a criminal, violence between the parents, or separation from a parent by divorce or death before age 18: these are some of the most common psychological injuries that people experience. They are so powerful, and shape people's lives to such a degree, that they show up 60 years later as poor health and premature death. That is why the heart specialists are more worried about what happens to 7 year olds, than the seniors who sit in their waiting rooms.

How Emotional Wounds Damage Our Flesh

How on earth does this happen? How does experiencing physical abuse as an 8 year old shorten one's lifespan? How do insulting words turn into diabetes? Or sexual abuse trigger a heart attack 50 years in the future? To answer this, we need to dive deep into what happens when a child is badly frightened.

When a person experiences a terrifying event, one system in the brain kicks in very rapidly, the fight or flight response. Regardless of the threat (a bear or a raging parent), the brain helps you to respond immediately, and have the maximum amount of energy available to either fight the threat or flee from it. A region of the brain called the amygdala monitors the information from the eyes, ears, and other senses. When it interprets something as dangerous, it zips a signal to another part of the brain, the hypothalamus. This functions as a command center, and activates the sympathetic nervous system. This system tells the adrenal glands to release adrenaline, which squirts into the bloodstream. Now things really start rocking, because adrenaline is designed to energize the body to either fight the threat and kill it, or flee from it into safety. The heart beats faster, pushing blood to the muscles and other organs. Blood sugar and fats are released from temporary storage, which puts more energy in the blood stream. Not only do people breathe faster, but the airways in their lungs open wider, to absorb more oxygen.

It is not just the organs that are activated, muscle cells are revved up by adrenaline as well. If you are faced by a bear, you want your muscles to work very fast and hard. As the adrenaline is carried to the muscles by the blood, it locks onto receptors. This triggers a very complex cascade in the cell, that frees up a lot of glucose. The glucose is broken down into carbon dioxide and water, and in the process, it creates dozens of molecules (ATP) that are used to power the muscles. This process happens in the power plant of the cell, the mitochondria. And like all power plants, it emits some noxious byproducts. Diesel engines produce little particles of soot, gasoline engines produce carbon monoxide, and the mitochondria produces a group of molecules known as reactive oxygen species (ROS). The worst member of this group of ROS are hydroxyl radicals. And like radicals everywhere, they are not interested in keeping things stable. They are radicals after all, and they want to bust things up. They will break bonds in DNA, in proteins, even in water.

The Tears in Our DNA

Breaking bonds in water is not a big problem for cells. Breaking apart DNA molecules is. DNA contains the genetic code for life, and if errors enter the code, then damage can compound. If the DNA in the mitochondria has breaks in the strands of DNA, then more hydroxyl radicals are created, which causes more breaks in the DNA, which leads to more hydroxyl radicals, and a vicious spiral is created. The hydroxyl radicals also attack DNA in the nucleus, causing breaks there as well. If your DNA has breaks or parts of it are cut out, then those flaws are passed on to the next generation. One of the results is that the cell dies early. And when your cells die early, you die early.

All that is just from the effects of adrenaline. But the body does more than release adrenaline to rev you up in the fight or flight response. Remember, your brain is extremely interested in keeping you alive, and has a second system in place to make sure that you either fight and kill the threat, or sprint away from it. The second system is activated in the hypothalamus, if it keeps on getting the message that danger is nearby. This system is the HPA axis, because the Hypothalamus signals the Pituitary gland, which signals the Adrenal glands. If the adrenal glands get the message that danger is still around (there is a swarm of bees, not just a single bee) then it releases cortisol.

Nearly every cell in the body has receptors for cortisol, showing how important it is, and how the whole body is involved in the fight or flight response. Cortisol mobilizes glucose into the bloodstream, giving the body energy for a longer period of time to either fight or flee. In order to keep the glucose in the blood so that it is available for your muscles, cortisol inhibits insulin from storing the glucose into cells. Cortisol also narrows the arteries, which increases blood pressure and forces the heart to pump faster. It reduces inflammation in the body as well. All of these effects help your body in the short term to cope with danger. Thanks to cortisol, your muscles have more energy available to them, your heart speeds up (which brings more oxygen and glucose to your muscles), and you are more able to cope with injury.

But there is a dark side as well. Experiments show that cortisol creates reactive nitrogen species inside cells. Like their nasty cousins (reactive oxygen species), they go on to damage DNA. No wonder that people with high levels of cortisol show more breakage in their DNA. And when people have high levels of cortisol in their blood for long periods of time, due to chronic stress, there is a cascade of negative effects. Cortisol suppresses the immune system, making people more susceptible to infections. Cortisol results in weight gain in three different pathways, including storing fat in the belly, overeating, and craving junk foods. Because cortisol puts glucose in the bloodstream, and stops insulin from taking it out, the cells become insulin resistant. This may lead to Type II diabetes. Cortisol also elevates blood pressure, which results in hypertension. And when you mix obesity, diabetes, and hypertension together, that is a good recipe for cardiovascular disease.

If this sounds familiar, it is because they are the conditions the American Heart Association was telling us are the greatest health burden in the US. Now we can see why the AHA is worried about kids' experiencing trauma and abuse in childhood. Because when a stepmother slaps an 8 year old's face, the kid goes into fight or flight mode. Adrenaline and cortisol gush into his bloodstream. And if she criticizes him repeatedly, the stress hormones fill his blood time and again. His DNA breaks down faster than his body can repair it, glucose is in his bloodstream for too long, and his blood pressure is too high.

Growing Up Does Not Heal You

The child is not healed of this destructive pattern simply by growing up and moving away. Terrifying events (such as being molested by a swimming coach) are imprinted on the amygdala in the brain as soon as they happen. Because the event was so frightening and dangerous, the brain constantly scans the environment, looking for any signals of danger. When it sees, hears, or smells anything that is associated with the original trauma, it triggers off the fight or flight response, in order to mobilize the person to get away from the danger.

This alters the brain of the child, so that the regions involved in fear, anxiety, and impulsive responses produce too many connections between the brain cells. This can change the stress system so that it responds at lower thresholds to events that might not be stressful to others. And if it is activated, it can take a lot longer for the traumatized child to calm down than a child without any psychological injuries. Therefore, the stress response system activates more frequently and for longer periods than is necessary, like revving a car engine for hours every day.

Now we see why getting older and moving away does not heal the child. Because their brain is over-wired for fear, anxiety, and other negative emotions. And leaving home does not rewrite damaged DNA. Psychological injuries produce a huge web of destructive effects. People freak out over small things, and cannot calm down. The mistakes in their DNA get passed on as their cells divide, a ticking time bomb of disease. The person carries shame, guilt, anger and more from the abuse. They believe they cannot reach out for help, because of the neglect.

The Wrong Bandaids Make Invisible Wounds Worse

When people carry a lot of emotional pain from their invisible wounds, they try to numb it out. And this is the second way that psychological injuries are a massive factor in 7 of the 10 leading causes of early death. Because junk food can be an anaesthetic to emotional pain. Smoking calms jittery nerves. Alcohol and drugs distract and dull painful memories. Anywhere you look, people with psychological injuries are abusing substances to try and soothe themselves. People with 4 or more traumas as a kid are 40% more likely to be overweight or obese than those with no traumas. They are 3 times more likely to smoke, and nearly 6 times more likely to have problems with alcohol, or use illicit drugs. The impact is so big that childhood traumas are estimated to account for one half to two third of serious problems with drug use.

And if people did not get consistent love in childhood, they will look in the wrong places to try and fill the void. Those with 4 or more traumas are 4 times more likely to start sexual activity earlier than their peers, and become pregnant as a teenager, than those with no traumas. They are 4 times more likely to have more than 50 sexual partners, and 6 times more likely to have sexually transmitted diseases. They are three times as likely to marry an alcoholic.

Stepping back, we see that psychological injuries have three major pathways by which they shape our lifespan. First, repeatedly going into fight or flight damages our DNA, and affects our body from the toxic and chronic stress. Second, people cope with the pain through abusing substances. And the dangers of excessive food, smoking, alcohol, and illicit drugs to our health are well known. Finally, people often seek out comfort through relationships, even if they are unhealthy. Teen pregnancy, sexually transmitted diseases, and the stress of living with a substance-abusing spouse seriously corrode a person's well-being.

Three Paths to Early Death

You can see where this is going. If a person has broken DNA because of the overly frequent releases of adrenaline and cortisol, and they cope with their psychological injuries by smoking, their risk of cancer skyrockets. If they have 4 or more childhood traumas, they are 2.5 times more likely to develop cancer, compared to people who are emotionally not injured. This is not just a statistic, this is the story of my family. My mother lost her mother when she was a little girl. She grew up in Holland during the Second World War, and had 4 psychological injuries from those experiences. Her risk of cancer was 250% higher as a result, and it showed up. Even though she did not smoke, cancer took her life in her early 50's.

Cancer is not the only possible outcome for people with 4 or more childhood traumas. They are 3 times more likely to develop heart disease. This actually dwarfs the influence of genetics - a team from Harvard found that those with the highest genetic risk of heart disease were 65% more likely to develop it, but those at the highest psychological risk were 310% more likely to have it. The story continues: 4 or more childhood traumas triples the risk of developing diabetes, it has a 6 fold increase in risk of stroke, a person is 3.5 times more likely to develop cardio-obstructive pulmonary disease, and 2.5 times more likely to have liver/digestive disease.

The most dramatic example is suicide. Having no childhood traumas gives a 1% risk of attempting suicide by middle age. One trauma doubles the risk, two traumas doubles it again, on and on until the people with 7 or more traumas are 36 times more likely to attempt suicide than those who have none. Thirty-six times more likely!

The data is overwhelming. Seven of the 10 causes of early death are hugely influenced by psychological injuries, and the influence is far greater than genetics. The mix of broken DNA, chronic stress on the body, dysfunctional ways of coping with pain by abusing substances, and rotten relationships rip years, even decades off people's lives.

Doctors Do Not Know Why People Die Early

And yet our health care system completely ignores this mountain of research. The doctors do not even know about it. I have met many fine family physicians who have never heard of these scientific findings. As I chat with them over lunch, or as we cycle together, they are astonished by the data. Although they are well-trained to diagnose what is diabetes and what is liver disease, they have no idea that psychological injuries are such a big cause of them. I have met professors at the top universities in the world, and have good friends who taught at Harvard. They work very long hours to research cancer and heart disease, and have never seen the science linking psychological injuries to these fatal conditions. They don't know that this link is much stronger than the genetic one. Think about it: Just by reading this article, you now know more on this topic than many doctors and professors in your city.

