Carrie* is not your average 13-year-old student. She was born into violence and neglect and lived in 15 foster homes before finally settling with her adoptive parents.

“The room she was going to have in our home had a cupboard that looked like a second door,” her mum remembers. “The social workers said she’d be terrified someone was going to come through it - people had come into her house and stabbed her mother - so we had to plaster over it. We couldn’t pretend somebody comes down the chimney at Christmas. It would have freaked her out.”

Imagining that danger is looming everywhere is common among children who have experienced trauma, explains Andrea Danese, a professor of child and adolescent psychiatry at King’s College London.

“The experience of trauma is very emotionally intense, so it might be processed by a person’s memory systems differently,” he says. “They might feel it’s happening - or might happen - again and again. So, a child who has experienced trauma might be hyper-aroused, spending much of their time and cognitive functions scanning for potential threats.”

He notes that this can have a profound impact on their education: “As long as they’re thinking about potential threats, they cannot pay attention to lessons.”

What’s more, it can lead to disruptive behaviour. Last year, Carrie went from being a student with a good track record to her school saying she was out of control.

“If a teacher is shouting, that could flip her back to a time when shouting led to violence,” her mum explains. “Talking to social workers, we think she was so terrified of getting that feeling, she’d intentionally get herself chucked out of classes where a teacher was prone to shouting.”

This makes sense, according to Danese: “When a child cannot avoid these memories, they might become very distressed, behaviourally dysregulated, oppositional and impulsive. And that’s not because they are bad kids - it’s simply because they are trying to avoid very intense negative emotions.”

How well do schools support pupils like Carrie? Those who advocate for “trauma-aware” approaches argue that, in many schools, the answer is “not well at all”. They believe teachers need to be more informed about trauma and its effects, and that school environments (including behaviour policies) should be constructed to be sensitive to these children’s needs. It’s a view that has gained a lot of traction - but a lot of criticism, too.

At the heart of that debate is the question of to what extent a link between trauma and challenging behaviour is inevitable - and what the best way to support a student who has experienced trauma is if their behaviour starts to deteriorate.

So, what exactly is trauma-informed practice? It’s tricky to find a consensus on a definition. “Trauma-informed” - also variously called “trauma-aware”, “trauma-sensitive”, “trauma-responsive” and “trauma-embracing” - is not a regulated term. “As someone who spends most of my working life thinking about trauma, I actually don’t know what the concept is because what different people mean by it is very different - it’s poorly defined,” says Danese.

But, for proponents of trauma-informed practice, this intangibility doesn’t necessarily matter. “A trauma-informed approach is an attitude, a philosophy - not a set of techniques,” says Dr Suzanne Zeedyk, a research scientist and an outspoken champion of trauma-aware approaches.

Julie Harmieson, who is co-director of Trauma Informed Schools UK - a community interest company that offers training to teachers - agrees.

“‘Trauma-informed’ means organisations are aware how unresolved painful life experiences can impact on a young person’s quality of life, capacity to learn, to relate, to behave, to achieve and function well,” she says.

With this broad definition in mind, Harmieson explains, schools aim to create a “psychologically safe” environment, rich in positive relationships.

What this looks like in practice can differ between schools, research papers and training offers - and it can play out in different ways for different ages, too. It can mean greeting pupils individually at the door, meditation and yoga sessions, providing spaces where children can go if they’re feeling strung out, and putting teddy bears in classes to give a friendly welcome.

But one thing that should be consistent across trauma-informed schools, says Harmieson, is that instead of a punitive approach to behaviour management with a rigid menu of punishments (eg, swearing in class means immediate detention), a teacher should talk an incident through with the pupil. “The pupil is supported to reflect on their thoughts and feelings, what caused the event and what we can do to support them to behave better in future,” she explains.

For some settings, consequences may then follow (often as a result of restorative conversations), but in others they will not. However, in almost all trauma-aware schools, there’s a move towards teachers being able to exercise their discretion in how to apply rules, and a move away from the dichotomy of “good” versus “bad” behaviour and a rigid enforcement of any behaviour policy.

It is this stance on discipline that might explain why the concept is getting so much air time. It is positioned as a direct counter to the zero-tolerance behaviour approaches that some UK schools have adopted from the US, and as an antidote to high school exclusion rates. But one common concern raised by critics about the trauma-informed approach is that it’s too lax, giving students a “get out of jail free card”. The fear is that, in avoiding consistent firm boundaries, you let down that child, as they never learn how to regulate their behaviour.

“Schools absolutely should be a safe space for children, where all children can be nourished in order to thrive,” says Stephen Lane, a head of year and author of Beyond Wiping Noses: Building an informed approach to pastoral leadership in schools. “However, a large part of that nourishment is actually learning how to participate as a member of a community. Ultimately, we all need to understand how to operate within the parameters of the various communities to which we belong. Children need the support of clearly defined structures in order to develop this understanding.”

Harmieson counters that critics have created a trauma-informed practice in their mind that simply does not exist.

“It’s a misconception that trauma-informed approaches don’t have rules,” she says.

While some schools do tout a “no punishment” approach, in reality these schools still have boundaries - and they also have systems to deal with pupils when those boundaries are broken. The process just tends to look very different to how schools have traditionally approached behaviour.

At The Key Education Centre in Gosport, Hampshire - a pupil-referral unit - the phrase “flexible consistency” is used as the basis of its trauma-informed approach.

“I’ve heard researchers talk about the idea of toolboxes,” explains Ollie Ward, transition and outreach lead at The Key. “Imagine people fixing a shed - one person has a rusty screwdriver, the other has a Black and Decker. The latter person is going to do much better, but the other didn’t have the tools to do the job as well.”

For children who have experienced trauma, those tools might include the ability to regulate their emotions or to put a perceived threat into perspective.

So, behaviour-management approaches work within that context - unpicking the challenges, finding the source of the issue, supporting the pupils with strategies to improve those areas. Ultimately, the teacher and leadership will decide whether a consequence is a necessary part of that package - it’s an option, not an inevitability.

Harmieson provides a specific example of how this might play out. If a child used disrespectful language, she’d envisage a teacher reminding them that they shouldn’t. But the teacher would also have a conversation, recognise that the child was clearly upset, and explore the behaviour.

“I may need to put time in for that conversation and that may happen at a playtime, which to other children looks like a consequence,” she notes. “It’s not the absence of consequences, but it’s about equipping the child with strategies to recognise their feelings and plan what they can do next time.”

There are teachers who have publicly challenged this flexible approach to sanctions, saying that it leaves room for manipulation and a lack of consistency in enforcement that will lead to a deterioration in behaviour generally across the school.

“If students believe they are seeing others getting away with misbehaving without consequences then I’d be concerned that ultimately children would (rightly) see this as unfair,” says Lane. “Or they would develop a belief that consequences are arbitrary and, ultimately, meaningless. There are, of course, always reasons why any child might behave in a particular way. But consequences exist no matter the background of those involved.”

Supporters of trauma-aware practice claim that children are more than capable of understanding a more flexible approach to behaviour - and often know more about the negative impacts of trauma on a friend than the teacher will. The tales of behaviour suddenly going downhill in schools where these approaches are adopted is down to the popularisation of examples of trauma-informed practice being done badly or not given enough time to bed in, says Vic Allan, Sendco at Orchard School Bristol, which has a trauma-aware approach.

“I think the bad press that trauma-informed teaching gets, or the way schools choose to overlook its use, comes about because school leaders don’t see immediate significant outcomes,” she says. “When you use trauma-informed teaching practices, it takes a long time to see a measurable impact.”

The Ace card

But does trauma always lead to the experiences of students like Carrie? And is a trauma-aware approach always right for those students who have experienced trauma?

On the first question, Tom Bennett, behaviour adviser to the Department for Education, believes the evidence is unclear.

“The relationship between early childhood adversity and later effects in their lives - we still don’t have enough data to make a convincing causal argument for that,” he says.

Once you dip your toe into the evidence, it’s inevitable that the literature around adverse childhood experiences will get drawn in, leaving a trail of opposing opinion pieces and social media spats in its wake.

Building on the Adverse Childhood Experiences (Ace) Study back in the 1990s, researchers have found associations between experiencing more so-called Aces (including everything from physical and emotional abuse to growing up in a home where adults have drug-use problems) and increased risk of everything from performing badly in school to mental health problems and heart disease.

The study (and subsequent research) has shone a light on the ways people’s experiences can affect them. However, how people should interpret the research is contentious. “The Ace framework doesn’t count well for how different children might process and respond to difficult experiences. Some thrive with adversity; some find meaning in it; some are scarred by it,” says Bennett.

The research seems to support this view. One concern relates to the temptation to use Aces surveys as a diagnostic tool - screening children and drawing conclusions about their educational, and life, trajectory from it. Even if well meaning, such an approach is misguided, argues Morag Treanor, professor of child and family inequalities at the Institute for Social Policy, Housing, Equalities Research at Heriot-Watt University.

“You can’t look at population-level data and apply it to individuals - that’s public health and epidemiology 101,” she says.

That is, you can’t predict how an individual child will behave or what their future holds from the Aces research.

One of the experts behind the study, Robert Anda, co-authored a paper saying that using it diagnostically could lead to both over- and under-estimation of individual risk, stigma, discrimination and anxiety.

And, crucially, the original Ace study didn’t consider factors in a child’s life that buffer against negative outcomes.

“Supportive relationships within family, friends, schools and services (public and third-sector) can all protect children from potential negative impacts of difficult life experiences. There are so many variables,” notes Treanor.

The indication here is that trying to predict behavioural outcomes from experiences of trauma is dangerous, but considering whether they might be one factor of many is likely to be a healthy part of any pastoral and behaviour approach in a school.

But how qualified are teachers to make those calls? There are concerns that encouraging teachers to wade into childhood trauma is dangerous, as the training can be hugely variable, if it is given at all.