This is just one of many reasons why our sophisticated healthcare system ignores the single largest cause of early death. Since the physicians do not know about the role of psychological injuries, they cannot assess for them. And if they cannot assess them, they cannot treat them. And if they cannot treat the problem, then it will just carry on, year after year, causing more unnecessary suffering. The role of psychological injuries in 7 of the 10 leading causes of early death is not being addressed and treated and solved in the current system.
Those Who Know, Are Paid to Shut Up
Oddly enough, the professionals in the system who know the most about psychological injuries and their role in terrible diseases and early death have no interest in telling their physician colleagues about them. Doing this would actually be against their financial interest - they would lose a lot of money. Consider this fact: the 273 speakers at the annual meeting of the American Psychiatric Association in 2008 had signed 1371 consulting or promotional contracts for one or another drug company. On average, 5 different drug companies were paying each speaker. And as I discussed in a previous article (which you can read here), the drug companies strongly want to promote the idea of 'chemical imbalances' as causing mental health problems. Once someone accepts the idea, they then believe they have to take pills to correct the imbalance. Which is very profitable for the drug companies.

And every psychiatrist who accepts money from the drug companies understands that they have to promote the interests of the drug companies. They signed a promotional contract, and they could get sued if they do not fulfill it. They better talk up chemical imbalances and pills. It would be quite uncomfortable if they were to describe the research on how psychological injuries (whether childhood trauma, highly stressful life events, toxic bosses, or trauma in adulthood) are the single largest cause of both physical and mental health problems. Some family doctor at the back of the room might raise their hand and say, "If sexual abuse has such a terrible impact on health, shouldn't we assess for it, and use psychotherapy first? The pills might numb the pain for a while, but if people stop taking them they relapse because the pain is still there. Therapy can address and help heal the sexual abuse, and has no negative side effects."

The psychiatrist is suddenly in an awkward spot. If they agree with the doctor, then they have just undercut the market for pills, and promoted psychotherapy, and no drug company will give them a consulting contract again. And these are very lucrative. Even though psychiatrists are 5% of MD's in the US, they are 55% of the best paid consultants to the drug companies.That is a lot of cash - top psychiatrists have made millions in consulting to drug companies.

Clearly, many psychiatrists are not going to change anytime soon. As long as they accept the dollars, the psychiatrists will sing the song that Big Pharma writes for them. They will not be pushing to reorganize the health care system around assessing and treating psychological injuries, they will be fulfilling their promotional contracts with the makers of pills. Which is a pity. Because understanding how emotional wounds shape our bodies, and cause so many illnesses, and coming up with highly effective ways to treat them, is arguably the single most important contribution to improving physical and mental health in the 21 st century.

But you do not have to wait for others. You may have been a bit on edge for the last few paragraphs, because you recognized that you have psychological injuries. Your anxiety may have jumped when you read how they contribute to so many fatal conditions. However, there actually is good news. Because injuries are very different from imbalances. Injuries can be healed. Imbalances cannot, you just have to take something for the rest of your life to correct it. There is a major difference between a broken hip and Type I diabetes. You may need surgery, casting, and physiotherapy for your broken hip, but you will eventually be walking on your way. With Type I diabetes, you will constantly be correcting the imbalance of insulin.

How to Heal Your Invisible Injuries

And the best way to heal a psychological injury is with psychotherapy. That is because therapy is the opposite dynamic to what caused the injury in the first place. In therapy, the client feels heard, understood, and respected by the therapist. Years earlier, the client felt overwhelmed and degraded by their abuser. In therapy, the client talks about their goals, and the therapist helps them to achieve those goals. Long ago, what the child wanted was totally ignored by the perpetrator, who was focused only on their evil desires. In therapy, the counselor uses an approach that fits well with the client and that they buy into. In the past, the abuser did exactly what they wanted, regardless of what the child wanted. In therapy, the client feels very safe. In the past, the child felt fear and uncertainty. And as the client experiences respect from the therapist as they work toward their goal, moving at a pace and in a direction that feels right to them, the psychological injury starts to heal. The support and encouragement nurtures a sense of worth, safety, and calm in the client that was not there before.

Healing in Every Cell of Your Body

And the healing can be very deep indeed. Psychologists in Germany worked with a group of refugees from the Middle East. These people had fled wars in Syria, and seen family members shot and their homes burned. They had experienced terrible trauma. In fact, when the researchers measured their DNA, they found that the refugees had as many breaks in their DNA as people who had been exposed to an atomic bomb blast. Their nightmares were terrifying, the flashbacks were intense, and although many of them took psychiatric pills, those did not solve the problem. Half of the group of refugees waited for treatment, while the psychologists treated the other half for their post-traumatic stress disorder. The people who had to wait for treatment had no change, either in their symptoms of PTSD or their DNA. However, the refugees who received psychotherapy for their PTSD not only had their symptoms vanish, but their DNA was as healthy as people who had never been exposed to a trauma at all!

The positive impact of therapy on physical health shows up in dozens of studies. When kids or adults respond well to psychotherapy, their DNA changes. These occur even if the people have serious problems with suicidal impulses, emotional instability and distorted thinking. Therapy results in improved functioning of the immune system and less diarrhea, nausea, and chronic pain among people treated for PTSD. It also reduces inflammation, as a variety of markers of inflammation (C-Reactive protein, Inter-leukin 6, tumor necrosis factor alpha) are lower after therapy than before. Therapy can even facilitate growth in a person's brain. Although people with PTSD had less gray matter than those without PTSD, after therapy, the amount of gray matter was equal between the two groups. In other studies, people with PTSD had a smaller hippocampus in their brain than those without PTSD. After therapy, the hippocampus of traumatized people grew to be the same size as the control group.

Therapy can be helpful even when people develop a major illness. If people develop coronary heart disease, therapy is associated with a 21% reduction in cardiac mortality, across dozens of studies. It also improves depression, anxiety and stress levels. There even is a positive impact of therapy on cancer. People who receive therapy (in addition to usual cancer treatment) survive significantly longer than those who do not. The effect exists for people with cancers that are less aggressive and developed, and who are single.

These findings give real hope for anyone, no matter how bad their psychological injuries. DNA that is damaged as badly as in an atomic bomb blast can be repaired and rewritten as a result of therapy. The immune system functions better, inflammation and chronic pain is reduced, and the brain can even grow to the same size as people who have never been traumatized. If people do develop heart disease or cancer, psychological interventions can help them survive longer.

But the hope is for those who seek out therapy, not pills. Psychoactive pills have a different effect on people's health. Antidepressants, and especially antipsychotics, can cause major weight gain. This increases the risk of diabetes from 30% to 258%, respectively. This is just one of 20 types of adverse effects, ranging from gastrointestinal problems to increased risk of osteoporosis and fractures, to sexual dysfunction, to cardiovascular problems and more. The pills can trigger suicidal thinking in young people, and have a black-box warning from the FDA to that effect. They also increase the risk of suicide attempts or completion in adults by 2.5 times. That is not the only fatal risk. Antidepressants increase the risk of early death by 33%, while antipsychotics increase the risk of sudden cardiac death by 226%. Whether it is increased risk of diabetes, fractures, cardiovascular problems, suicidal acts or early death, pills can result in a shorter lifespan, not a longer one.

Now we see how the Psychological Injury model can help save your life. It says that the single biggest factor in 7 of the 10 causes of early death is emotional wounds. (They also are the biggest cause of mental health problems, which you can read about here.) And even though the physicians do not know about this cause, and therefore cannot assess for these emotional injuries and then treat them, you now have this knowledge and power. You can use this truth to guide your changes to a longer and more robust life.

The Most Important Document for Your Health

The next step for you is assessment. The current approaches miss the mark. Hospitals use machines to look at broken bones or malformed flesh, psychiatrists ask about clusters of symptoms you have had in the last few weeks - neither approach systematically looks at the emotional wounds you have experienced in the past. (Why psychiatrists do not ask these questions is a huge topic for another time.) The PI model says that a new approach to assessing people is needed, which is to map out all their psychological injuries. Only then can a professional understand what happened to a person, how they coped with it, and how they wound up in this particular place in life. You can access this new approach for free by going to psychologicalinjuryindex.com and downloading it. When you fill it out, you will notice that it asks about 4 major areas: childhood trauma, toxic boss, highly stressful life events, and trauma in adulthood. Each area is relevant and has a major impact on your health. For example, working in an environment that you strongly feel is unfair increases your risk of heart attack by 55%. Or having a trauma in adulthood and developing PTSD is strongly associated with suicidality. It may be challenging to fill in the Psychological Injury Index (PII), as emotions may rise up, or you may have thoughts that you should be over these experiences. I encourage you to press on, as your life is worth it.

Once it is filled in, the PII is the single most important document in your healthcare plan. Because for the very first time, you have a map of the factors that are most likely to trigger 7 of the 10 leading causes of early death for you. Nobody else has this map. Your doctor does not have it, heck, they likely do not even know what you now know about the link between psychological injuries and fatal diseases. It would be very good if they knew (feel free to share this article with them, it has dozens of research articles supporting it). However, you do not have to wait for your physician. Because you can shape the path of your life yourself, by acting on the results of the Psychological Injury Index.

Finding the Best Healing for Your Invisible Wounds

With assessment in hand, you can start your treatment. The third major tenet of the PI model is that psychotherapy is the optimal approach for healing psychological injuries, because it creates the opposite dynamic to that which caused the wound. But seeking out the best therapy can be tricky. There is a bewildering variety of approaches, and it can leave your head spinning. The key truth to keep in mind when seeking out therapy is that the single biggest factor that influences whether clients improve is their sense of teamwork with their therapist. It is not so much about the technique used (ACT, EMDR, CBT), it is far more about the therapeutic alliance you experience with your psychologist or counsellor. The sense of teamwork is crucial, for people heal people. For that reason, try out two or three therapists to evaluate with whom you have the best sense of connection. And since the sense of teamwork is so central, seek out therapists who measure it in each session. The process of measuring helps to create a culture of feedback and dialogue about your work together, and whether it is on track or not. If you were being treated for high blood pressure, you would want your physician to measure your blood pressure each time you met her, to see if the interventions are working. Multiple research studies show that measuring if clients are making progress in therapy, and their sense of teamwork with the therapist in each session, can double or even triple the effectiveness of therapy. These are major improvements in the quality of therapy, and are crucial to the PI model.

Although clients improve faster when the therapist measures outcomes and alliance, it is well worth staying in therapy even if the immediate pain has diminished. Deep psychological injuries take a long time to heal, and affect people in many different ways. I have repeatedly had the experience where clients disclose sexual abuse only after a year or more of therapy, because it has taken so long for them to build sufficient trust to discuss this very painful event. Even after disclosure, beliefs that they deserved the sexual abuse, or are filthy and worthless, can take many months of steady effort to undo. It also is a real journey to change the dysfunctional patterns of coping with emotional wounds. Reaching for a phone to talk to a sponsor in AA when angry or lonely instead of reaching for a bottle of vodka usually does not happen immediately and permanently. It is a challenge to learn to navigate one's pain, instead of numbing it out with a substance. But it is a very worthwhile one.

You and your loved ones now have a new future. Whether the psychological injury was early in your life or recent, whether your boss bullied you, or your business partner stole from you, whatever the nature of your emotional wound, a healthy new future is possible. Torn DNA can be woven together again, blood pressure can drop, gray matter in the brain can grow, and you can greatly reduce the risk of 7 of the 10 leading causes of early death. Download the Psychological Injury Index, fill it in, and seek out a therapist you connect with, who measures outcomes and alliance in therapy. And as you are heard and respected, as the counselor helps you achieve your goals, or the psychologist uses an approach that works for you, the emotional injuries heal, and your body does as well. The Psychological Injury model shows a path that can save your life, and with all you have been through, you deserve a long and robust future.

Dr. Eric Kuelker is a practicing clinical psychologist. He is the only psychologist in his country (Canada) to publish aggregate data on how much his clients progress in therapy. His TEDx talk and access to the Psychological Injury Index are available at psychologicalinjuryindex.com.

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How Psychological Injuries Cause Physical Illness-And How Therapy Can Heal It - Mad In America

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Your brain really wants to keep you alive. It is a major preoccupation, literally of life and death importance. And with good reason - the people in the past who did not detect danger got gobbled up by the wolves or bears.

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Confessions of an ignorant and frustrated teacher

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Trauma during development or, childhood trauma, changes the architecture of the physical brain and the ability to learn and social behavior. It impacts 2 out of 3 children at some level, but I didn't even know what it was...

Childhood Trauma can be defined as a response of overwhelming fear or helplessness to a painful or shocking event, or to chronic, toxic stress, including ACEs (adverse childhood experiences).

ACEs include physical, emotional and sexual abuse, physical and emotional neglect, a missing parent (due to separation, divorce, incarceration, death), witnessing household substance abuse, violence, or mental illness and more.

Trauma-impacted children are not sick or "bad", they are injured. Developmental trauma is an injury. It happens TO the child. In turn, when they become adults, many re-enact unaddressed trauma, injuring the next generation in a merciless cycle of pain and fear. When multiple injuries fester unaddressed, they set off a chain of events leading ultimately to early death, according to the CDC.

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Deep Impact: Developmental trauma changes the architecture of a developing child's physical brain.

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Part 1: The changes to the physical structure of the brain impair cognition. The specific changes to brain architecture damage children's memory systems, their ability to think, to organize multiple priorities (" executive function"), and hence to learn, particularly literacy skills

Part 2: The changes to the child's neurobiology predispose hypervigilance and suspicion, leading trauma-impacted children to misread social cues. Their fears and seemingly distorted perceptions generate surprisingly aggressive behaviors. Their 'hair trigger' defenses ( or a withdrawn, dissociation) are often set off by deep memories outside of explicit consciousness of the child.

Adults' view, from the 'outside', of the seemingly illogical, or worse, oppositional behavior, is often one of shock, confusion, frustration and maybe anger.

If we act on our uninformed views, we risk re-triggering more of the child's trauma, and even more aggression. I confess, as a less experienced classroom teacher, I often did exactly that.

The child's inner pain and fear are often intentionally camouflaged and nearly impossible to perceive from the outside.

The trauma history, which connects the inside fear to the outside behavior, is often buried so deeply in the brain that even the injured child can be unconscious of the connection.

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Some adults normalize the pain and fear of the injured child, thinking "they'll get over it." It's actually the opposite. Young children have fewer coping mechanisms and their immature brains are still developing.
The impacts of trauma are actually greater on the still-developing brain.
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ACE-impacted kids are more common than seasonal allergy sufferers

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Experts including Surgeon Generals and the Attorney General have described children's exposure to violence and trauma with specific terms 'national crisis', and '' years ago. The CDC says impacts from childhood trauma are critical to understand.

Childhood trauma is a broad-based crisis. It impacts children of all colors, all income levels, all education levels, all social strata, across all geographies. It's all of us.
Scientists Felitti/Anda(CDC) have found that even in beautiful, suburban San Diego about one-fourth of middle class, mostly white, college educated, working folks with medical insurance had THREE or more ACEs!
Three or more ACEs is significant because three+ ACEs correlate over a lifetime, with doubled risk of depression, severe obesity, drug abuse, lung disease, and liver disease. It triples the risk of alcoholism, STDs and teen pregnancy. There is a 5X increase in attempted suicide. The lifelong impacts are shocking and alarming.

The American Academy of Pediatrics' policy says that child abuse and neglect are significantly "associated with many leading causes of adult death "

Children did not cause their own trauma and they can not address their trauma alone. They need adult support.

Nevertheless, presently many adults ignore childhood trauma. It's rarely spoken about.

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Schools are not trauma-informed organizations

I am embarrassed to admit my own ignorance.

I did know about the inner pain and fear of my students more intimately than most. I began, and still begin, every school year by visiting my student's families, sitting in their living rooms to discuss school, life and their hopes and concerns about their child. In the classroom, I quickly experience the child's outward behaviors which can seem random, nonsensical at times, and often angry.

Yet, I still do not easily connect the angry, outward behavior in the classroom to the inner fear or pain.

As an adult, the classroom seems "safe." There isn't an obvious or logical connection to continuing fears, in our safe context. It seems contradictory.

What I forget is that the pain and fear are not in the environment.

The pain and fear are hidden inside the child: they bring intense fear memories and altered neurobiology with them like they bring their backpack ( wherever they go).

Making the connection, intellectually, is even more difficult in the midst of my own stress from a triggered student's emotional, intentionally distracting, sometimes screamed, personal insults or abusive attacks.

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Even when I have been able to stay calm myself, and to connect the (seeming) anger to the (hidden) fear, that was only the beginning. I still did not understand.

There's more.
The group context, or the social complexity in the classroom may be the most difficult aspect of all.
I learned the hard way:

when I stay calm in the midst of the triggered child's barrage, it seems like "unfair" leniency to other children. They see only the aggressive outward behavior from a peer and they expect "punishment".

More learning when I succeed in maintaining composure:

the other 30 children in the room are calmly or politely for me so I can focus solely on de-escalating one of their peers. It's an uncomfortable and off-task process for other kids to endure so they also digress quickly.

Even more learning:

whether I stay calm or not, the aggression and commotion of one triggered student will often trigger a second student's fear, maybe others too.

Keeping the academic context in mind, all above initiates from a single instance only. Several instances involving different students can happen every day, sometimes simultaneously. Meanwhile, each minute invested to de-escalate a single student is a minute lost to academic endeavors for all thirty other students.

It's complex.

Now, imagine NOT being trauma-informed and facing 20 to 30 students, and NOT knowing that 20% to 50% are trauma-impacted...

"Success" would require becoming expert at detecting multiple, virtually undetectable triggers, within multiple students. It is not quick or simple or instinctive.

There's more.

That same teacher must become expert at defusing all those students' fear triggers, and all in advance of any "fight or flight" response.

All day today.

All week this week.

All month this month.

More context: A teacher is not permitted to consider adjusting the scope or pace of lessons: the "Common Core", or academic "national standards" which are synchronized and connected, lesson-by-lesson, and which lead to "standardized" testing.

The recurring, "standardized" tests and the resulting stresses are rightfully controversial for many reasons, by themselves. Trauma-impacts add more controversy. First, the stress of the high stakes of the tests can re-trigger past traumas during testing. Second, the tests also occur in urban settings with higher concentrations of violence, poverty, stress and trauma, all impairing cognition. Test results can then be distorted as "achievement gaps" for higher concentrations of students of color in that setting and socioeconomic status.

Let's pile on top: budget cuts for public schools each year translate to fewer Teachers/Counselors/Nurses with fewer resources to accomplish trauma-informed education, year after year.

"Teaching" in this context becomes nearly impossible at many points.

We are trying to scoop water out of a boat which has gaping trauma-holes in the bottom.

Trauma-impacted children are losing their right to equally access their education, while adults stand by, while school districts stand by, while states stand by.

That leads to the central conclusion and key action :

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Schools must become trauma-informed organizations

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Cognitive, or "educational", processes are muted neurologically in triggered children: a direct conflict with schools' missions.

If schools are going to achieve their educational mission, for all students, then schools must be aware of and accommodating of trauma-impacted students.

"Success" with trauma-impacted students comes slowly, over time. It is crucial to maintain a safe, predictable, calm, environment, and safe relationships, school-wide, with all adults responding calmly, hour by hour, day by day, month after month. Safety, safety, safety, at all levels, in all endeavors, in all domains. And that's only the beginning.

Just as children can not address their own trauma alone, teachers can not create trauma-informed school organizations all alone.

Teaching trauma-impacted children is an intense role. Teachers need training, support, strategies and resources. Explicit training and support are essential. It's crucial that the classroom training and personal training and support for school-wide staff be on-going. A few hours in a "PD" session can help build awareness, but becoming competent with the depth and breadth of the issues requires much more than a PD.

Training should start with brain science, including the continuing, lifelong impacts of developmental trauma. Practical basics include de-escalation and then also strategies to avoid in our school systems, so schools themselves are not re-triggering or re-traumatizing children. Otherwise, our attempts at "academics" will be, at best, inefficient, more likely futile. Explicit training also includes the community context and the expectations for school context, and efficiently accessing school supports (along with "how-to" implement)... only a few of the beginning requirements.

Simultaneously, at the school level, we need to identify, or in some way, screen for students' trauma histories. It's too easy to miss camouflaged trauma, in particular those who defend by quietly dissociating.

'Trauma-informed' includes an adequate ratio of adults to students in a classroom. One adult for thirty children is not trauma-informed. The data says that six-to-ten children ( minimally) in a classroom of thirty are trauma-impacted. Inadequate staffing is unethical, and is directly in conflict with 'equal access' to education for all the children in the same classroom.

'Trauma-informed' includes physical space for students' off-line de-escalation, away from the 'crowd', noise, stress, and triggers - not simply 'the corner' of the same classroom with 30-plus other folks trying to learn. Off-line de-escalation space also requires trauma-competent adults, including on-site counselors and a nurse.

'Trauma-informed' radically restructures discipline away from 'zero-tolerance'. Otherwise, school systems continue filling "the school-to-prison pipeline " with injured, trauma-impacted children.

Further, we need to confront the impotence, the stress, and the damage created by the paradigm of school as a "learning factory" with synchronized timing and "standardized" testing.

Finally, we should be adjusting efforts against "achievement gaps" to a laser focus on communities with greater violence, stress and trauma.

All the above efforts at 'trauma-informed' help confront the horrifying litany of lifelong implications of trauma during childhood development. Meanwhile, children are losing their right to equally access their education
In spite of the devastating impacts and implications, Developmental Trauma remains "the elephant in the [class]room"! That is wrong, morally wrong.
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Help build awareness of developmental trauma

"Nowhere to Hide" blogposts are designed to help grow awareness of childhood trauma. Each post focuses on a single component of the workings of developmental trauma, via a real life example in short, "60 second" soundbite links, akin to "Public Service Announcements" (PSAs).

All the narratives are all about real kids (with pseudonyms). I live in community with them, and know them personally as students, neighbors and friends. These are not "combined" or imaginary narratives, or caricatures.

Most of the children in the stories lived in a single neighborhood. Each one passed through my classroom. More than half were in the same classroom, the very same year"! Difficult to imagine...