“I’ve seen quite a range of material shared with teachers,” says Danese. “Some do a very good job of describing, from a clinical point of view, what we have learned about trauma and others are based on not very well-supported theories. I think there needs to be an element of quality control.”

Bennett adds that it’s not something that should be a teacher’s responsibility. “Teachers are not qualified to diagnose trauma, and should not make simple assumptions about complex mechanisms,” he says.

Many offering training will point to the fact that they are (or they collaborate with) experts in childhood trauma and developmental and educational psychology, and some courses are accredited by external bodies. They add that this is not about diagnosis: it is about being aware that other factors can be at play with challenging behaviour and knowing how to react to them.

Ward acknowledges the potential issues of teacher responsibility for trauma, but says his team are acutely aware of the boundaries.

“When we first started doing the training, we made it really clear to staff that what we do isn’t therapy,” he says.

With proper training, it might be that a teacher has an initial chat with a child who’s breaking rules to see if there’s cause for concern, but they wouldn’t delve into their most painful experiences Freud-style. Instead there would be a structure in place - for example, with pastoral staff and a joined-up approach with other community services - for them to flag concerns.

But even with boundaries and good training in place, is there a working definition of when a past event can be classed as trauma or not? It’s a thorny issue in the discourse: what do we actually mean by “trauma”?

It depends on whom you talk to.

“People may phrase it differently but the overall sense is trauma refers to painful life experiences that rocked ‘belief in a safe world’, with no one there at the time to soothe, comfort and help you make sense of the experience,” says Harmieson, quoting philosopher Alain de Botton.

But that’s not the definition that Danese works with. “In the medical world, including the psychiatric world, the word ‘trauma’ has a clear definition - it’s an experience that involves danger of death, injury or sexual violation,” he explains. “Also trauma is an event, not the consequences of it. Very often, I hear people talking about trauma but actually meaning psychiatric conditions that emerge after trauma.”

Some worry that the word “trauma” is being attached to children’s experiences where there’s no evidence of it. But Dr Zeedyk is sceptical about this kind of debate.

“If what you’re trying to say is ‘my trauma is better than your trauma and yours doesn’t count as trauma’ it can be a bit of a swamp,” she suggests. “So, trying to be more open to what counts as trauma would be more helpful.”

Danese disagrees. “If people talk about trauma and really mean any sort of emotional distress, well every child has some at some point,” he says. “If everything becomes trauma, nothing is trauma. The definition becomes meaningless. Children who actually have experiences of trauma are not recognisable and cannot be helped properly.”

He doesn’t think trauma is more important than other problems, but that jumbling all issues together doesn’t help anyone.

From all of the above, it’s clear that, in getting involved in trauma, schools are entering a contentious area, where consensus is often elusive. But the schools using these approaches report better behaviour in their settings and staff being more comfortable with the approaches being used.

For them - and it is important to stress that other schools and other teachers have reported being less comfortable with the approach - whatever the version of trauma-informed practice being used, it seems to work. And they say that they are not trying to identify trauma, but rather to create a school environment that supports every pupil to succeed.

“A trauma-informed approach benefits everyone because it creates a climate of psychological safety, which promotes learning - social, emotional and academic,” notes Harmieson.

So, is there a middle ground where some of the critics may meet those schools where it is working and where these schools can meet their opponents? After all, every teacher cares about pupils - they just believe that this should be demonstrated in different ways.

Interestingly, there is a middle ground where academics in this field agree. Despite their differences of opinion, both Danese and Zeedyk sing from the same hymn sheet on the value of making schools more informed about children’s mental health.

“Even for a specialist in trauma like me, the better approach seems to be a broader move to a better understanding of mental health needs in young people,” says Danese.

In fact, he argues that while the approaches that trauma-informed advocates suggest - such as talking through behaviour with children in school - typically haven’t been tested scientifically as interventions for trauma specifically, some have been shown to be potentially beneficial for other mental health issues.

Few teachers would fail to find common ground on mental health. And it’s inarguable that the trauma-informed cohort has done a good job in putting children’s mental health on the agenda. So, perhaps the debate needs to be reframed in that context? If we move it away from behaviour and towards mental health instead, would we get a more productive conversation? A more productive conversation is certainly what Dr Zeedyk believes this issue needs.

“Change is messy. But I would rather we had the debate,” she says. “We have to ask really philosophical questions such as what is our role as a society? What are the expectations we have of the way we should treat one another?”

There is no one right answer to those questions. Different methods can get the same results. Would Carrie have got on better in a trauma-informed school? It’s impossible to say. But without trauma-informed practice being in existence, we may never have believed an alternative was possible. And trying to find a way to help children like Carrie is, according to her mum, long overdue.

“I think it’s a really difficult, delicate problem,” she says. “I have sympathy with teachers. But we have lots of children like Carrie in our society and it’s imperative they don’t slip through the net.”

Jessica Powell is a freelance journalist

*The child’s name has been changed to protect their anonymity

This article originally appeared in the 19 June 2020 issue under the headline “The trouble with trauma”