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"Nowhere to Hide" series links

Trigger warning:
The children's experiences in the vignettes are unvarnished. Their traumatic responses may trigger painful memories. Nowhere to Hide: Maria; Fight, flight or freeze Nowhere to Hide: Andre's Fear; What are Adverse Childhood Experiences? Nowhere to Hide: Jamar's Hyper-arousal Nowhere to Hide: Roberto's Dissociation Nowhere to Hide: Danny's Memory Nowhere to Hide: Ashley's "Normal" Education? Part 1 Nowhere to Hide: Ashley's "Normal" Education? Part 2
More to come

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Please share a PSA link to help grow public awareness of the impacts of developmental trauma. There are so many of us who've never heard of the overpowering life-long impacts.

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"Peek Inside a Classroom" series overview

The second original series, "Peek Inside a Classroom", provides much more detailed looks inside my classroom, primarily focused on specific students: Jasmine, Danny and José.

Other children are captured in broader looks at education reform concepts: "Failing Schools or Failing Paradigm?" and "Effective Education Reform", co-authored with Sandra L. Bloom, M. D..

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"Peek Inside a Classroom" series links

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Peek Inside a Classroom: Jasmine Peek Inside a Classroom: Danny Peek Inside a Classroom: José Peek Inside a Classroom: Failing Schools or Failing Paradigm? Peek Inside a Classroom: Effective Education Reform (with Sandra Bloom, M.D.)
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"Click for Resources..." series overview:

"Click for Resources" posts are the theory and research behind the narrative posts in " Nowhere to Hide" and " Peek Inside a Classroom".

Each post in " Click for Resources " is divided in three parts:
1) general press articles, 2) Research Journals or academic papers 3) social media, often with video.
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"Click for Resources" series links:

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1. Adverse Childhood Experience (ACE) Studies: CLICK HERE 2. Impacts of Childhood Trauma: Overview CLICK HERE Click for Resources: Social Media on Impacts of Childhood Trauma Click for Resources: Journal Articles on Impacts of Developmental Trauma 3. Trauma-Informed Schools CLICK HERE 4. Trauma-Informed Social Services CLICK HERE 5. Trauma-Informed Juvenile Justice CLICK HERE 6. Trauma-Informed Public Policy CLICK HERE 7. Childhood Trauma Training and Tools CLICK HERE 8. Book and Publication selections CLICK HERE 9. #800 phone numbers CLICK HERE
Developmental trauma, still "the elephant in the [class] room" for many adults.

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* * * NOWHERE TO HIDE * * * "The Elephant in the [Class]Room"

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Trauma during development or, childhood trauma, changes the architecture of the physical brain and the ability to learn and social behavior. It impacts 2 out of 3 children at some level, but I didn't even know what it was...

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Inclusion, Education and Learning Resources

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Teaching Emotional Regulation as a Behaviour Strategy

The ability to regulate our emotions should not be presumed, emotional regulation is a skill and needs to be learned, sometimes through explicit instruction. Recognising your own emotions and identifying effective strategies for managing these is a key skill for any child. For those who require additional skill teaching around managing their own emotions Systems such as emotion works and Zones of Regulation are great. I won't repeat their systems here but they are both widely used and effective strategies.

I think it is unhelpful to label emotions negative or positive as all are reactions to interactions or events occurring around or to you. Many of the responses to emotions in young people are shaped by their needs, communication skills or background, including potential trauma and abuse. Teachers need to be mindful of this and the impact it will have on the child reactions to certain situations. Some emotions are specifically designed to keep you safe (fear) so additional work may be better focused on desensitisation or applying a functional and clear method of escape - The symbol above is a simple example of this. The child can use it to immediately end an activity, food tasting, game etc. I believe symbols and cards like this are essential even for students who can verbalise requests. In times of stress, expressive language skills can be impaired so grabbing a symbol can reduce potential "challenging behaviour" by easily communicating a need to exit the situation.

No Worries

I have just discovered this book No Worries! Mindful Kids: An activity book for young people who sometimes feel anxious or stressed by Dr Sharie Coombes This is the excellent little resource which has a number of self-regulation strategies the child can start to use to reduce anxiety.

I wanted to share here some of the approaches I have used with the autistic students I have worked with. All of these need to be highly personalised and be ready to adapt. The following Top Tips are things I have tried and found effective I would love to hear your tips and experiences in the comments.

Top Tips for Teaching Emotional Regulation.

Use emotional vocabulary all the time- identify and name the emotion you see or feel.

The context of the emotion is as important as the behaviour that stems from it

Teach coping strategies when the child is at their baseline stress level.

Practice emotional regulation strategies regularly.

Model the positive behaviours you want to encourage.

Simple Strategies are best, however be ready to get creative.

Ensure all adults honor their side of all agreed responses.

Create a safe space to develop these skills - A Zero Tolerance Classroom is not going to work.

Link known triggers to functional responses.

Give emotional regulation time to work (At least a fortnight of consistent application)

You need to be the child's emotional brakes when teaching these skills.

Emotions Charts

These, as well as thermometers, can be a valuable tool in promoting self-regulation and teaching coping strategies. Download this free Emotion Levels Chart to complete with the child with strategies. This version is for older children/adolescents

Emoji Emotions Free Worksheets

Okay, this is a bit gimmicky but the idea of using emoji's is to link with aspects of online safety lessons. We introduced emoji's because we also use widgit symbols of the emotion faces as they are very similar in appearance. More and more often our children are called on to be able to decode hidden meaning in messages through using this quite accessible system.

Download the Free Emoji Emotions 3 worksheet bundle including matching and the checklist. To use the checklist I hid emoji's around the room and they were checked off as the children found them.

My Little Worry book.

This post contains a great little resource for emotional regulation that I made last year " My Little Worry Book ". This is a free PDF printable that can be carried in a child's pocket for when they just can't find the words.
Thank you for taking the time to read. I would love to hear your comments.

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Emotional Regulation in SEND: Resources - Free Pritnable Resources

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The ability to regulate our emotions should not be presumed, emotional regulation is a skill and needs to be learned, sometimes through explicit instruction. Recognising your own emotions and identifying effective strategies for managing these is a key skill for any child.

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As the summer sets in, you may be thinking about taking lessons outside.

But such moves can be tricky to justify; is it really going to benefit learning or will it just become a distraction?

It's often intuitively believed that nature is good for children, and that being away from the restrictions of the classroom environment enables them to learn more effectively.

Quick read: Why are we so reluctant to take learning into the outdoors?

Quick listen: How to spot education education myths and read research

Want to know more? Is mindfulness the answer to teachers' wellbeing woes?

But what is the evidence telling us? Are such claims based on any research findings?

There is certainly a benefit to spending time outside.

In a 2014 study by researchers at the UCL Institute of Education, children from urban communities who had access to parks and other green spaces were found to have higher levels of emotional and behavioural resilience, while other studies have found relationships between nature and academic achievement and symptoms of depression, for example.

The benefits of outdoor learning

But there hasn't been a systematic critical review of the evidence until now. Ming Kuo and her team at the University of Illinois recently examined hundreds of studies that reported many different positive outcomes of outdoor learning and spending time with nature.

They found that nature does indeed boost learning, in several different ways.

It has a rejuvenating effect on attention, relieves stress, boosts self-discipline, increases physical activity and fitness, and promotes self-motivation, enjoyment and engagement.

Additionally, nature creates calmer, quieter and safer learning environments, fosters warmer, more cooperative relations among students and encourages more creative and exploratory forms of play.

All of these factors are clearly conducive to more favourable academic outcomes; if students are calmer, they learn better.

If they are able to regulate their own behaviour, they are less likely to disrupt their own and other students' learning.

More specifically, increased connection with nature was found to result in better attention, higher standardised test scores and higher exam grades, and better reading, maths and writing skills.

Improving pupils' wellbeing

Because such a large number of studies are reporting similar results using different research methodologies (including randomised controlled trials), Kuo proposes that what is being seen is a real cause-and-effect relationship.

Collectively, these studies add weight to the view that outdoor-based learning brings wide-ranging benefits, both cognitively and in regards to wellbeing and personal control.

The review would also support alternative learning environments such as the forest school approach and perhaps even provide evidence for those teachers wishing to get their pupils out of the classroom for a while.

These findings may also indicate that the trend towards increasing indoor learning in the hopes that it will maximise exam results could be having the opposite effect, a view proposed by Kuo and her team.

Access to the great outdoors

There are, of course, some obvious problems with these conclusions. Schools in inner-cities tend to have fewer green spaces than those in the leafy suburbs, which also tend to have fewer pupils from lower socio-economic backgrounds.

Trips out into the countryside or to outward bound-type facilities can be expensive, leaving some children disadvantaged. As is often the case, the research doesn't necessarily match what happens in the real world.

However, the authors of the study say that even brief exposure to nature can be beneficial. This could even include just being able to see green spaces from classroom windows or spending just a short period of time learning outside.

Justifying outdoor learning could also be difficult in a climate where a traditional academic curriculum is the highest priority and exam results are so important.

Such a climate may often lead to an emphasis on classroom learning rather than more non-traditional methods. Teachers might even feel that outdoor learning gives them less control.

Kuo and her colleagues, however, are convinced that the more we allow learners to experience nature, the greater the benefits to both their academic performance and overall wellbeing.

Marc Smith is a chartered psychologist and teacher. He is the co-author, wth Jonathan Firth, of The Emotional Learner and Psychology in the Classroom. He tweets @marcxsmith

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As the summer sets in, you may be thinking about taking lessons outside. But such moves can be tricky to justify; is it really going to benefit learning or will it just become a distraction? It's often intuitively believed that nature is good for children, and that being away from the restrictions of the classroom environment enables them to learn more effectively.

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Secondary Traumatic Stress for Educators: Understanding and Mitigating the Effects

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Teaching kids who have experienced trauma can be stressful to educators. Acknowledging that teachers might be experiencing secondary traumatic stress is a step in the right direction to help teachers feel that they are not working alone.

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When training teachers on trauma-informed classroom strategies, the most frequent pushback I hear is "I don't have enough time or resources."

Maybe this is because we start with defining the problem, and it is bleak. Some estimate that between one third and one half of all children experience trauma. The impacts of trauma on the brain and body can be severe, pervasive and long-lasting. Trauma can contribute to challenging behavior and mental health challenges, and can negatively affect a child's ability to learn.

It's easy to feel hopeless.

Something we've known for a long time is that consistent, caring relationships are one of the biggest factors in helping children heal from trauma. Enter the teacher's protest: "I have so many students," "I don't have enough time to help them all," "There are no resources in my school."

All of those things are true - and I do believe that we need to drastically change the education system in many ways, for the benefit of all students. But what can we do the in the meantime?

The answer, it turns out, is to sweat the small stuff.

In Bruce Perry's updated version of The Boy Who Was Raised as a Dog, endnotes add updates from current research to his classic accounting of the effects and treatment of trauma. In one section, Perry discusses the idea of "therapeutic dosing" - the question of the timing, frequency and content of therapy that best supports healing from trauma.

Indeed, long-term and enduring changes to neural networks can be created by an intense period of stimulation that lasts less than a minute. Synaptic splitting, which is one way these connections can change, can occur in meres seconds of intense stimulation - and if the intense experience is repeated four times within an hour, the change will be maintained long term.

Just as a traumatic experience can alter a life in an instant, so too can a therapeutic encounter.

....The good news is that anyone can help with this part of 'therapy' - it merely requires being present in social settings and being, well, basically, kind. An attentive, attuned, and responsive person will help create opportunities for a traumatized child to control the dose and pattern of rewiring their trauma-related associations. ... The more we can provide each other these moment of simple, human connection - even a brief nod or a moment of eye contact - the more we'll be able to heal those who have suffered traumatic experience.
-Bruce Perry , 2017 edition of The Boy who was Raised as a Dog, p 308-9

This idea of "therapeutic encounters" or "therapeutic moments" should be one of the first things we teach pre-service teachers. What I love about this concept is that it both gives us permission, and it holds us accountable. It gives us permission to play an active role in the healing of others, because that role can be a tiny empathetic moment, a personal question, a joyful high-five. It also holds us accountable, because this work isn't too hard for any of us: none of us can say we don't have the training, the experience, or the expertise to have a therapeutic encounter.

Now imagine that every teacher, staff member, adult in a school commits to creating therapeutic moments within the school day. Imagine they all agree to slow down just a little bit, be kinder in the hallways, use twenty seconds of passing time as an opportunity to say a genuine "It's nice to see you" to a student. If we can create a web of therapeutic moments, interconnected by our unconditional positive regard, we can create the environment for change.

My favorite part from the quote above, again: as a traumatic experience can alter a life in an instant, so too can a therapeutic encounter. You never know how the small moments can add up to change for a trauma-affected child - so let's create a tapestry of these small moments within our schools so we all can heal.

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What can one teacher really do about trauma?

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When training teachers on trauma-informed classroom strategies, the most frequent pushback I hear is "I don't have enough time or resources." Maybe this is because we start with defining the problem, and it is bleak. Some estimate that between one third and one half of all children experience trauma.

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University of Georgia education professor Peter Smagorinsky wrote a piece last year about a promising young teacher who chose to leave education. She has now returned to the classroom but in a different Georgia district.

In this column, Smagorinsky explains how her new district, with a focus on enhancing relationships rather than test scores, has revitalized her enthusiasm for teaching.

By Peter Smagorinsky

A year ago I wrote a Get Schooled essay about an outstanding early-career high school English teacher in Georgia who had become so frustrated with testing and scripted curricula that she decided to leave the profession. She had been a participant in a study I am doing of the career development of teachers, with interviews each semester since 2010, when she was still at UGA education major.

I'm happy to say she contacted me in the spring with the news that working in the private sector for a year had produced a yearning to be back in the classroom. Her job had been quite pleasant, and she had appreciated the way her day began at 9 and ended at 5, and did not involve late afternoons and evenings filling out forms, tutoring, grading papers, planning classes, recovering from exhaustion, and consuming her life until she started over again the next day.

It was a nice respite from what had become a grind in the classroom. But, ultimately, to her it was unchallenging, a bit boring, and unfulfilling. It was time to get back to the kids.

We talked for about 90 minutes recently about her first semester back at work. She did not return to her old position, her old school, or her old district, all of which she had found stultifying to her creativity and her relationships with her students. Her former district relies on test-driven curriculum and instruction, determining teacher effectiveness by test scores, no matter what kind of shape the kids are in. It was exactly what she wanted to avoid.

Her new district provides quite a contrast. At the school's orientation before classes began in the fall, her superintendent spoke about the importance of human relationships, above all else. Not test scores. Not real estate values tied to test scores. No, he spoke compassionately about how everything follows from developing and fostering productive relationships within the district.

The emphasis on relationships was the central driving force in her return to teaching and in her happiness with this new position. The school is not perfect, of course. She has quibbles with some of the policies, for instance. But she loves the fact she has tons of latitude in what to teach, and how to teach it. And she loves her students and the idea that her main task is to ground her instruction in the relationships she develops with them.

Many of the kids come from low-income households, are immigrants, have personal challenges, and, in general, represent the demographic groups whose test scores often reflect poorly on a faculty and administration. But here was the superintendent telling the faculty to tune out the noise about test scores and focus on making the school feel positive to kids, teachers, counselors, principals, and I'm sure the cafeteria staff, grounds crew, and custodians as well.

What, then, helps teachers form these relationships? It's useful to contrast her current district with the district she left a year ago in frustration. Her previous district administration had created a lot of barriers between students and teachers that produced alienation of each from the other.

The school's scripted curriculum had reduced her flexibility in teaching on the basis of what she believed her students needed most. A curricular barrier of this sort assumes all students in the district (and other districts that purchase the same materials from edupreneurial corporations) have the same interests and needs. Anyone who has raised two children in the same household knows even the most closely bonded youth have different needs, however, and those needs are probably quite different from what a remote corporate textbook writer provides for them.

Making instruction responsive to the textbook's materials and accompanying assessment products, rather than to what teachers understand about kids, alienates teachers from kids, and kids from both teachers and school. In a school like the one that now employs this teacher, with a predominant population of students of color whose heritages get little representation in these corporate products, the likelihood of estrangement from the institution of school is great.

The testing mandates further damage the possibility of constructing and cultivating strong relationships with students. These bonds in turn may lead to instructional insights that produce relevant, on-target instruction. Tests intervene in relationships by warping instruction toward the most reductive, least compelling ways of thinking: picking the best of four multiple choice items in response to a question the test-taker has little interest in answering.

The teacher I interviewed asserts this emphasis discourages teachers from teaching in any way that is not ultimately tested. This requirement means shutting down all open-ended, creative, constructive thinking and focusing on how to pick the best of four possible answers to irrelevant questions, posed only for diagnostic purposes. Kids see through this sham pretty quickly. It's a shame policymakers are too dim to understand what any teenager could tell them in a second.

Relationships are not developed by limited-choice options. They follow from genuine interaction, mutual listening, generosity, care, responsiveness to emerging needs and hopes, and constructive thinking in relation to shared challenges. These processes are fluid, not restricted to four choices. By presenting teaching and learning as static, with fixed answers to immutable questions, the possibility of growth into active citizenship in a tumultuous social world is damaged.

I often hear administrators lack the will or fortitude to buck the assessment movement and its grounding in business-style accountability measures that reduce complex actions to single numbers. There's at least one district in Georgia, however, where the superintendent has rejected the premises behind that assumption and has insisted good teaching begins with forming relationships with kids.

I wish there were a whole lot more school systems with leadership of this sort. I suspect most teachers would agree with me, and that kids would buy into education much more if such alienating barriers to the building of relationships were removed.

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What if schools focused on improving relationships rather than test scores?

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University of Georgia education professor Peter Smagorinsky wrote a piece last year about a promising young teacher who chose to leave education. She has now returned to the classroom but in a different Georgia district. In this column, Smagorinsky explains how her new district, with a focus on enhancing relationships rather than test scores, has revitalized her enthusiasm for teaching.

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When Julie* adopted three young children nearly 20 years ago, she knew that they hadfetal alcohol spectrum disorders (FASD) and had been removed from their biological parents after undergoing extreme emotional, physical and sexual abuse, but otherwise she was told very little about their backgrounds.

Julie already had a 14-year-old son from a previous marriage when she was given custody of the three siblings, ages two, three and four. She set out to create a safe and nurturing home for the children, and those early days were full of hugging and reading storybooks together. She slept in the hallway every night in case they needed her. But the first hints that creating a family might not be so simple appeared quickly as the magnitude of the children's challenges became clear.

Over time, as her children opened up, the two eldest girls explained that they had been kept in cages by their foster parents and their baby brother had been hit when he cried. Case workers also indicated that their biological parents, who had addiction and mental health issues, had always kept their family on the move. Sometimes, when Julie would go into the girls' room early to wake them up, they would already be dressed in many layers of clothes-as if they were ready to leave at a moment's notice.

At first, when Julie took the children out for walks, they would climb into garbage cans and start eating. At one point, all three children locked themselves in the bathroom with a bag of cat food, and Julie would sometimes find them in bed with cans of soup or bags of milk. "They were always looking for something," says Julie, who would have to check their pockets before leaving a friend's house or a store. "That's part of the neglect-they would just squirrel things away."

Emotionally, the children were often distraught, highly reactive and full of phobias. They were terrified of insects, and even a single hair on a snowsuit could set them off.

Bonding was challenging, too. Julie says that the eldest girl was what one doctor referred to as a "vending machine kid," a child who views relationships as transactional and who gives exactly what she has to in order to have her own needs met. "She was very easy to parent but really difficult to connect to," says Julie. Her younger daughter was engaging, drawing affection and praise. But if she couldn't get what she wanted, "all hell would break loose."

I said I wouldn't adopt a child with FASD-and now I have fourIt wasn't until a decade later that Julie learned that there was a term to describe the way her kids were being haunted by their early years: developmental trauma disorder. She learned about it somewhat accidentally while working in an early psychosis unit at the Canadian Mental Health Association. Through her research, Julie discovered that developmental trauma occurs when significant adverse experiences have an impact on the physical development of a child's brain, particularly in the first three years of their life, and have lasting effects on their self-concept, relationship-building skills and behaviour.

Julie had noticed the common symptoms that make both bonding and discipline an enormous challenge, including hypervigilance, anxiety, attachment and attentional difficulties, poor impulse control and trouble with delayed gratification and forward thinking. Unfortunately, she also learned that, though developmental trauma is set in motion during the early years of a child's life, the repercussions are likely to last a lifetime.

What is developmental trauma disorder?

The term "developmental trauma disorder" was first coined in 2005 by US psychiatrist and neuroscientist Bessel van der Kolk and a group of fellow researchers who specialize in childhood trauma. It was established after a study of 20,000 kids found that children who experience early neglect or abuse are more likely to experience behavioural problems, substance abuse and negative health outcomes later in life.

"This isn't about an event; it's about the context in which people develop," says Van der Kolk, who noted that most trauma in children is inflicted by their own caregivers. In his 2005 paper, he points out that young children learn to regulate their behaviour based on their caregivers' responses to them-a process that has an impact on both neural development and social interaction. Those earliest patterns of attachment can shape information processing and perception throughout life.

Though developmental trauma disorder has not yet been recognized as an official diagnosis, a group of advocates in Ontario is working to spread awareness about the issue. Collectively known as the Developmental Trauma Action Alliance (DTAA), this coalition of parents, medical professionals and adoption specialists has hosted panel discussions across the province in hopes that it will bring legitimacy to the disorder and increase access to funding.

How does developmental trauma affect the brain?

While the early years of a child's life often feel like utter chaos to parents, they actually reflect an intense and critical process of stabilization and self-regulation. If a child is in good care, their brain is able to develop the neural circuitry that facilitates developmentally appropriate emotions and regulation. If a child is in an environment of prolonged stress, the neural circuitry that develops facilitates survival using a fight-flight-freeze response, says Sian Phillips, a psychologist in Kingston, Ontario, who specializes in relational trauma and attachment difficulties. Usually, a child learns to trust their parents-and, by extension, others-during that crucial period. Children thrive on safety, nurturance and predictability, all delivered at the hands of loving and accessible caregivers. But in cases of neglect or abuse, where a caregiver is unreliable or even punitive, it affects everything about a child's development.

Phillips explains that children are designed to be cared for. With caregivers looking out for any danger, the child can get on with the business of typical development. But once a child is chronically afraid, his developing brain changes its trajectory.

The amygdala-the part of the brain that alerts the body to danger-begins to develop in the womb during the last trimester. But when children experience abuse or neglect while the brain is still developing, the amygdala sends a message to the brain to focus on building circuitry that drives a fight-flight-freeze response at the expense of developing other brain functions.

"The amygdala helps sculpt the brain to be able to survive in that environment," says Phillips. "For kids with developmental trauma, it's as though a fire alarm is always on. It means that it's incredibly difficult to learn or talk through things because your brain is constantly telling you 'There's a fire, there's a fire.' You often get kids who go into care with very lovely parents who offer them safety, but the kids can't see it. They anticipate that people will be hurtful and are not able to learn something new."

Recognizing trauma

Sharon,* a foster parent for more than 30 years, says that all of the approximately 100 children who have come through her home have experienced trauma, and many have symptoms of developmental trauma. Sharon has an eight-year-old girl named Lucy* in her care who experienced extreme sexual abuse in her early years. She remains so terrified of her birth family that she refuses to put her name on any artwork at school because she is worried about her birth parents finding her. For the first couple of years, after she came into Sharon's care at age five, she behaved in an aggressively sexual manner with both adults and children, offering oral sex as a kind of currency and viewing relationships as largely transactional. "It's just what she knows and what she's used to," says Sharon.

Sharon says that forming a bond with Lucy has been challenging. "We have people come over to the house and she'll ask if she can live with them next," says Sharon. "I think she feels safe, but I also think that if you picked her up and moved her tomorrow, she wouldn't really mourn that loss."

It might seem like all these kids need is love to help them view relationships in healthier ways. But Charlie Menendez, a psychologist in Peterborough, Ontario, describes children who have been affected by developmental trauma as "triggered by love." In other words, while they clearly need connection, love and a sense of security because they have been taught that those things are dangerous, their first reaction is to push them away.

Lucy, for one, craves affection but quickly shuts down in the face of emotional intimacy, like when her foster home starts to feel a little too much like a family. Just before a recent family trip to Walt Disney World, Lucy's behaviour took a nosedive. Sharon says that Lucy acts out, doing anything she perceives might make her unlikeable, even unlovable. She steals toys from other children, lies and even hides bowel movements. "These kids want to be close, but they have huge trust issues because adults never kept them safe," says Sharon.

Getting a diagnosis

Parents of children who have developmental trauma might not yet be familiar with the term, but many are well acquainted with a number of other supplementary diagnoses, including attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), post-traumatic stress disorder (PTSD) and reactive attachment disorder (RAD). But Van der Kolk says these diagnoses fail to capture what's really going on with these kids. When Menendez assesses a child that he concludes has developmental trauma, he sometimes diagnoses other recognized disorders that they qualify for to help them get access to mental health services.

Julie's younger daughter, Tara,* is now 21, and she still struggles with emotional self-regulation and bouts of psychosis. "There isn't a diagnosis known to the DSM that kid hasn't had," says Julie. "I stopped counting because, at one point, there were 16 distinct psychiatric diagnoses." Tara struggles with low IQ, and she has been on antipsychotics and anti-anxiety medications since she was five. As a teen, Tara acted out more and more violently. When she was 15, Julie surrendered her to the Children's Aid Society to have her moved into a group home. Even with Julie's awareness of developmental trauma, there was no clear path to resources for her children.

Tara continues to live in a group home with professional caregivers where physical contact is prohibited. A therapist told Julie that Tara sometimes acts out just to be placed in restraints and satisfy her need for touch.

Helping kids deal with developmental trauma

In cases where developmental trauma is identified and kids get proper treatment, they can learn to connect with people in healthier ways, and access to key resources can make a difference.

Kathy Soden, manager of the Permanency and Adoption Competency Training (PACT) Program for the Adoption Council of Ontario, says these kids can be pigeonholed as having behavioural challenges, particularly in the classroom, where resources are limited, attention is divided and a disruptive child is simply labelled as a problem. Phillips says that kids who have experienced developmental trauma often have difficulties at school because they are locked in a fight-flight-freeze response but need to use advanced brain functioning, such as sitting still, listening to the teacher and picking up social cues. "The most important thing is safety and predictability," says Van der Kolk. "These kids need to know what is going to happen next."

Phillips presently oversees two small trauma-oriented classrooms in Kingston, alongside teachers and support workers, where they use an approach called dyadic developmental practice (DDP), including the PACE strategy, which involves playfulness, acceptance, curiosity and empathy. "Those four ingredients are signals of safety," says Phillips. By gradually building a sense of safety and offering more positive narratives through storytelling (for example, directly challenging the idea that love is painful or that people deserve the bad things that happen to them), Phillips tries to help these kids turn down the fire alarm that's been ringing for years and eventually have it under their control. It can go on and off as it was designed to do, but not all the time.

These therapies involve a lot of remedial elements, such as outdoor playing and storytelling, and include books that explore relevant ideas, such as creating dependence on people you can trust and learning to like yourself. Academic learning is postponed until children have made sufficient progress at feeling safe and are settled and ready to absorb more-conventional teaching methods. Students typically attend the program for two years and are supported in their home schools for an additional six months.

After just one year, Phillips typically sees significant improvements in executive functioning, including the ability to problem-solve, self-regulate and manage social relationships. "We see kids being invited to birthday parties and sleepovers for the first time," says Phillips. "They learn to work through conflicts and understand that relationships can endure disagreements."

When trauma goes untreated

If trauma goes unresolved, children can have continued struggles in their interpersonal relationships, even as they grow up and have their own families, and they may have interactions with the criminal justice system. Sylvia Gibbons, a parent liaison with the Adoption Council of Ontario, offers training to lawyers and judges about developmental trauma. "You look at this little kid and you want to help," says Gibbons. "But if she doesn't get help, she becomes the person who appears in court and then we want to punish her. If she still doesn't get help, she becomes the parent she had and the cycle continues."

Julie's kids are now in their early 20s, and she is still learning about developmental trauma. When she recently attended a program for parents with children who have experienced developmental trauma, she found herself near tears being surrounded by parents who have struggled with similar issues in their families. "It was the first time I heard that I wasn't alone in this kind of parenting," says Julie, "but there was also sadness because my kids are grown now and we could have come out of it better if we had more information."

Julie wishes she had the chance to find the right support to help her better understand and respond to her children's needs. Looking back, she would've wanted to adjust her expectations around the view that they weren't simply testing boundaries but fighting for their lives. "I went into it with the idea that loving them so much would fix them," she says, "but it wasn't enough."

Tara continues to need a lot of support, while Julie's other two adoptive children live independently, despite their struggles. Julie has never fully bonded with her eldest daughter, who mostly gets in touch now when she needs money. Her son was recently admitted to college, but he hasn't been able to secure the academic and personal resources he needs to overcome challenges, like help with time management.

There is hope that, with greater awareness and dedicated resources, a new generation of children will be able to heal some of the worst wounds associated with developmental trauma. Lucy started attending one of Phillips' classes in Kingston, and Sharon says her progress has been significant. "The old school used to call us every day to pick her up, but she just loves this program," she says.

When Lucy acts out, Sharon tries to focus on "I wonder" exercises, a non-confrontational method recommended by Phillips to help Lucy recognize that her needs and feelings are important. "I might say 'I can see that you're struggling to get along with everyone and I wonder if it's because today was a hard day for you,'" says Sharon. "She won't answer, but I can see it in her face. It lets her know that I understand."

Phillips adds that the act of "wondering" together encourages the building of reflection and engagement. "It doesn't matter if we are right or wrong in our wonderments because it's the process of staying engaged and wanting to know about their experience that is therapeutic," she says. "It helps integrate brain regions that will later knit together to help them be curious or be better at self-regulating. If a child says 'I don't know,' it stops the conversation. 'I wonder' lets us keep going."
*Names have been changed.
Read more:
How trauma reverberates down through generations and affects kids
How to help a child who is dealing with trauma
Depression is on the rise in kids

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What developmental trauma disorder looks like in kids

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When Julie* adopted three young children nearly 20 years ago, she knew that they hadfetal alcohol spectrum disorders (FASD) and had been removed from their biological parents after undergoing extreme emotional, physical and sexual abuse, but otherwise she was told very little about their backgrounds.

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Early intervention to reduce the impact of adverse childhood experiences (ACEs) such as abuse or neglect is "fragmented and variable" across England, MPs warn.

The Science and Technology Committee says more help in the formative years can help stave off mental health problems in later life.

The committee is urging the government to draw up a new national strategy for early intervention approaches.

It says early intervention can save the government money in the long term.

What does the committee's report say?

The report says: "There is now a body of evidence that clearly demonstrates a correlation between adversity suffered during childhood and an increased prevalence of health and social problems in later life."

It adds that while there is evidence of good practice in some local authorities in England, there is no "clear, overarching national strategy".

"This has led to a fragmented and highly variable approach to early intervention across England, with evidence of a significant gap between what the latest evidence suggests constitutes best practice and what is actually delivered by many authorities.

"Where local authorities are not providing early intervention based on the best available evidence, vulnerable children are being failed."

What do the MPs want?

The MPs are calling for more support for local councils to plan and deliver effective early intervention.

They also want to see better collection of data to help assess the effectiveness of intervention schemes.

But the report is clear that stepping in to help children is worthwhile, both for the children and the public purse.

"When delivered effectively, there is strong evidence that early intervention can dramatically improve people's lives and reduce long-term costs to the government," it says.

What sorts of things are considered to be ACEs?

The report says there is no universally agreed definition of what an ACE is, but that the following issues are typical:

verbal abuse

physical abuse

sexual abuse

physical neglect

emotional neglect

parental separation

household mental illness

household domestic violence

household alcohol abuse

household drug abuse

incarceration of a household member

What does the committee chairman say?

Norman Lamb MP says: "Adversity in childhood appears to be the biggest single risk factor in the emergence of mental ill health in childhood and teenage years and beyond.

"If we are to make any impact on the high prevalence of mental ill health in childhood, we have to transform how we address the causes.

"Early intervention offers young people who have suffered adversity in their childhood an opportunity to avoid the long-term problems associated with such experiences.

"When delivered effectively, there is strong evidence that early intervention can dramatically improve people's lives, whilst also reducing long-term costs to the government."

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Help for trauma in childhood 'fragmented'

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Early intervention to reduce the impact of adverse childhood experiences (ACEs) such as abuse or neglect is "fragmented and variable" across England, MPs warn. The Science and Technology Committee says more help in the formative years can help stave off mental health problems in later life.

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'Exclusion is the first step on a dangerous road' | Tes News

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After years of rising school exclusions, Kiran Gill says the political will to tackle one of the root causes of street violence is finally re-emerging

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Something remarkable is happening in Scotland. A resurgence of interest in children's emotional experience is underway, especially experiences of fear and anxiety.

Tens of thousands of people throughout the country are now curious about how childhood suffering changes a person's biology. They want to understand the science showing that experiences of uncertainty and alarm and loss can lead to increased risk of lifelong struggles with physical and mental health. They want to know why relationships are a robust protective factor against that risk, and most of all, they want to know how to help.

The banner under which this grassroots interest has coalesced has come to be known as the "ACE-Aware Movement". ACE is an acronym for the term "adverse childhood experiences", which comes from a seminal study published in 1998. Drawing on a sample of 17,000 people in the US, the research was able to show that traumatic childhood experiences - such as domestic abuse, sexual abuse, a parent in prison, a parent with mental health problems - were strongly associated with negative adult health outcomes. Those outcomes included heart disease, liver disease, diabetes, as well as alcoholism, drug dependency, suicide and many others.

The association with such outcomes feels surprising for many members of the public. They haven't imagined that a condition like diabetes could be in any way associated with childhood distress. It can feel unexpected to realise that an adult's demeanour influences not only a child's behaviour, but their very physiology. That's a key reason I think the ACE study has proved so engaging: it gives us profound insights into our own humanity.

This Scottish groundswell has emerged over the past 18 months. Arguably, it began in the summer of 2017, when interest in a documentary film by the title Resilience: The Biology of Stress and the Science of Hope exploded across Scotland. The film tells the story of the ACE study and explores what communities in the US are doing to prevent and mitigate the harmful impact of ACEs, saving both lives and money.

The film may have had such impact because it builds on discussions about ACEs that have been taking place for the past decade in Scotland, led by organisations like the Violence Reduction Unit, who invited one of the study's co-authors to Scotland in 2007. Sir Harry Burns, during his tenure as chief medical officer from 2005 to 2014, talked continually about ACEs in his work with the public.

Last month witnessed one of the latest landmarks in Scotland's ACEs journey. A national conference was held at Hampden Park in Glasgow, under the ambitious title " Making Scotland the World's First ACE-Aware Nation". The two-day event drew nearly 2,500 attendees from the general public, keen to learn more about how the knowledge of ACEs is being used to make positive change in Scotland. Such massive attendance had not originally been anticipated by the two small independent organisations who hosted the conference. One of those was TIGERS, which oversees modern apprenticeships for young people. The other was Connected Baby, which works to help the public understand the science of connection, and of which I am the founder.

I have spent a lot of time thinking about why the conference drew such large numbers, not only from Scotland, but across the UK and beyond. What brought together lawyers and teachers and GPs and social workers and family support staff and civil servants and local councillors and early-years practitioners and parents and young people and so many others? What generated the societal impetus for this unprecedented gathering, with so many people willing to think about ACEs not just through a medical lens, but as an issue of attachment wounds, social justice, human rights? Why did attendees leave feeling hopeful and inspired, given they were confronting the uncomfortable issue of childhood distress?

I think the answer is two-fold. First, we were talking about relationships. Yes, we were talking about stress and trauma and adversity, but we were not stopping there in our analysis. The real focus of the conference was relationships, as protective and healing "interventions". Second, we were enabling attendees to see what they could do personally to help. The conference enabled them to visualise steps they could take to make their own and others' lives better. They felt empowered by the stories told of individuals and organisations already taking action. They left knowing, in whatever words they might choose, that adults' responses co-regulate a child's stress-response system to distressing events. They left determined to talk about this information with others.

I know there are many who are cautious about this groundswell. They are concerned about the use of scoring tools, like the 10-item questionnaire used in the original ACE Study. They are concerned that the 10 experiences named in that questionnaire may be perceived as the only causes of suffering that count as ACEs. They are concerned that people will not think deeply enough or curiously enough, and may thus consider themselves to be sufficiently " trauma-informed" on the basis of a single viewing of the film Resilience. They are concerned that the emphasis on kindness and compassion is trite.

I agree these are important issues to reflect on. I would worry too, if this was what I saw happening. That is not, though, what I am witnessing. I have not heard an unbridled emphasis on scoring. I have not come across people restricting their definitions of suffering. I have not seen people's life journeys reduced to an arbitrary ACE score. I have not seen us become trapped in individualising biological explanations that fail to pay attention to context and environment. I have not seen a shift toward more diagnostic labels or an acceptance of the dichotomy of "them" versus "us".

Instead, I have watched people open their minds and hearts to others' suffering. I have observed them become more willing, sometimes courageously so, to offer care and kindness and patience to others. I have seen blame dissolve into curiosity. I know we have a very long way to go, with rates of mental illness, suicide, drug use, poor educational outcomes and many other challenges on the rise. But I am also more hopeful than I was 18 months ago. And I am only one voice amongst thousands of others.

Stories, not data, are proving to be the most powerful element of this movement. Chris Kilkenny's story of poverty and hunger, two banal but crippling ACEs, is currently driving change in schools. Michelle Brennan-Jones' story of tackling her alcoholism as a result of finally understanding her own childhood ACEs featured recently on STV news. Jennifer Riley tells the story of how becoming a trauma-informed parent helped her feel more confident in understanding her children's behaviour.

Pitteuchar East Primary School in Glenrothes, Fife, tells the story of shifting its language, replacing the common phrase "challenging behaviour" with "distressed behaviour". Children 1 st tells the story of discovering just how many adults in its organisation had suffered childhood trauma, in the process of training every single member in trauma-awareness. TIGERS tells the story of how relationship-led practice reshaped its business, benefiting not only employees, but the young people and partners it serves in unexpected sectors like construction. Bainsford Primary in Falkirk tells why it got rid of behaviour charts, and Big Bird Nursery talks of how it changed its drop-off procedures. Lawyer Iain Smith recounts how ACE-awareness has changed the way he practises law. Retired police officer Graham Goulden says that had he known this information earlier, he would have been a better police officer. Business owner John Gibson tells the story of donating £20,000 so that low-paid parents could attend the ACE-Aware Nation Conference, because he believes everyone in our society must be part of this conversation. All of these stories are now in the public domain.

Some of my favourite stories have not yet made it into print. There is the football coach who said: "This would explain the behaviour of that young lad on my team. I only learned about this stuff a month ago, but already it makes sense." There is the young man who burst into his headteacher's office at Portobello High School saying, "Miss, see all this new stuff we're doing in the school? I finally feel like I can learn because things are calmer and I'm not on edge the whole time." And there is the trauma survivor in his fifties, who left the conference saying: "It feels like, at last, people are beginning to really get what I experienced as a child."

These stories are the evidence of this movement's impact.

The Scottish grassroots movement seems to be succeeding in embracing the single most important insight to emerge from ACEs science: the ultimate impact of adversity stems not from the stressors themselves, but from the presence or absence of reliable relationships that can help a child cope with the stress. More and more people are empowered by the realisation that where we cannot (yet) eliminate traumatic circumstances, we can at least help by refusing to leave children alone in their suffering. And guess what? Companionship comforts struggling adults too, and once they feel less scared, they can begin to heal.

Much debate awaits, some of it undoubtedly heated. That is because there are now more voices in the conversation. The science of ACEs has moved beyond professional and academic circles, where it sat for 20 years, and is now in the hands of the public. To quote from the film Resilience: "If we can get this into the hands of the general population, they will invent very wise actions."

If the "simplistic" language of kindness and compassion is generating a new urgency for addressing the suffering caused by ACEs, then I am relieved. I hope our nation's children will forgive us for having taken a decade to finally get here.
Dr Suzanne Zeedyk is an honorary fellow in developmental psychology, based at the University of Dundee. She is also the founder of the organisation Connected Baby, which co-hosted the ACE-Aware Nation Conference in Glasgow in September

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Childhood trauma: Why I celebrate the ACE-aware movement's impact

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Something remarkable is happening in Scotland. A resurgence of interest in children's emotional experience is underway, especially experiences of fear and anxiety. Tens of thousands of people throughout the country are now curious about how childhood suffering changes a person's biology.

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Under the skin

Exclusively on Luminary with new episodes every Saturday. This podcast asks: what's beneath the surface - of people we admire, of the ideas that define our time, of the history we are told.

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Russell Brand is an award-winning comedian, writer, actor and presenter. He is one of the most recognisable and best-loved comedy performers in the world, with a series of sold-out tours, best-selling DVDs and a number of major film roles to his name.

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When public health officials get wind of an outbreak of Hepatitis A or influenza, they spring into action with public awareness campaigns, monitoring and outreach. But should they be acting with equal urgency when it comes to childhood trauma?

A new study published in the Journal of the American Medical Association suggests the answer should be yes. It shows how the effects of childhood trauma persist and are linked to mental illness and addiction in adulthood. And, researchers say, it suggests that it might be more effective to approach trauma as a public health crisis than to limit treatment to individuals.

The study drew on the experiences of participants from the Great Smoky Mountains Study, which followed 1,420 children from mostly rural parts of western North Carolina, over a period of 22 years. They were interviewed annually during their childhood, then four additional times during adulthood.

This study has something other similar studies don't, says William Copeland, a professor of psychiatry at the University of Vermont who led the research. Instead of relying on recalled reports of childhood trauma, the researchers analyzed data collected while the participants were kids and their experiences were fresh. And the researchers applied rigorous statistical analysis to rule out confounding factors.

Even when the team accounted for other adversities aside from trauma, like low income and family hardships, and adult traumas, the associations between childhood trauma and adult hardships remained clear. The associations remained clear.

The study is "probably the most rigorous test we have to date of the hypothesis that early childhood trauma has these strong, independent effects on adult outcomes," he says.

For Copeland, the wide-ranging impacts of trauma call for broad-based policy solutions in addition to individual interventions. "It has to be a discussion we have on a public health policy level," he says.

Nearly 31 percent of the children told researchers they had experienced one traumatic event, like a life-threatening injury, sexual or physical abuse, or witnessing or hearing about a loved one's traumatic experience. And 22.5 percent of participants had experienced two traumas, while 14.8 percent experienced three or more.

The childhoods of participants who went through traumatic events and those who didn't were markedly different. Participants with trauma histories were 1.5 times as likely to have psychiatric problems and experience family instability and dysfunction than those without, and 1.4 times as likely to be bullied. They were also 1.3 times more likely to be poor than participants who didn't experience trauma.

When these children grew up, psychiatric problems and other issues persisted. Even after researchers adjusted for factors like recall bias, race and sex, the impact of those childhood psychiatric problems and hardships, the associations remained. Participants who experienced childhood trauma were 1.3 times more likely to develop psychiatric disorders than adults than those who did not experience trauma, and 1.2 times more likely to develop depression or substance abuse disorder.

Participants with histories of trauma were also more likely to experience health problems, participate in risky behavior, struggle financially, and have violent relationships or problems making friends. And the more childhood trauma a person experienced, the more likely they were to have those problems in adulthood.

Copeland acknowledges the study's limitations-it included mostly white participants in rural settings, and a disproportionately high number of Native American participants compared to the rest of the United States due to the area's high concentration of members of the Eastern Band of Cherokee Indians. But the study is nonetheless important, says Kathryn Magruder, an epidemiologist and professor of psychiatry at the Medical University of South Carolina.

"I think it should put to rest any kind of speculation about early childhood trauma and later life difficulties," she says.

Though the link has been shown in earlier research, Magruder says, this new study can help direct future research and policy. "Why are we revisiting it? Because it is time to think about prevention," she says. Trauma is a public health problem, she adds, and should be met with a public health approach.

Psychologist Marc Gelkopf agrees. In an editorial published along with the study, he writes: "If the ills of our societies, including trauma, are to be tackled seriously, then injustice must be held accountable."

The policy implications are clear, says Jonathan Purtle, a mental health policy researcher and assistant professor at Drexel University's Dornsife School of Public Health. "We need to prevent these things from happening to children and support family and community so that people can be more resilient," he says. Policymakers can create coalitions around issues like mental health and trauma-informed approaches in contexts like education and healthcare, he says.

One step in that direction comes with the SUPPORT for Patients and Communities Act, a bipartisan bill to address the opioid crisis that was signed into law October 24. The law recognizes links between early childhood trauma and substance abuse. It includes grants to improve trauma support services in schools, created a task force to provide recommendations on how the federal government can help families whose lives have been impacted by trauma and substance abuse, and requires the Department of Health and Human Services to help early childhood and education providers spot and address trauma.

Bills like the SUPPORT Act enjoy bipartisan and are a promising start, says Purtle - but they don't go far enough. To really reduce trauma and mitigate its effects, he says, policymakers must pursue community investment and policies like minimum wage laws that reduce economic pressure on people who are struggling.

"It's more than just 'toughen up and deal with it,' " he says. "A lot of it comes down to people not having to live their lives in a state of chronic and constant stress."
Erin Blakemore is a science writer based in Boulder, Colo.

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Should Childhood Trauma Be Treated As A Public Health Crisis?

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When public health officials get wind of an outbreak of Hepatitis A or influenza, they spring into action with public awareness campaigns, monitoring and outreach. But should they be acting with equal urgency when it comes to childhood trauma? A new study published in the Journal of the American Medical Association suggests the answer should be yes.

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(Image: Andrew McCaren)

A young headteacher who has turned round one of Britain's worst primary schools said modestly: "It's not magic - it's about caring."

Sam Coy was aged 27 when he was put in charge of struggling, 210-pupil Benjamin Adlard School, and knew he had his work cut out.

Disadvantaged Year Six pupils were lagging up to NINE terms behind their peers nationally in certain subjects.

Ofsted had graded the school "Inadequate", slamming weak leadership and low expectations. But in less than four years Sam has reversed its fortunes with a series of clever innovations.

One is a forest garden where disruptive kids go to calm down and light cooking fires, plant vegetables, look after chickens and play old-fashioned conkers.

Another is a rewards scheme offering treats dreamed up by the children, including football afternoons, chocolate parties and the chance to be "head for the day", wearing one of Sam's ties.

Emphasis is put on politeness and visitors are ushered through the school by pupils opening doors. In Sam's first 12 months, Ofsted upped its grading two places to "Good" and issues including truancy were tackled. In 2014, just a third of the kids were achieving good results in reading, writing and maths. Now seven in ten are hitting their targets.

Sam's approach has changed life for some of the area's most needy children, including a 10-year-old so troubled he was on the verge of being expelled from another school and a Year 4 child who could not cope with more than 10 minutes a time in the classroom.

They are both now full-time at Benjies, as the school is affectionately known.

Others in the deprived, low-income district have been helped by the school taking on a family support worker, providing free uniforms and running breakfast and young carers clubs.

Sam's efforts were recognised by an acclaimed Pearson national award, School of the Year: Making a Difference, which gets lovingly polished every day.

Sam, now 31, who had previously taught in Nottingham and worked with under-privileged children in Lincoln, said: "I can't take all the credit because it's been a real team effort.

"We recognise academic progress is important but we realise lots of building blocks need to be put in place. Many of those involve interventions that help pupils develop socially as well as academically." He went on: "When I first joined the school I was a little nervous. There were staff members who had been here for years, which was a bit daunting.

"I could see the drive and commitment staff had so I kept the same team. I wanted the school and the staff to get the reputation they deserved."

Benjies' pupils live in one of Britain's 1,000 worst-off districts - Gainsborough South-West Ward - which has high unemployment and crime.

Seven in ten kids are entitled to free school meals and 40 per cent have special educational needs, compared to a national average of 14 per cent.

But one of the pupils, ten-year-old Keegan, said: "I like this school because they do very good education and Mr Coy always make the teachers do very hard work for the children."

Sam is now working on creating a community hub at the school where families can access debt counselling, housing support and a food bank.

He added: "We want the school to be at the heart of the area. All the staff here are incredible and want to do their very best for the pupils - and that is everything."

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Headteacher who turned round one of UK's worst schools reveals how he did it

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A young headteacher who has turned round one of Britain's worst primary schools said modestly: "It's not magic - it's about caring." Sam Coy was aged 27 when he was put in charge of struggling, 210-pupil Benjamin Adlard School, and knew he had his work cut out.

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What would you do if you were a school teacher and your students started misbehaving? Traditionally school teachers would give detention or suspension depending on the situation.

Most people wouldn't discipline a misbehaving student by telling them to sit down and meditate, but this new strategy is happening at Robert W. Coleman Elementary School in Baltimore Maryland.

Since the beginning of last year, the primary school has not suspended a single student. Their new method of serving consequences is definitely working.

The school decided to focus on meditation as a new way to serve detention for misbehaving students.

Instead of sending children to stand outside the classroom, or go to the principal's office every time they misbehave, they get sent to the 'Mindful Moment Room'.

The school has also been seeing a nice tangible benefit from this program as well.

Philips said that at Robert W. Coleman Elementary, there have been exactly zero suspensions last year and so far this year.

Meanwhile, nearby Patterson Park High School, which also uses the mindfulness programs, said suspension rates dropped and attendance increased! Ever since this new method, kids are wanting to come to school!

I hope all schools can use this new method of giving consequences to misbehaving children!

Source: Via higher perspectives, video Upworthy

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This School Replaced Detention With Meditation And The Results Are Mind-Blowing

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What would you do if you were a school teacher and your students started misbehaving? Traditionally school teachers would give detention or suspension depending on the situation. Most people wouldn't discipline a misbehaving student by telling them to sit down and meditate, but this new strategy is happening at Robert W.

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Zones of Regulation Home Page Zones of Regulation Blog Link to Social Thinking to order The Zones of Regulation Plus overview of program

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My name is Frances Dickens and I worked as a primary school teacher in an inner London school. Many of the children I taught came from multicultural backgrounds, and some had special needs. I wanted a resource that would promote inclusivity, help all of the children integrate and learn to appreciate their differences and value their different abilities.

So I created this resource, developing the story collaboratively with the children. It started with an idea about a Giant who came from Nowhere and wanted to find somewhere to live. He discovers a village called Somewhere but the unfortunate thing was all the inhabitants of the village were tiny, and he was far too big to fit in.

I took children ages 5 years to 8 years on the Giant's journey. Through drama role-play the children became transformed because we created an imagined world, which seemed real to the children. They wanted to be tiny villagers, reporters, police investigators, witnesses, and even giantesses. And amazingly they accepted all the roles that I acted out, whether it was a villager, a newspaper reporter, a police investigator, a Giant and many more. This approach made their learning enjoyable and meaningful and supported creative writing because the children had had experience of what they could write about.
So how did the journey with the Giant start?
I explained the differences between towns and villages in order for the children to create:-

A village called "Somewhere"

We created a 2 dimensional poster of a village. From cut up squares on A4 sheets of paper, the children made simple fold and stand buildings, houses, shops, church, synagogue, mosque, temple, school, doctors and farms to stick on the poster on the classroom wall.
Who has walked across our village?
The children came in and saw gigantic footprints crossing their poster. They realised they belonged to a Giant.

This Giant was looking for somewhere to live, and came across the village called "Somewhere", the only problem was that all the village inhabitants were tiny. How was he going to fit in? Did he cause any damage? If so, how did the tiny inhabitants deal with him?
What damage did he cause?
He caused a lot of damage to the village. He got angry, he stamped his feet and roofs fell off

houses, windows were broken, furniture was in pieces. He had to be stopped, but he walked away.
The local newspaper, "The Daily Nosepaper"
For the children to write about him in a newspaper article, the class became the village of "Somewhere". They worked in pairs or groups of three and discussed the damage, and described this Giant. Now they had information to catch him.

I then acted as a reporter from the local newspaper. I asked them questions about the Giant and the damage he had caused to their village. Then I split them into pairs again, in order to give them the experience of being reporters and villagers. Then they swapped roles.. Each child was then able to contribute to creating a front page for the newspaper either by their drawings or writing. The newspapers were put up in the school for all to see and the school community became involved, including the Headteacher, and the teaching assistants.

The journey had started and there was no going back. Something had to be done about this unhappy Giant, he had to be caught. Next time I came in as a Police Investigator, I had caught the Giant, and he was waiting outside the classroom. Another investigation started, with the children becoming villagers and police investigators.

What is going to become of the Giant? Will his journey end happily?

With the help of the children, 'the villagers', we did arrive at a positive solution. But there were a few difficult steps to overcome. What about all the damage he caused? Why is he always sad? Could it be because he is lonely? What could the villagers do to help him?

If you want to find out go on a journey with The Giant from Nowhere and don't forget to bring the children along too.

The Giant from Nowhere
At the back of the book is a link to Jessica Kingsley Publishers where you can find comprehensive Lesson Plans, which guide you through each step of the Giant's journey. Immersive role play was used throughout to stimulate children's imaginations. Worksheets and templates for Newspapers, Questionnaires, Letters, Wedding Invitations and Lists are also included.
Can a Giant from Nowhere learn how to belong in the village of Somewhere, even though he's so much bigger than everyone else? This fun and uplifting tale helps children aged 5-8 to think about inclusivity and difference. With flexible lesson plans and creative activities, it is ideal for both children and those who teach or care for them.
Buy the book... If you would like to read more articles like this and get the latest news and offers on our classroom resources, why not join our mailing list? We can send information by email or post as you prefer. You may also be interested in liking our Special Ed, PSHE and Early Years Resources Facebook page.

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One Giant Step for Children Everywhere... Introducing, The Giant From Nowhere!

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Promote inclusivity with The Giant From Nowhere class project! Help children learn to appreciate their differences and value their different abilities.